Midwifes Linked to Fewer Premature Babies
Women cared for by midwives throughout pregnancy tended to have less-complicated births and were less likely to go into labor earlier than women getting standard medical care, according to a new review of more than a dozen studies.
Pregnancy care that was led or entirely provided by hospital- or community-based midwives was linked to fewer epidurals, episiotomies and use of instruments like forceps or vacuums during delivery. The risk of losing the baby during the first two trimesters was also significantly lower, UK researchers found.
It’s important to figure out why those differences exist for midwife-led care, said lead author Jane Sandall, professor of social science and women’s health in the Division of Women’s Health of King’s College London.
“For example, whether it is the model of care itself where midwives are in a position to pick up problems and get the right specialist input as early as possible, or whether a relationship where a women knows and trusts her midwife leads to a better outcome,” Sandall told Reuters Health by email.
In some countries, including the U.S., an obstetrician or family doctor takes responsibility for women’s care during pregnancy, but midwives may assist the expectant mother in preparing for pregnancy and deciding when a doctor’s attention is needed.
Those “medical” models of pregnancy care were weighed in 13 studies covering 16,000 women against models in which a licensed midwife takes primary responsibility for a woman during pregnancy and is also the primary caregiver during birth and postpartum – which is the most common model in New Zealand, for example.
Women with midwives were 23 percent less likely to give birth prematurely and 19 percent less likely to lose the fetus before 24 weeks of gestation. After 24 weeks, though, fetal death was equally common with all care models, according to the review in The Cochrane Library.
Cesarean-section births tended to be equally common with midwife-led care or medical-model care, though women with midwives labored for about 30 minutes longer than others.
The percentage of women attended during delivery by a caregiver they knew ranged from 63 to 98 percent for midwife-led care and 0 to 21 percent for other models, including obstetrician-led care.
Women seemed to be more satisfied with midwives than with other models and also seemed to save money on medical care, which may be the result of needing fewer costly medications and procedures, as well as the lower salaries among midwives compared to medical staff salaries, the authors write.
Dr. James Byrne, chairman of the obstetrics and gynecology department at Santa Clara Valley Medical Center in San Jose, California, said, “The cost of care difference was only five percent, which isn’t actually a large difference.”
“In the U.S., we have equivalent certified nurse-midwives, but we also have professional or lay midwives, who have less training and would actually be illegal in many of the UK countries,” said Byrne, who is also an associate clinical professor at the Stanford University School of Medicine.
It is possible for women in the U.S. to get the same kind of care as the women in the review, he said, but it’s not the first option in the U.S.
“The main takeaway for women should be that a team of coordinated caregivers monitoring them throughout pregnancy is the best choice, regardless of their degrees,” Byrne said.
SOURCE: bit.ly/14ifrqI The Cochrane Library, online August 21, 2013.
via Blogger http://chiropractic-lane.blogspot.com/2013/08/midwifes-linked-to-fewer-premature.html
Recent Comments