By Kathryn Doyle

Reuters Health – Women cared for by midwives throughout pregnancy tended to have less-complicated births and were less likely to go into labor early than women getting standard medical care, according to a new review of more than a dozen studies.

Pregnancy care that was led or entirely provided by hospital- or community-based midwives was linked to fewer epidurals, episiotomies and use of instruments like forceps or vacuums during delivery. Risk of losing the baby during the first two trimesters was also significantly lower, UK researchers found.

It’s important to figure out why those differences exist for midwife-led care, said lead author Jane Sandall, professor of social science and women’s health in the Division of Women’s Health of King’s College London.

“For example, whether it is the model of care itself where midwives are in a position to pick up problems and get the right specialist input as early as possible, or whether a relationship where a women knows and trusts her midwife leads to a better outcome,” Sandall told Reuters Health by email.

In some countries, including the U.S., an obstetrician or family doctor takes responsibility for women’s care during pregnancy, but midwives may assist the expectant mother in preparing for pregnancy and deciding when a doctor’s attention is needed.

Those “medical” models of pregnancy care were weighed in 13 studies covering 16,000 women against models in which a licensed midwife takes primary responsibility for a woman during pregnancy and is also the primary caregiver during birth and postpartum – which is the most common model in New Zealand, for example.

Women with midwives were 23 percent less likely to give birth prematurely and 19 percent less likely to lose the fetus before 24 weeks of gestation. After 24 weeks, though, fetal death was equally common with all care models, according to the review in The Cochrane Library.

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