The Australian Medical Association on midwifery-led care in maternity services, September 2008:
“[…] midwifery services were expanded without any reference to the medical profession and without any clear evidence base around the impact on safety and clinical outcomes for patients. This has introduced significant uncertainty about the lines of responsibility for patient care and increased risk in respect of health outcomes for patients.”
Rosanna Capolingua, head of the AMA:
“Midwives are very involved in obstetric care right now in a team environment under medical supervision and that model works very well. It’s not about Medicare, it’s about the medical supervision and the safety for the patient.”
The Cochrane Collaboration, the largest and most reputable collection of evidence-based medicine reviews in the world, on “Midwife-led versus other models of care for childbearing women”[1,2], 8 Oct 2008 (emphasis is mine):
The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women.
Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.
The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman’s chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks.
The review concluded that all women should be offered midwife-led models of care.
Who do you believe?
While you’re deciding, it’s worth contemplating a flipping of the way the data is reported in this study. Try this:
The main risk of a medical model of care was an increased risk of losing a baby before 24 weeks. Also during labour, there was an increased use of regional analgesia, with more episiotomies and instrumental births. Medical-led care also decreased the woman’s chance of being cared for in labour by a person she had got to know. It also decreased the chance of a spontaneous vaginal birth and decreased initiation of breastfeeding. In addition, medical-led care led to fewer women feeling they were in control during labour.
Language. It’s a powerful thing.
 Read the full text of the Cochrane Collaboration report here.
 Some background on the models of care examined:
[…] Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called ‘team’ midwifery. Another model is ‘caseload midwifery’, where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.
Further reading from Hoyden About Town:
“Safe Motherhood: Care in Normal Birth”