Midwife‐led versus other models of care for childbearing women
Abstract
Background Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led and other models of care. Objectives To compare midwife-led models of care with other models of care for childbearing women and their infants. Search strategy We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), Cochrane Effective Practice and Organisation of Care Group's Trials Register (January 2008), Current Contents (1994 to January 2008), CINAHL (1982 to August 2006), Web of Science, BIOSIS Previews, ISI Proceedings, (1990 to 2008), and the WHO Reproductive Health Library, No. 9. Selection criteria All published and unpublished trials in which pregnant women are randomly allocated to midwife-led or other models of care during pregnancy, and where care is provided during the ante- and intrapartum period in the midwife-led model. Data collection and analysis All authors evaluated methodological quality. Two authors independently checked the data extraction. Main results We included 11 trials (12,276 women). Women who had midwife-led models of care were less likely to experience antenatal hospitalisation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), the use of regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.…
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When combined with other RCTs in a Cochrane review of midwife-led care, no differences were found in caesarean rates compared with standard care.
“but when combined with other RCTs in a Cochrane review of midwife-led care, no differences were found in caesarean rates compared with standard care. 13”
In contrast to the caesarean rate, the secondary outcomes in our study were similar to those in the Cochrane review.
“In contrast to the caesarean rate, the secondary outcomes in our study were similar to those in the Cochrane review. 13”
The primary finding of this trial is in contrast to the Cochrane review on midwife-led care, which compared other models of maternity care and did not find any effect on the caesarean rate.
“Our primary finding is in contrast to the Cochrane review on midwife-led care that compared other models of maternity care 13 and did not find any effect on the caesarean rate”
The addition of our findings is likely to change the conclusion of the Cochrane review from no effect of continuity of midwife-led care on caesarean rates to a statistically significant reduction.
“although the addition of our findings is likely to change the conclusion of the review from no effect of continuity of midwife-led care on caesarean rates to a statistically significant reduction.”
In the Cochrane review, midwife-led care is compared with 'other' models of care; however, the 'other' models had varying degrees of medical involvement and in many cases midwives were the principal carers.
“In the Cochrane review, midwife-led care is compared with 'other' models of care; however, the 'other' models had varying degrees of medical involvement and in many cases midwives were the principal carers.”
Our secondary outcomes are consistent with the Cochrane review.
“Our secondary outcomes are consistent with the review; that the caseload model was associated with more spontaneous vaginal births, less intrapartum analgesia and fewer episiotomies. 13”
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References 80 · Cited by 621
- Authors
- Hatem, M., Sandall, J., Devane, D., Soltani, H., & Gates, S.
- Affiliations
- Université de Montréal (CA)
- King's College London (GB)
- Ollscoil na Gaillimhe – University of Galway (IE)
- Sheffield Hallam University (GB)
- University of Warwick (GB)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2008-10-08
- Issue
- 4
- Pages
- CD004667-CD004667
- ISSN
- 1361-6137 (ISSN-L)
- OpenAlex
- W2097848095
- Cited by
- 621
- References
- 80
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 6 · 2022: 15 · 2021: 8 · 2020: 6 · 2019: 12 · 2018: 13 · 2017: 17 · 2016: 24 · 2015: 36 · 2014: 52 · 2013: 181 · 2012: 62
- Type
- reference entry
- Language
- en
- Open access
- closed
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- midwife-led care, intrapartum care, prenatal care, normal delivery, episiotomy, instrumental delivery, regional analgesia, intrapartum analgesia, maternal satisfaction, maternal morbidity, maternal mortality, infant outcomes, psychosocial outcomes
- MeSH terms
- Continuity of Patient Care, Female, Humans, Infant, Infant, Newborn, Midwifery, Postnatal Care, Pregnancy, Prenatal Care, Randomized Controlled Trials as Topic, Models, Organizational, Perinatal Care
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