Expecting mothers prefer midwife-led labour

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Most women should be offered midwife-led care that uses fewer interventions and is just as safe as the consultant-led model, a major study recommends.

The study, commissioned by the Health Service Executive and conducted by the School of Nursing and Midwifery at Trinity College Dublin, found most women prefer midwife-led units.

It also discovered the number of babies requiring resuscitation at birth or admission to the special care baby unit was the same for both groups of women.

Almost six in 10 women in the consultant-led units (57%) had their labours speeded up by either having their waters broken or having oxytocin given intravenously by a drip, compared to only four in 10 women in the midwife-led units.

The study involved 1,653 women who had babies in the HSE Dublin North-East region from 2004 to 2007 and compared the consultant-led maternity care with a new model of care provided in two integrated midwifery-led units in Our Lady of Lourdes Hospital in Drogheda and Cavan General Hospital.

The two midwife-led units, which have hotel-like private rooms with birthing pools, were opened in response to recommendations made in the Minder Report in 2001 to provide more choice in maternity care in the north-east.

... fewer women in the midwifery-led unit group chose pain-relieving epidurals in labour.

Despite having fewer epidurals, 83% of women in the midwife-led units were satisfied with their pain relief compared with 68% of women in the consultant-led unit.

"When women are supported by one-to-one midwifery care, are encouraged to labour gently at their own pace and have the pain-relieving benefits of relaxing in warm water, they are far better able to tolerate pain and labour more effectively," ...

The study found that 85% of women attending the midwife-led unit would recommend the care they had received to a friend, compared to 70% having the usual care.

Although facilities in the midwifery-led units were quite luxurious, the cost of care for each women was €332.80 less than in the usual hospital system.

A recent KPMG report on maternity care in the greater Dublin region also recommended the introduction of midwifery-led units throughout the country.

These results have been found in other studies, particularly the claim around pain relief. It is interesting that epidurals don't equate with a more positive birth experience; rather, a woman who feels well-prepared and who is supported with one-to-one midwifery care in a drug-free birth, will rate her birth as being highly satisfying.

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