Low-risk moms face fewer complications with midwives

Pregnant patients with a low risk of birth problems who are cared for by a midwife will likely leave the hospital maternity unit having experienced fewer interventions and complications than if attended by an obstetrician, a new study has concluded.

Researchers reviewed data from the medical records of more than 20,000 women with no known medical or obstetric complications. The data involved 11 Pacific Northwest hospitals and spanned 2014 to 2018. Their findings indicated that women who were attended by midwives during labor had fewer interventions such as cesarean delivery or use of an epidural. The data was collected as part of the a perinatal quality-improvement effort to gather birth data for analysis and improvement of maternal and newborn outcomes.

The UW Medicine hospitals participating in the program include the University of Washington Medical Center and Northwest Hospital & Medical Center in Seattle and Valley Medical Center in Renton. The researchers included obstetricians, certified nurse-midwives, and epidemiologists from Washington, Oregon and Canadian hospitals and universities.

The study covered 23,100 births, of which 3,816 (14%) had labor managed by midwives and 19,284  who had labor management by obstetricians. The study involved singleton births between 37 and 42 weeks with no significant medical complications. Most of the mothers (53%) were 30 to 34 years old.

“Compared with obstetricians, midwifery patients had significantly lower intervention rates,” the authors. These patients wre less likely to have artificial rupture of membranes, labor induction, episiotomy, and use of vacuum or forceps. 

The midwife patients who were giving birth for the first time had an approximately 30% lower risk of cesarean delivery, the paper said. For mothers who had previously given birth, the midwife group had a 40% lower rate of cesareans compared with the obstetrician group. There was, however.  a higher incidence of shoulder dystocia, a complication of vaginal birth, in the midwife-attended group.

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