Midwives take better care of you

The Government's policy of encouraging midwife-led management of pregnancy and childbirth is safe and effective, a study has demonstrated.

The findings provide reassurance for a programme launched three years ago with only limited evidence of its effectiveness. But, according to the Lancet, which publishes the study today, it also has big implications for many European Union countries, the United States and Canada, where doctor-dominated deliveries are increasing, with attendant risks for pregnant women.

The study involved almost 1,300 women attending the Glasgow Royal Maternity Hospital, a big teaching hospital which delivers about 5,000 women a year. Many of the women come from socially disadvantaged areas.

The women had been assessed to see whether they were likely to have any complications which could threaten mother or baby. The majority who did not were then allocated on a random basis to shared care, where midwives, hospital doctors and GPs divided the care between them, or to midwife- managed care, where a named midwife managed care up to and including delivery.

Mothers and babies did just as well in the midwife-led programme, or better. The mothers in the midwife programme tended to make fewer visits to the doctor and had fewer interventions. They were less likely to be given drugs to start labour, to have an episiotomy - a cut in the perineum - to ease delivery and were no more likely to have a perineal tear.

Complication rates were similar. A fraction fewer than a third were transferred to medically-managed care; 29 per cent for clinical reasons and just under 4 per cent because they chose to make the change.

Both groups of women were satisfied with their care. But those in the midwife-managed group were more so. They were happier with the choices they were offered, with the information that was given, with the decision- making and with the sense that they were being cared for as individuals.

Intriguingly, fewer had raised blood pressure during pregnancy, a finding which the Lancet says "suggests that supportive midwifery care can, perhaps because of its more relaxed atmosphere, have valuable biological effects".

The Glasgow team stressed that the midwife-led service was integrated within a consultant unit, so the results might have differed in another setting.

"There is a need for further studies, to establish whether we would get similar results in a rural unit, or a stand-alone maternity unit," Mary McGinley, head of maternity services at the Glasgow Royal, said.

Dr Marsden Wagner, a Danish specialist on maternity, says in a leading article that the study has big implications, although relatively high rates of Caesarean section and fetal monitoring suggest that the Glasgow team could still lower its rate of intervention.

But the findings, which will bring comfort to the Government, are of "overriding importance" for North American and EU countries, "where doctors have convinced the public that, although expensive, they are safer than, and to be preferred to, midwives".

The study, Dr Wagner adds, suggests that midwives are "the best lead professional for primary maternity care for the majority of women who have no complications".