Midwifery Research

Below are summaries of some interesting studies on midwifery from around the globe. We'll add new information to this section periodically, so check back.

Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia.

Summary: The results of this study show that women who gave birth at home attended by a midwife had fewer procedures during labor, were less likely to have epidural analgesia, be induced, have their labors augmented with oxytocin or prostaglandins, or have an episiotomy or a caesarian section than those birthing in the hospital attended by a physician.

Janssen PA, Lee SK, Ryan EM, Etches DJ, Farguharson DF, Peacock D, Klein MC

Original PubMed Abstract

Centre for Community Health and Health Evaluation Research, BC Research Institute for Children's and Women's Health, Vancouver.

BACKGROUND: The choice to give birth at home with a regulated midwife in attendance became available to expectant women in British Columbia in 1998. The purpose of this study was to evaluate the safety of home birth by comparing perinatal outcomes for planned home births attended by regulated midwives with those for planned hospital births.

The researchers compared the outcomes of 862 planned home births attended by midwives with those of planned hospital births attended by either midwives (571) or physicians (743). Comparison subjects who were similar in their obstetric risk status were selected from hospitals in which the midwives who were conducting the home births had hospital privileges. Our study population included all home births that occurred between Jan. 1, 1998, and Dec. 31, 1999.

RESULTS: Women who gave birth at home attended by a midwife had fewer procedures during labor compared with women who gave birth in hospital attended by a physician. Women in the home birth group were less likely to have epidural analgesia (odds ratio 0.20, 95% confidence interval [CI] 0.14-0.27), be induced, have their labors augmented with oxytocin or prostaglandins, or have an episiotomy.

Comparison of home births with hospital births attended by a midwife showed very similar and equally significant differences. The adjusted odds ratio for cesarean section in the home birth group compared with physician-attended hospital births was 0.3 (95% CI 0.22-0.43).

Rates of perinatal mortality, 5-minute Apgar scores, meconium aspiration syndrome or need for transfer to a different hospital for specialized newborn care were very similar for the home birth group and for births in hospital attended by a physician.

Midwife-led versus other models of care for childbearing women.

Hatem M., Sandall J., Devane D., Soltani H., Gates S.

Département de médecine sociale et préventive,
Université de Montréal, Faculté de médecine,
C.P 6128, succursale Centreville,
Montréal, Québec, Canada, H3C 3J7.

Original PubMed Abstract

Summary: The results show that women using midwife-led care were less likely to experience hospitalization after the birth, the use of epidural, episiotomy and instrumental delivery, and fetal loss at 24 weeks or later. Those receiving midwife-led care were more likely to experience spontaneous vaginal birth, a feeling of control regarding their delivery, and their babies had shorter hospital stays.

The researchers searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), Cochrane Effective Practice and Organisation of Care Group's Trials Register (January 2008), Current Contents (1994 to January 2008), CINAHL (1982 to August 2006), Web of Science, BIOSIS Previews, ISI Proceedings, (1990 to 2008), and the WHO Reproductive Health Library, No. 9 for published and unpublished research trials relating to midwifery.

The trials analyzed included all published and unpublished trials in which pregnant women were randomly allocated to midwife-led or other models of care during pregnancy, and where care was provided during labor and in the post-partum period. All authors evaluated the methodological quality of the studies used, and two authors independently checked the data extraction.

Eleven trials were included in the analysis which encompassed 12,276 births. The studies indicated that women who had midwife-led models of care were less likely to experience:

• antenatal hospitalization
• the use of regional analgesia, episiotomy, and instrumental delivery
• fetal loss before 24 weeks' gestation

they were more likely to experience

• no intrapartum analgesia or anesthesia
• spontaneous vaginal birth
• to feel in control during labor and childbirth
• their babies were more likely to have a shorter length of hospital stay

They women using midwifery were also more likely to initiate breastfeeding.

There were no statistically significant differences between groups for overall fetal loss/neonatal death, or fetal loss/neonatal death of at least 24 weeks.

Home-like versus conventional institutional settings for birth

Hodnett E.D., Downe S., Edwards N., Walsh D.

Original PubMed Abstract

Faculty of Nursing, University of Toronto, 50 St. George Street, Toronto, Ontario, Canada, M5S 3H4.

The purpose of this study was to assess the difference between a home-like birth environment and a conventional labor ward and to determine if the effects of birth settings are influenced by the staffing or organizational models used or the geographic location of the birthing center.

This analysis used randomized or quasi-randomized controlled trials that compared the effects of a home-like institutional birth environment to conventional hospital care. Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. Two review authors evaluated methodological quality. Double data entry was performed. Results are presented using relative risks and 95% confidence intervals.

Six trials involving 8,677 women were included. No trials of freestanding birth centers were found. Between 29% and 67% of women allocated to home-like settings were transferred to standard care before or during labor. Allocation to a home-like setting significantly increased the likelihood of:

• no intrapartum analgesia/anesthesia (4 trials)
• spontaneous vaginal birth (5 trials)
• vaginal/perineal tears (4 trials)
• preference for the same setting the next time (1 trial)
• satisfaction with intrapartum care (1 trial)
• breastfeeding initiation (2 trials) and continuation to six to eight weeks (2 trials).

Allocation to a home-like setting decreased the likelihood of episiotomy (five trials). No firm conclusions could be drawn regarding the effects of staffing or organizational models. Caregivers and clients should be vigilant about immediately addressing complications.

Immersion in water in pregnancy, labor and birth

Cluett E.R., Nikodem V.C., McCandlish R.E., Burns E.E.

School of Nursing and Midwifery, University of Southampton, Nightingale Building (67), Highfield, Southampton, Hants, UK, SO17 1BJ.

Original PubMed Abstract

Summary: This analysis shows that water immersion during the first stage of labor reduces the use of analgesia and reported maternal pain, without adverse outcomes on labor duration, operative delivery or neonatal outcomes.

The purpose of this study was to assess the evidence from randomized controlled trials about the effects of labor and birth in water on maternal, fetal, neonatal and caregiver outcomes.

The researchers used trials from the Cochrane Pregnancy and Childbirth Group trials register (September 2003). They used all randomized controlled trials comparing any kind of bath tub/pool with no immersion during pregnancy, labor or birth.

Eight trials are included (2,939 women). No trials were identified that evaluated immersion versus no immersion during pregnancy, considered different types of baths/pools, or considered the management of third stage of labor.

There was a significant reduction in the use of epidural/spinal/paracervical analgesia/anesthesia among women allocated to water immersion water during the first stage of labor compared to those not allocated to water immersion There was no significant difference in vaginal operative deliveries or caesarean sections.

Women who used water immersion during the first stage of labor reported statistically significantly less pain than those not laboring in water. There were no significant differences in incidence of an Apgar score less than 7 at five minutes, neonatal unit admissions, or neonatal infection rates.

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marin home birth
marin home birth