What if the lead professional on your pregnancy care team was in partnership with you and stayed by your side throughout labor, attended the birth of your baby, and was dedicated to helping you through the first hours, days and weeks afterward?
What if she also understood your emotional strengths, culture, and family dynamics and incorporated these into your care?
If your caregiver is giving you this level of care, she’s most likely a midwife, and you are receiving midwife-led continuity of care.
Midwife-led Care Was Shown to Benefit Mothers and Babies
In a review of 13 studies involving 16,242 low and increased-risk women in five countries within a variety of health systems and settings, the midwife-led model of care was shown to benefit mothers and babies more than physician-led or shared models of care.
The studies included licensed midwives and prenatal/postpartum home visits, as well as health center, hospital and community clinic settings, but did not include any home births.
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Midwife-led care was defined as a situation in which midwives provided all care during pregnancy, labor, birth and postpartum.
Collaboration between doctors and midwives in this model took place either as a routine or when needed.
Prenatal Care Usually Led by Physicians in North America
In the physician-led model of prenatal care, an obstetrician or family doctor provided prenatal care and delivery services. Nurses were charged with monitoring labor and postpartum recovery. Obstetrician-led care, a subset of this model, is prevalent in the United States. All studies included in the review were conducted in the public health systems of Australia, Canada, Ireland, New Zealand and the United Kingdom.
A shared care model is one in which the lead professional changes depending on whether the woman is pregnant, in labor, delivering or has delivered, and on the setting of care. This model generally lacks continuity and there is little opportunity for patients to build relationships with caregivers.
Prenatal Care Models: Subsets Also Examined
Midwives may work as a team to serve all the women under their care or on a caseload system, where women are assigned to an individual midwife and her partner. Caseload was most often used in community-based settings that provided outreach and local accessibility. In one study of 5,118 women, 45 mothers were assigned to each midwife per year. In another study of 11,124 women, individual midwives averaged 32 to 35 clients per year.
In comparison to other models, mothers who used midwife-led care enjoyed greater satisfaction with overall experience, including the information, advice, explanations and childbirth preparation they received, even though labors averaged about an hour longer than in other models.
Natural Birth More Common Under Midwife-led Care
Pregnancy loss before 24 weeks gestation and preterm birth were significantly reduced in this model, as were episiotomies and deliveries by forceps or vacuum devices. Mothers were more often pleased with where birth took place and the caregiver’s behavior.
Moms in midwife-led care were significantly more likely than women under physician-led or shared care models to experience the spontaneous vaginal birth of their infants – as opposed to deliveries requiring medical intervention.
Although an increase in natural birth is probably the result of saying no to medications and yes to upright positions in labor and delivery, other benefits are likely due to the differing philosophies between midwives and their medical colleagues.Decoded Pregnancy
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