Midwifery care is shown to lead to better outcomes (again)

Another study has shown that receiving pregnancy care from a midwife can reduce the chance of having problems (McRae et al 2018). This time, the focus was on women of low socioeconomic position and the researchers looked at three particular types of problem: having a small baby (described in the study as SGA, or small for gestational age), having a pre-term birth (PTB) and having a baby with a low birth weight (LBW).

The study was carried out in British Colombia, Canada and the researchers compared the outcomes of 4705 women who were cared for by midwives, 45114 women cared for by GPs and 8053 women cared for by obstetricians.

Women who had midwifery care had the best outcomes in all three of these areas. That is, they were less likely to have a small or low birth weight baby and less likely to have a baby born pre-term than women who received pregnancy care from GPs or obstetricians. The authors conclude that, “Antenatal midwifery care in British Columbia, Canada, was associated with lower odds of SGA birth, PTB and LBW, for women of low socioeconomic position, compared with physician models of care. Results support the development of policy to ensure antenatal midwifery care is available and accessible for women of low socioeconomic position.” (McRae et al 2018).

We don’t know why midwifery care leads to better outcomes than care given by doctors. As the authors of this study note, “Future research is needed to determine the underlying mechanisms linking midwifery care to better birth outcomes for women of low socioeconomic position.” (McRae et al 2018).

This isn’t the first time that we have seen these kind of outcomes; many studies have shown similar results as well as many other benefits of midwifery care. But this kind of care is sadly still not a reality for many women, for all sorts of political, economic and systemic reasons, and many midwives are being prevented from using their education and skills to the full.

McRae DN, Janssen PA, Vedam S et al (2018). Reduced prevalence of small-for-gestational-age and preterm birth for women of low socioeconomic position: a population-based cohort study comparing antenatal midwifery and physician models of care. 8(10):e022220. doi: 10.1136/bmjopen-2018-022220.

 

The Research

OBJECTIVE: Our aim was to investigate if antenatal midwifery care was associated with lower odds of small-for-gestational-age (SGA) birth, preterm birth (PTB) or low birth weight (LBW) compared with general practitioner (GP) or obstetrician (OB) models of care for women of low socioeconomic position.

SETTING: This population-level, retrospective cohort study used province-wide maternity, medical billing and demographic data from British Columbia, Canada.

PARTICIPANTS: Our study included 57 872 pregnant women, with low socioeconomic position, who: were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, delivered between 2005 and 2012 and received medical insurance premium assistance.

PRIMARY AND SECONDARY OUTCOME MEASURES: We report rates, adjusted ORs (aOR), and 95% CIs for the primary outcome, SGA birth (<the 10th percentile), and secondary outcomes, PTB (<37 weeks’ completed gestation) and LBW (<2500 g).

RESULTS: Our sample included 4705 midwifery patients, 45 114 GP patients and 8053 OB patients. Odds of SGA birth were reduced for patients receiving antenatal midwifery versus GP (aOR 0.71, 95% CI 0.62 to 0.82) or OB care (aOR 0.59, 95% CI 0.50 to 0.69). Odds of PTB were lower for antenatal midwifery versus GP (aOR 0.74, 95% CI 0.63 to 0.86) or OB patients (aOR 0.53, 95% CI 0.45 to 0.62). Odds of LBW were reduced for midwifery versus GP (aOR 0.66, 95% CI 0.53 to 0.82) or OB patients (aOR 0.43, 95% CI 0.34 to 0.54).

CONCLUSION: Antenatal midwifery care in British Columbia, Canada, was associated with lower odds of SGA birth, PTB and LBW, for women of low socioeconomic position, compared with physician models of care. Results support the development of policy to ensure antenatal midwifery care is available and accessible for women of low socioeconomic position. Future research is needed to determine the underlying mechanisms linking midwifery care to better birth outcomes for women of low socioeconomic position.

Photo by wang dongxu on Unsplash

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