Women who have one midwife caring for them during pregnancy are more likely to avoid medical interventions during labour including caesarean sections, Australian research has found.
The world's largest comparison of one-to-one midwifery care against standard public hospital care also found the one-to-one model was better for babies, reducing the need for special care after birth.
Researchers from La Trobe University randomly assigned 2314 women with low-risk pregnancies to either a midwife for consistent care or standard care at the Royal Women's Hospital between 2007 and 2010. Standard care involved a mix of random midwives whereas one-to-one midwifery involved a primary midwife with several known backup midwives who could step in if the primary midwife was unavailable. All women were seen by doctors at the beginning of their pregnancy, near the end of their pregnancy and again if they were overdue.
The study found that 19.4 per cent of women in the one-to-one model had a caesarean, compared with 24.9 per cent in standard care, making those in the one-to-one model 23 per cent less likely to have a caesarean. Women in the study group were also more likely to have a spontaneous birth, with 63 per cent avoiding induction of labour, compared with 55.7 per cent in standard care.
Epidurals were less common, too, with 30.5 per cent having them in the study group, compared with 34.6 per cent in standard care. Infants were also better off, with only 4 per cent needing special or intensive care after birth, compared with 6.4 per cent in standard care.
The study, published yesterday in the British Journal of Obstetrics and Gynaecology, concluded that one-to-one midwifery care showed promise for reducing caesareans, which increase recovery time for mothers while putting them at higher risk of problems in subsequent pregnancies.
Associate Professor Helen McLachlan said although it was difficult to say what was causing the different outcomes, midwives in the one-to-one model might be more philosophically committed to avoiding medical interventions such as caesarean sections. They were also more flexible in the time spent with patients, compared with midwives in the standard care model, and had the chance to get to know women better throughout pregnancy.
''This relationship appears to build a woman's trust and confidence before, during and after birth, helping women have a more positive birth experience,'' she said.
Footscray mother of two Laura Firth said she liked being part of the study so much with her first baby, Lucy, she called her midwife to see if she could care for her again during her second pregnancy with Molly, who was born in April.
''She was fantastic, she was down to earth, friendly and very approachable. I always felt like she had time for me,'' she said.
Ms Firth, 30, said the model helped her achieve her goal of two smooth deliveries with very little intervention.
''I've had friends who have been through standard care and they had different experiences to me. They didn't feel quite as empowered, so I definitely appreciated having midwives around with a similar philosophy to mine,'' she said.
Dr Della Forster, a professor of midwifery at the Royal Women's Hospital, said the model had continued to operate at the hospital since the study ended in 2010. ''We're now looking at whether there is demand for us to expand it,'' she said.
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