Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia

Thanks to local midwife Heather Ashthorn for sharing this recent study conducted in British Columbia.

The article is a bit technical, but the message is simple. For women with normal pregnancies, births attended by midwives involve far fewer medical interventions than those attended by doctors AND they are just as safe. Healthy mommies, healthy babies, and major cost and resouce savings for our medical system -- what more could you ask for?

Birth. 2007 Jun;34(2):140-7, Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia.

Janssen PA, Ryan EM, Etches DJ, Klein MC, Reime B. Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada.

BACKGROUND: The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada.

METHODS: All women planning a hospital birth attended by a midwife during the 2-year study period who were of sufficiently low-risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n=488). The comparison group included women meeting the same eligibility requirements but planning a physician-attended birth in hospitals where midwives also practiced (n=572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data.

RESULTS: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39-0.86), narcotic analgesia (OR 0.26, 95% CI 0.18-0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16-0.30 ), amniotomy (OR 0.74, 95% CI 0.56-0.98), and episiotomy (OR 0.62, 95% CI 0.42-0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04-0.83) in the midwifery group.

CONCLUSIONS: A shift toward greater proportions of midwife-attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity.

PMID: 17542818