Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis

Abstract

Background Experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth. Objective The aim of this study was to compare midwifery-led and obstetrician-gynaecologist-led care-related vaginal birth outcomes. Participants Pregnant women in Kaunas city maternity care facilities. Methods A propensity score-matched case–control study of midwifery-led versus physician-led low-risk birth outcomes. Patient characteristics and outcomes were compared between the groups. Continuous variables are presented as mean ± standard deviation and analysed using the Mann–Whitney U test. Categorical and binary variables are presented as frequency (percentage), and differences were analysed using the chi-square test. Analyses were conducted separately for the unmatched (before propensity score matched [PSM]) and matched (after PSM) groups. Results After adjusting groups for propensity score, postpartum haemorrhage differences between physician-led and midwifery-led labours were significantly different (169.5 and 152.6 mL; p = 0.026), same for hospital stay duration (3.3 and 3.1 days, p = 0.042). Also, in matched population, significant differences were seen for episiotomy rates (chi2 = 4.8; p = 0.029), newborn Apgar 5 min score (9.58 and 9.76; p = 0.002), and pain relief (chi2 = 14.9; p = 0.002). Significant differences were seen in unmatched but not confirmed in matched population for obstetrical procedures used during labour, breastfeeding, birth induction, newborn Apgar 1 min scores, and successful vaginal birth as an overall spontaneous vaginal birth success measure. Conclusion The midwifery-led care model showed significant differences from the physician-led care model in episiotomy rates, hospital stay duration and postpartum haemorrhage, and newborn Apgar 5 min scores. Midwifery-led care is as safe as physician-led care and does not influence the rate of successful spontaneous vaginal births.

Estudio descriptivo de los resultados obstétricos y neonatales en dos modelos de asistencia al parto en primíparas

“…(3) Diversos estudios han evidenciado que, en modelos dirigidos por matronas, estas son menos intervencionistas y hay un menor uso de oxitocina. (18)(19)(20)(21)(22) Además en el presente estudio se observa que, a pesar de un mayor uso de oxitocina para la estimulación del parto en el modelo biomédico, la duración del parto es mayor que en el modelo humanizado. En un estudio de revisión conducido en 2015 tampoco se evidenciaron diferencias en la duración del parto entre el grupo asistido por matronas y el grupo asistido por obstetras.…”

“…En otros estudios también se concluyó que los modelos de asistencia al parto son igual de seguros que los dirigidos por obstetras, en cuanto a los resultados neonatales porque no se han observado diferencias entre ellos, y además incrementan la satisfacción de la mujer con su proceso de parto. (19,23,26,28) Este estudio presenta algunas limitaciones, entre ellas, que la muestra recogida fue pequeña y por conveniencia. El hecho de usar una muestra por conveniencia se justifica porque supone un menor coste económico y que se haya podido realizar en un período de tiempo más breve.…”

Woman-Centered Care: Standardized Outcomes Measure

“…Woman-centered care, which emphasizes the unique individual needs, expectations, and aspirations of women, is often associated with midwife-led care [ 15 ]. However, while studies in Lithuania have investigated the effects of midwife-led care and obstetrician-led care on maternal and neonatal outcomes in low-risk deliveries [ 16 , 17 , 18 ], there remains a research gap regarding the holistic evaluation of physical and emotional patient-reported outcomes experienced by women during low-risk pregnancies, from their own perspectives.…”