Exploring health professionals’ and women's awareness of models of maternity care evidence

The organisation of maternity care is paramount in providing safe, cost effective and normalised care for women (Sandall et al, 2010). Maternity care can be delivered using different models. These include midwife-led care—where a midwife is the lead professional but one or two consultations with an obstetrician or a physician is part of routine care; medical-led care—where an obstetrician or physician are the primary care providers; or shared care—where responsibility is shared among different health professionals.

Evidence for the safety and effectiveness of midwifery-led care has been available in various formats including primary research, reviews and guidelines (National Institute for Health and Care Excellence (NICE), 2007; Hatem et al, 2008; Sandall et al, 2010; Sandall et al, 2013). In their Cochrane review, Sandall et al (2013) demonstrated explicit benefits for mothers and babies receiving midwifery-led care compared with other models of maternity care, with a comparable level of safety. The review included 13 trials, involving 16 242 women, from the UK, Australia, Canada, Ireland and New Zealand. Women receiving midwifery-led continuity models of care were less likely to experience regional analgesia, episiotomy and instrumental birth, and more likely to have a spontaneous vaginal birth, a known midwife attending the birth, no intrapartum analgesia and a longer mean length of labour. There were no differences between groups for caesarean births. Women who were randomised to midwifery-led continuity models of care were also less likely to experience preterm birth and fetal loss before 24 weeks’ gestation, although no differences in fetal loss and/or neonatal death after 24 weeks or overall were found. The majority of studies within the review also reported a higher rate of maternal satisfaction in the midwifery-led continuity care model. It is speculated that the main contributing factors to the observed differences lie in the philosophy of care behind each model (Soltani and Sandall, 2012). Midwifery-led care is based on the belief of normality in childbirth, continuity, advocating autonomy and building relationships with mothers, whereas in the medical model there may be an over-reliance on technology and preference for medical interventions. The Cochrane review (Sandall et al, 2013) concluded that the majority of women should be offered midwifery-led models of care, although caution should be applied with women with substantial medical or obstetric complications.