The authors of this review analyzed studies published between 1990 and 2008 to compare care provided by physicians with care provided by certified nurse midwives during labor and delivery. The analysis included 21 articles providing data on 18 studies (there was some overlap). The studies reported data only on hospital deliveries. Two studies were randomized controlled trials, and most of the observational studies employed a retrospective cohort design.

In terms of care provided during labor-including labor augmentation, labor induction, labor analgesia, and use of an epidural-most studies reported that nurse midwives used pharmacologic interventions less frequently than physicians. Similarly, nurse midwives performed fewer cesarean deliveries and were less likely to use forceps or vacuum or perform an episiotomy. Nurse midwives also performed more vaginal births after cesarean delivery than physicians. Infant and maternal outcomes were also compared, and only one of 11 studies assessing Apgar scores found a difference between nurse midwives and physicians, and that difference favored the nurses. There was also little difference found between the nurses and physicians in terms of the delivery of low-birth-weight babies and neonatal ICU admission. Results from three observational studies demonstrated higher rates of breastfeeding among women treated by nurse midwives than among those seen by physicians.

The authors acknowledge a number of study limitations, including the fact that most studies included in the review were observational. Although some studies aimed to examine comparable groups of women, it's common for women who use a midwife to be at lower risk for complications. Based on the review findings, the authors conclude that clinical nurse midwives provide safe and effective care during labor and delivery and should be used more frequently, particularly as the need for labor-and-delivery specialists grows.-SDSJ

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