Today the NZ Herald published a front page article entitled “Baby health concerns” (along with similar articles on other media outlets) based upon the Comparison of Maternity Care Models study by the University of Otago.
Auckland Homebirth Community would like to iterate midwife-led continuity of care as safe, expert, healthy and satisfying.
A recent Cochrane Review using 15 studies involving 17,674 mothers and babies found the following:
The main benefits were that women who received midwife-led continuity of care were less likely to have an epidural. In addition, fewer women had episiotomies or instrumental births. Women’s chances of a spontaneous vaginal birth were also increased and there was no difference in the number of caesarean births. Women were less likely to experience preterm birth, and they were also at a lower risk of losing their babies. In addition, women were more likely to be cared for in labour by midwives they already knew. The review identified no adverse effects compared with other models. [[Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5]] [Emphasis ours.]
Further, Karen Guilliland, chief executive of the New Zealand College of Midwives states:
Firstly the research is reassuring in that the incidence of adverse outcomes is very low and comparable with all similar countries so this is not a new finding as New Zealand is noted for its excellent maternity service.
The study is methodologically limited to only the data it could access and therefore its analysis is weakened considerably because the researchers couldn’t measure all the contexts/circumstances that women and babies are in. They couldn’t tell individual women’s education or income levels, whether they lived rurally or remote rurally, if they lived in violent circumstances, in appropriate housing or if they had existing medical conditions other than diabetes and high blood pressure.
In addition, this study mainly looks at the women under the care of midwives and these women are more likely to be rural, remote rural, Māori, Pasifika, younger, book with an LMC later, smoke, be obese and sicker. These are all well known risk factors that cause the adverse outcomes described. Unfortunately the study could only identify the care giver at registration in early pregnancy. There was no way they could identify whether women had referrals in pregnancy or labour so the results don’t tell us who was managing care and what assessments etc were undertaken by other practitioners. Therefore there has been an assumption that there were not any others involved in care decisions. [Emphasis ours]
The study is not comparing two models of care as there is really only one…obstetricians always have midwives providing care on their behalf and midwives also call on obstetricians when needed. [[Response from Karen Guilliland, chief executive, New Zealand College of Midwives to questions from New Zealand Herald about Comparison of Maternity Care Models study. https://www.midwife.org.nz/latest-news/study-highlights-under-resourcing-/response-to-nz-herald/]]
We would again like to emphasise our support for midwives and for the midwifery-led care system in New Zealand.
- The full study can be read here: A Comparison of Midwife-Led and Medical-Led Models of Care and Their Relationship to Adverse Fetal and Neonatal Outcomes: A Retrospective Cohort Study in New Zealand. Wernham E, Gurney J, Stanley J, Ellison-Loschmann L, Sarfati D (2016) A Comparison of Midwife-Led and Medical-Led Models of Care and Their Relationship to Adverse Fetal and Neonatal Outcomes: A Retrospective Cohort Study in New Zealand. PLoS Med 13(9): e1002134. doi: 10.1371/journal.pmed.1002134
- Study highlights under resourcing. 28 September 2016. Study Supports Midwives’ Claims of Maternity Service Under Resourcing | NZCOM