Pregnant women who received prenatal, intrapartum, and postnatal care primarily from a midwife were less likely to deliver prematurely (before 24 weeks) and needed fewer medical interventions, compared with women cared for by obstetricians or family physicians, according to a review of 13 studies of midwife-led care (with a total of 16,242 women) from the Cochrane Collaborative. Eight of the trials evaluated women at low-risk for complications, and five trials looked at women at high risk for complications. Other benefits of midwife-led care included fewer epidurals, fewer episiotomies, lower odds of delivering before 37 weeks, and greater odds of experiencing spontaneous vaginal birth and being happier with the overall experience. Midwife care didn't reduce the number of cesarean births, and women were in labor about 30 minutes longer.

The midwife-led care during labor and delivery cost less than standard care, according to the five studies that measured costs, and midwife-led care overall trended toward cost savings, although the studies lacked consistency in reporting costs.

In the trials, all midwives delivered babies in hospitals, not in the home. This parallels the midwife model of care promoted by the American College of Nurse-Midwives (ACNM), although none of the studies reviewed was conducted in the United States. According to Ginger Breedlove, president of the ACNM and a professor at Shenandoah University in Winchester, Virginia, "95% of the 12,000 members of ACNM assist with births in hospitals. We need to integrate more certified nurse midwives into our health care system to improve outcomes for healthy women and lower costs."

The ACNM views pregnancy as a normal, healthy life event that includes the use of medical intervention in labor when medically indicated. "Our goal is for all women to experience a healthy pregnancy and be cared for by certified nurse midwives [who are] working in collaboration with physician colleagues for seamless transfer to higher levels of care when indicated," says Breedlove.-Carol Potera

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