31 October 2008
All women should be offered midwife-led care -
International and NZ evidence that Midwifery led care gets the best outcomes
“New Zealand women and their families can be confident that their midwifery care is safe and birth outcomes are in line
with international and national evidence”, says Karen Guilliland, CEO New Zealand College of Midwives (NZCOM).
Two recent reports highlight the advantages of midwifery led care, where the midwife is the main care provider for
mother and baby, making appropriate referrals to other health professionals as required. Currently about 75% of women
have a midwife as their lead maternity carer (LMC).
Firstly the New Zealand College of Midwives has launched its review of 10,000 births throughout New Zealand in 2004. The
Care Activities and Outcomes Report produced by the MMPO practice management system for midwives gives the public and
the profession a wide range of outcomes to compare within New Zealand and other maternity systems globally. Clinical
information supplied by the MMPO midwives is entered into a database from which relevant maternity data can be measured.
The report, co-produced by University of Canterbury Health Sciences Centre and NZCOM researchers summarises the outcomes
for mothers and babies based on birthing facility types, age, ethnicity, smoking and a whole range of other information
including smoking antenatally and postnatally.
Chris Hendry, MMPO Director comments, “Following years of technical development we now have access to a fantastic amount
of reliable data. This will not only enable comparisons to be made from one year to the next but we can really start to
drill down into the successes of midwifery care in New Zealand”.
The report provides information for women who gave birth in 2004, which enables comparisons with other New Zealand
reports – such as the MOH Report on Maternity 2004. All MMPO midwives are members of the New Zealand College of
Midwives, which sets standards to ensure high quality midwifery care.
“A picture is emerging of a higher percentage of normal births, a lower elective caesarean section rate, fewer assisted
births for women, less episiotomies, less haemorrhage and more likely to give up smoking when attended by an MMPO
midwife. Most importantly it reinforces the safety of midwifery care in New Zealand” Norma Campbell, NZCOM Midwifery
Advisor.
Secondly, the recent publication by the world renowned Cochrane Research Collaboration where they analysed 11 Randomised
control trials of midwifery led care paints a similar picture. The New Zealand outcomes in the MMPO report reflect the
outcomes in the Cochrane meta analysis of all the research trials comparing midwifery led care to other forms of
maternity care.
The international evidence found that midwife led care was associated with a number of benefits for mothers and babies,
and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks, reduced
use of regional analgesia, fewer episiotomies or instrumental births. Midwife led care also increased the chance of
vaginal birth and initiation of breastfeeding. The review concluded that all women should be offered midwife-led models
of care which puts women in control of the birthing process.
MMPO is a membership organisation and now has approximately 74% of New Zealand’s LMC midwives on their database. Hendry
states “although the number of midwives included in the 2004 data is much lower than current membership we are very
excited to be in a position to provide this information and this is only the starting point – we plan to have 2005, 2006
and 2007 reports sequentially over the next year.”
ENDS