Mamas on Bedrest: Midwifery Care is Safe for Mamas on Bedrest

September 20th, 2013

IMG_3750 1x13One of my greatest disappointments being a high risk mama was that I was unable to have my births attended by a midwife. In Austin at the time when I was having my children, midwives had been banished from the hospitals and the only women who could have a midwife assisted birth were women who gave birth at home or at Birthing Centers. Thankfully that trend is reversing and many (but not all) women in Austin, TX have access to and the ability to choose midwifery care.

However, a recent study out of Australia reports that midwifery care is safe and cost effective for all women regardless of the level of complication of their pregnancies. Published in The Lancet and reported in MedScape OB/GYN Women’s HealthSally K. Tracy, DMid, a professor in the Midwifery and Women’s Health Research Unit at the University of Sydney, Royal Hospital for Women in Randwick, New South Wales, Australia, and colleagues sought to see of the benefits and positive birth outcomes seen in low risk pregnant women who are receive prenatal and intra-partum care from midwives could also occur for high risk pregnant women who received care from midwives. This was an unusual undertaking, the first of its kind, as midwives are usually removed from a woman’s case once she is labeled “high risk”, and her care is assumed by obstetricians and Maternal Fetal Medicine Specialist.

“We undertook a randomised controlled trial to assess maternal and perinatal clinical outcomes and cost of care for caseload midwifery compared with standard maternity care for women of all risk,” the authors write.

The researchers randomly assigned 871 pregnant women to caseload care consisting of antenatal, intrapartum, and postpartum care from a “caseload” (study prescribed) midwife and 877 women to standard care provided separate wards or clinics.

As for outcomes, the outcomes were fairly similar. There were similar number of cesarean sections for each group, however the number of elective cesarean sections for the standard care group was significantly higher as were the number of labor inductions. Instrumentation, use of epidurals and numbers of spontaneous vaginal births was similar for both groups. Women in the study group were significantly more likely to experience spontaneous labor onset, less likely to have labor induction, and more likely to have labor augmentation (walking, massage, manual manipulations, etc…) than women in the standard care group. Those in the study group were significantly more likely to have birth-related blood loss of less than 500 mL, but the risk for severe blood loss (>1000 mL) was similar between the groups. There were no maternal deaths during the trial. Additionally, more mothers from the study group were breastfeeding their babies than the standard group at 6 weeks post partum. There was no significant different difference in the infants at birth as assessed by Apgar scores, NICU admissions or birthweight.

A very significant difference was cost. The cost of midwifery care for prenatal and peri-partum care versus the standard hospital care was on average $566.74 (in Australian dollars) less.

While this is the first study of its kind to delve into providing midwifery care to high risk pregnant women, I feel its a landmark study. Midwifery has been the standard of care for childbirth since the beginning of time. Midwives and other women in the community would come and attend a birthing mother, caring for not only the mother but also for her family. With the advance of modern day obstetrics and hospital care, much of the intimate woman to woman care and community care of the family has been lost. It is my hope that with studies like this one and others all women will be able to experience pregnancy and childbirth and a safe and loving environment. Yes, sometimes things happen and interventions are necessary. However, there is always time and space for “humanizing” of the experience and that is what midwifery brings.

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