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All Women Should Be Offered A Midwife

This couldn’t have come at a better time for the maternity reveiw. Just in case anyone was under the impression that midwives aren’t the best primary carers for women the cochrane data base, obstetric lovely that it is, has backed us up 100%

Midwife model of care versus other care

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.

The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman’s chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour.

There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

I could resist making it nice and big. I feel like shouting.

12 responses to “All Women Should Be Offered A Midwife”

  1. kate

    great news….shout lisa, shout!!!

  2. Kel

    yup, keep hollering! problem is despite evidence, people keep doing same old same old and its not until education practices change and policy changes to provide structural support will women see the benefits. so, hopefully, the maternity review will take notice. keep screaming cochorane and EBP.

  3. Amy Tuteur, MD

    Wrong again. You didn’t even bother to read the paper, so you don’t know what it said.

    ALL women in BOTH arms of the study were cared for by BOTH midwives and obstetricians. The study compared midwife LED team care with other forms of team care. That’s why the study is titled “Midwife-led versus other models of care for childbearing women”; it is not titled midwife are vs. other models.

  4. Lisa Barrett

    Dr Amy you obviously didn’t read the database it wasn’t one study but 11 trials, this is how the cochrane review works. It looks at all relevant results and gives an overall view.

    We included 11trials (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 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96) and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), to feel in control during labour and childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76). In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks’ gestation (RR 0.79, 95% CI 0.65 to 0.97), and their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% CI -2.15 to -1.85).

  5. Lisa Barrett

    You said this Amy

    “The bottom line is that is a poorly done study that is designed to compare midwife led team care with other forms of team care. Did it show that midwife-led care is superior to other forms of team care? The authors think that it did, but that may be simply because the data selection was biased”.

    Now either the authors were wrong and bias, or midwifery advocates haven’t been reading the study properly. Make up your mind. maybe those awful midwifery advocates have infiltrated the cochrane review commitee and poisoned them against obstetric care for normal healthy pregnant women.

  6. Amy Tuteur, MD

    “Now either the authors were wrong and bias, or midwifery advocates haven’t been reading the study properly.”

    Why do you think it can be only one or the other? Both factors are at work here. First, the study does NOT compare midwife care to doctor care as you claimed. It compares various forms of team care. Almost every woman in the study was cared for by both midwives and doctors working together. The only difference between the two groups was that one group had teams led by midwives.

    Second, the conclusion of the study is that midwife LED team care is superior to other forms of team care. However, the results may not be reliable because there were 31 studies that met the criteria for the review, but only 11 were analyzed and the other 20 were ignored. The authors don’t bother to explain what uniform criteria they used to decided which studies were included and which were excluded. It appears that they simply picked the ones they liked and discarded the rest.

  7. Lisa Barrett

    Thanks for your reply,
    Maybe since you are so much better than everyone else you should just get yourself onto the cochrane review committee. Then you could set them totally straight on their mistake. You could also tell them, as you pointed out in your post that they are not the gold standard that they and the rest of the obstetric world mistakenly think. YOU are the authority on everything birth related.

  8. Lisa Barrett

    You can find a whole list of replies to Amys claims daft claims about the cochrane review here.
    http://www.haloscan.com/comments/atuteur/2938408741087646699/

  9. Rose

    Great stuff, i love it…..
    The obstetric world must be stuffed now if even the ‘gold standard’ cochrane database cant ‘get it right’!!!
    *eyes roll*

  10. jennifairy

    This may be naive, but I question the value of taking the time & effort to argue with Dr Amy. My hat is off to those that do & do eloquently, Im personally not up for the narrow-minded vitriol (often personal and based on no evidence) she dishes out to those who disagree with her, and I do wonder at the end of all the mudslinging just what has been gained. She is more than obviously completely locked in her world-view – if someone can direct me to a post of hers where she has admitted being wrong or offered an apology I would like to see that.
    I would also like to see any post of hers where she has offered a case story of her own practice where things have not gone completely to plan, and not blamed someone else for it.

    She seems like a woman who likes a good stoush, & I respect that. However its hard for me to find motivation for reading the opinions of someone who wont make room for other opinions (even when they're evidenced), who has a habit of being personally nasty to those that do offer those different opinions, and who never ever offers any honest insights into her own journey.

    If I want to see a real debate regarding maternity care issues, there are better sites than hers to go to. Voices only have power when they are listened to.

  11. Lisa Barrett

    I agree Jen, however I’m always happy to publish another view point here as long as there is no personal abuse. I put up the link to the comments because some of them are well referenced to the idea that there was a random selection of the trials. In fact there weren’t and I didn’t want to go through the rigmaroll of saying it all myself.

    I find lots of her comment on me amusing but extremely personal. I think however we do a disservice to ourselves by never approaching what we don’t like or don’t agree with. The trouble with her website is that slanderous comments often take the place of actual facts.

  12. Midwifery is catching

    I find it amusing mostly that she has left the same comments around several other blogs I read…