Best outomes from midwifery care

A Cochrane systematic review. Which is internationally recognised as the best available evidence on a topic, has found that women who have midwifery led care have fewer antenatal problems and as good or better outcomes than other models of care. The reviewers conclude that all women should have the option of midwifery led care.
Below are the main results of this study from the reviewers

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). There were no statistically significant differences between groups for overall fetal loss/neonatal death (RR 0.83, 95% CI 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53).

Great news for New Zealand where all women do have access to midwifery led care. We have a huge responsibility to make sure that this does result in the best possible outcomes for mothers and babies.

I just have to put this video in here again. Midwives Rock!!

Routine epidural denied. Is this a problem?

A news item today discusses women in the UK being denied epidurals because of a lack of anaesthetists. Epidurals are a local anaesthetic injected into the epidural space in the spine near to the spinal cord, which provides numbing and therefore relief of pain in labour. This emotive article quotes the Vice President of the Royal college of Obstetricians saying that epidurals should be routine in birth.

There are clear associations between epidural anaesthetic and the need for other interventions in labour, such as instrumental birth with forceps or ventouse(suction cap applied to the babies head)or caesarean section.

The article sites the Cumberland Royal Infirmary as being particularly affected by this inability to provide epidural. It is not so strange then that the Cumberland Royal Infirmary has a lower level of intervention in childbirth compared with other local hospitals. Cumberland Infirmary has a 50% normal vaginal birth rate, Cresswell maternity has a 30.8% normal birth rate and Furness has a 44.4% normal birth rate. Normal vaginal birth leads to lower incidence of complications in the postnatal period for both mother and child. There are also fewer complications with following pregnancies. Do women want pain free birth at this price? What do women think about 'routine' epidural? How do staff support women to birth normally and without intervention if they expect every woman to have a epidural? How do they walk alongside women through the triumphant process of normal and natural labour and birth?

Do you have any thoughts or comments about this? Are women told enough about what to expect in childbirth and the effects of interventions such as Epidural?