Midwives make a difference

small_89166669Sometimes it’s important to take a moment to reflect on the importance of what we do, and it is just fantastic that 2013 is proving to be a bumper year for evidence that supports continuity of midwifery care in all settings.  This is from the editorial which Petra ten Hoope-Bender wrote to accompany the print publication of the M@NGO trial in this week’s Lancet:

The effect of continuity of midwifery carer on the health and wellbeing of women and their newborn infants has been underestimated and neglected for many years. The increased focus on mitigating risk, especially during labour, childbirth, and the first 24 h of life, has led to an increase in hospital births, where the highly individual and idiosyncratic processes of labour and delivery have to fit into hospital routines, timelines, and protocols. Such practices can lead to an increase in routine interventions and the presence of a multitude of carers working typical 8 h shifts. In such settings, women are less in control of their pregnancy, labour, and delivery, which can have adverse effects on the progress of childbirth through to early childhood.1 and 2

Research into continuous support for women in hospital during childbirth3 shows a strongly positive effect on the length of labour, the use of pain drugs, Apgar scores, the number of unassisted vaginal births, and women’s satisfaction. Additionally, research into midwife-led models of care4 has revealed reductions in the use of regional analgesia, episiotomies, and instrumental births while women are less likely to experience preterm birth and fetal loss before 24 weeks’ gestation. The underpinning philosophy of midwife-led care is normality, continuity of care, and being cared for by a known and trusted midwife during labour. Investigators of a recent WHO study5 reported that high coverage of essential interventions for maternal and newborn health did not automatically imply lower maternal mortality, leading to the conclusion that the vertical, and often delayed, provision of essential interventions in isolation from comprehensive care affected the quality of care and the ability to save lives.

Petra ten Hoope-Bender (2013)  Continuity of maternity carer for all women. The Lancet, Volume 382, Issue 9906, 23–29 November 2013, Pages 1685-1687, ISSN 0140-6736, http://dx.doi.org/10.1016/S0140-6736(13)61793-6.

References from the original:

1. AR Tinajero, A Loizillon (2010). The review of care, education and child development indicators in early childhoodUnited Nations Educational, Scientific and Cultural Organization, Paris (2010) http://unesdoc.unesco.org/images/0021/002157/215729E.pdf (accessed Aug 8, 2013).

2. ER Moore, GC Anderson, N Bergman, T Dowswell (2012). Early skin-to-skin contact for mothers and their healthy newborn infants.Cochrane Database Syst Rev, 5 (2012) CD003519.

3. ED Hodnett, S Gates, GJ Hofmeyr, C Sakala (2013).  Continuous support for women during childbirth. Cochrane Database Syst Rev, 5 (2013) CD003766.

4. J Sandall, H Soltani, S Gates, A Shennan, D Devane (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev, 8 (2013) CD004667.

5. JP Souza, AM Gülmezoglu, J Vogel et al (2013). Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet, 381 (2013), pp. 1747–1755

photo credit: Etolane via photopin cc

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