Midwifery Care Safely Manages Pregnancy Complications

People who had a midwife as their most responsible provider had improved birth outcomes relative to obstetrician-led care across medical risk levels.

Midwives in British Columbia are providing safe primary care for pregnancies of all medical risk levels, contrary to a popular belief that midwives mostly manage low-risk pregnancies, according to a study published in the Canadian Medical Association Journal.

Researchers examined a decade of births in B.C. between 2008 and 2018 to compare birth outcomes for people who had a midwife as their most responsible provider (MRP), with those who were cared for by a family physician or obstetrician.

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‘As medical risk increases, midwives collaborate with obstetrician specialists to ensure that birthing people are receiving safe and appropriate care.’

The findings reveal that people who had a midwife as their MRP had comparable or improved birth outcomes relative to family physician- or obstetrician-led care across medical risk levels.

Midwifery clients were less likely to have preterm births and low-birth-weight babies compared to physician-led care, and the risk of infant death was comparable across MRPs.

The study provides evidence that midwifery care in B.C. is a safe and effective option for childbearing people, regardless of medical risk. These findings are a reflection of how midwives are integrated into B.C.’s health system.

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Midwives operate in two worlds: They are in the community working with people in their homes, but they are also integrated into the hospital system. When complications develop, midwives are a bridge to the specialist and hospital care that a person needs.

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Midwifery clients also had consistently lower cesarean delivery rates compared to people with physician MRPs, although the rate of cesarean delivery increased as medical risk increased. Close to 37 percent of births in B.C. were cesarean deliveries in 2019-2020, the highest in the country.

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The new study shows how midwifery care in B.C. has evolved since it became a regulated health profession in 1998. The proportion of births that had a midwife MRP increased from 9.2 percent in 2008 to 19.8 percent in 2018. That proportion has continued to climb in more recent years, with midwives now assisting with nearly a third of all births in B.C. — the highest proportion in Canada.

Whereas midwifery care may have started primarily with low-risk clients, the study provides evidence that the profile of clients is changing and that midwives are increasingly caring for clients safely at all medical risk levels.

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A large part of midwifery education is teaching students about medical complexities and how to triage clients in terms of their medical risk. It’s always been a part of midwifery training and the care midwives provide.

Despite increases in midwifery care during the study period, Canada has some of the lowest rates of midwifery access in the world and increasing rates of cesarean delivery.

The study recommends that the growing midwifery profession should be supported by policies and payment structures that enable the retention of midwives, and by health system integration and collaboration with physician colleagues.

As the midwifery profession continues to grow, it holds the potential for meeting national mandates to lower obstetric intervention rates and increase access to midwifery care in underserved communities. It is the combination of good outcomes and lower intervention rates that make midwifery a great public health strategy.

Source-Eurekalert