Midwife-led care works in Manitoba!

9638588715_af44f94078Over the past year or three, I have shared numerous studies and respected reviews that have shown midwifery-led care to be effective all around the world in countries from Australia to Ireland. Midwifery care helps keep birth normal and it helps women to feel more proud of themselves. I’m now delighted to tell you (and not that I thought you were in any doubt) that midwifery care has been shown to be effective for women in Manitoba, Canada as well.

An analysis of 83,744 births occurring in women who did not have major health problems or a raised chance of complications showed that, compared to having physician-led care:

  • women who had a midwife had less chance of having an episiotomy, epidural or caesarean
  • babies whose mums had midwifery were less likely to be admitted to neonatal intensive care

Other important outcomes, such as postpartum haemorrhage and the need for neonatal resuscitation were the same across the groups (Thiessen et al 2016). It’s great to know that midwifery care keeps coming out on top around the world.

Thiessen K, Nickel N, Prior HJ et al (2016). Maternity Outcomes in Manitoba Women: A Comparison between Midwifery-led Care and Physician-led Care at Birth. Birrth, online ahead of print. DOI: 10.1111/birt.12225

 

The research

Background: Registered midwives, obstetricians/gynecologists, and general or family practice physicians (GPs) provide maternity care across Canada. Few North American studies have assessed whether maternity outcomes differ across these three groups. This study compared maternal and neonatal outcomes of low-risk pregnant women whose birth was attended by registered midwives, obstetricians/gynecologists, and family practice physicians in Winnipeg, Manitoba from 2001/02 to 2012/13.

Methods: Descriptive statistics and logistic regression were used to examine differences in types of intervention, mode of delivery, and outcomes by provider type among low-risk women. Logistic regression models controlled for socio-demographic and birth-related covariates.

Results: Low-risk births comprised 83,774 (48.7%) of total births (n = 171,910). The adjusted odds ratio (aOR), (95% confidence interval) for midwife vs OB/GYN showed women who had a midwife attend the birth had reduced odds of having an episiotomy 0.47 (0.40–0.54), epidural 0.25 (0.23–0.27), and cesarean delivery 0.13 (0.10–0.16) and their infants had less Neonatal Intensive Care Unit admissions 0.28 (0.18–0.43). The aOR for GP versus OB/GYN showed women who had a GP had reduced odds of having an epidural/spinal 0.83 (0.79–0.88) and cesarean delivery 0.44 (0.40–0.48). There was no difference by the provider type in outcomes such as postpartum hemorrhage and neonatal resuscitation.

Conclusions: The effectiveness of Manitoba maternity services can be improved with increased use of integrated midwifery services. Future research should examine how midwifery and physician-led models of care differ, and the influence of these differences on birth outcomes and cost-effectiveness to the health care system. Improvement of data tracking systems is also needed.

photo credit: St. Andrews, Manitoba (492779) via photopin (license)

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