“In many parts of the world, midwives are the main providers of care for childbearing women. Midwife-led continuity models aim to support women to experience a healthy pregnancy and birth, and provide care from a known and trusted midwife during the pregnancy, birth and early parenting journey. Midwife-led continuity of care is provided in a multi-disciplinary network of consultation and referral with other care providers. This contrasts with medical-led models of care where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.
We identified 15 studies involving 17,674 women both at low and increased risk of complications. Midwife-led continuity of care was associated with several benefits for mothers and babies, and had no identified adverse effects compared with models of medical-led care and shared care. The main benefits were a reduction in the use of epidurals, with fewer episiotomies or instrumental births. Women’s chances of being cared for in labour by a midwife she had got to know, and having a spontaneous vaginal birth were also increased. There was no difference in the number of caesarean births. Women who received midwife-led continuity of care were less likely to experience preterm birth, or lose their baby before 24 weeks’ gestation, and to lose their baby overall, although there were no differences in the risk of losing the baby after 24 weeks. All trials included licensed midwives, and none included lay or traditional midwives. No trial included models of care that offered out of hospital birth.”