Access to Midwifery Care
| Rationale for Compliance |
Evidence Grade |
|
|---|---|---|
| Compared with physicians caring for similar populations, care by professional midwives results in the following maternal outcomes: | ||
| • more antepartum visits and/or increased length of visits (De Koninck, 2001; Fraser, 2000). | Quality: | A |
| Quantity: | B | |
| Consistency: | A | |
| • more education and counseling during prenatal care (e.g., nutrition, sexuality, smoking) (Oakley, 1996). | Quality: | A |
| Quantity: | C | |
| Consistency: | NA* | |
| • decreased incidence of antepartum and/or intrapartum hypertension (PIH, PET, preeclampsia) (Blanchette, 1995; Tucker, 1996; Turnbull, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | B (One study found equivalent rates of hypertension with midwifery care.) | |
| • fewer hospital admissions during the antepartum period (Fraser, 2000; Jackson, 2003 American Journal of Public Health (AJPH); Hodnett, 2000; Tucker, 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | B (One study found equivalent rates of hospital admissions with midwifery care.) | |
| • fewer inductions of labor (see also Step 6, p. 42S) (Blanchette, 1995; Campbell, 1999; Davis,1994; Fraser, 2000; Harvey, 1996; Jackson, 2003 AJPH; Johnson, 2005; Tucker, 1996; Turnbull, 1996; Woodcock, 1994). | Quality: | A |
| Quantity: | A | |
| Consistency: | B (One study found equivalent induction rates with midwifery care.) | |
| • less need for augmentation of labor (Blanchette, 1995; Bodner-Adler, 2004; Campbell, 1999; Davis, 1994; Fraser, 2000; Harvey, 1996; Hueston, 1993; Jackson, 2003 AJPH; Johnson, 2005; Law, 1999; Tucker, 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | B (Two studies found equivalent rates of labor augmentation rates with midwifery care.) | |
| • increased access to food and drink in labor (Jackson, 2003 AJPH; Oakley, 1995). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • increased use of ambulation in labor (see also Step 4, p. 25S) (Jackson, 2003 AJPH; Hundley, 1994; Oakley, 1995). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • less use of nonsupine positions for birth (see also Step 4, p. 26S) (Bodner-Adler, 2004; De Koninck, 2001; Oakley, 1995). | Quality: | A |
| Quantity: | B | |
| Consistency: | A | |
| • less use of intravenous fluids in labor (see also Step 6, p. 34S) (Harvey, 1996; Jackson, 2003 AJPH; Johnson, 2005; Law, 1999; Oakley, 1995). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • less use of amniotomy in labor (see also Step 6, p. 38S) (Fraser, 2000; Harvey, 1996; Jackson, 2003 AJPH; Johnson, 2005). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • fewer episodes of abnormal fetal heart rate in labor (Jackson, 2003 AJPH; Woodcock, 1994). | Quality: | B |
| Quantity: | B | |
| Consistency: | A | |
| • less use of continuous electronic fetal monitoring, external and internal (see also Step 6, p. 39S) (Fraser, 2000; Jackson, 2003 AJPH; Johnson, 2005; Hundley, 1994; Oakley, 1995). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • more effective pain management in labor, including: | ||
| ○ no need for pain medications (Turnbull, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| ○ less need for analgesia (Jackson, 2003 AJPH; Harvey, 1996; Hodnett, 2000; Law, 1999; Oakley, 1995; Turnbull, 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | B (Two studies found equivalent rates of analgesia use in labor with midwifery care.) | |
| ○ less need for epidural anesthesia (Blanchette, 1995; Campbell, 1999; Carr, 2000; Davis, 1994; Fraser, 2000; Jackson, 2003 AJPH; Harvey, 1996; Hodnett, 2000; Hundley, 1994; Oakley, 1995; Turnbull, 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | B (Two studies found equivalent epidural rates with midwifery care.) | |
| ○ more use of nonpharmacological pain relief measures, including hydrotherapy, comfort measures, and other strategies (see also Step 7, p. 65S) (Campbell, 1999; Fraser, 2000; Harvey, 1996; Hundley, 1994; Jackson, 2003 AJPH; Oakley, 1995). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • increased or equivalent number of spontaneous vaginal births (Harvey, 1996; Jackson, 2003 AJPH; Law, 1999; Tucker, 1996; Walsh, 2004). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • fewer or equivalent vaginal instrumental births (vacuum extraction and forceps) (Davis, 1994; Durand, 1992; Fraser, 2000; Harvey, 1996; Jackson, 2003 AJPH; Johnson, 2005; Law, 1999; Oakley, 1995; Woodcock, 1994). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • fewer cesarean sections, as follows: | ||
| ○ fewer cesareans overall (Davis, 1994; Durand, 1992; Fraser, 2000; Harvey, 1996; Hueston, 1993; Jackson, 2003 AJPH; Johnson, 2005; Law, 1999; Walsh, 2004). | Quality: | A |
| Quantity: | A | |
| Consistency: | B (One study found equivalent cesarean section rates with midwifery care.) | |
| ○ fewer cesareans in nulliparous women (Davis, 1994; Fraser, 2000). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| ○ fewer cesareans in multiparous women (Davis, 1994; Fraser, 2000). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| ○ more vaginal births after cesarean (VBACs) (Blanchette, 1995). | Quality: | A |
| Quantity: | C | |
| Consistency: | NA* | |
| ○ fewer cesareans for emergencies in labor, such as fetal distress (Davis, 1994; Tucker, 1996; Woodcock, 1994). | Quality: | A |
| Quantity: | A | |
| Consistency: | B (One study found equivalent rates of cesarean sections for emergencies with midwifery care.) | |
| ○ fewer cesareans for inadequate progress in labor (Davis, 1994). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| ○ fewer first cesareans (Blanchette, 1995; Davis, 1994; Fraser, 2000; Jackson, 2003 JOGGN). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • fewer perineal injuries, as measured by: | ||
| ○ fewer episiotomies (Blanchette, 1995; Bodner-Adler, 2004; Campbell, 1999; Fraser, 2000; Harvey, 1996; Harvey, 2002; Hueston, 1993; Hundley, 1994; Jackson, 2003 AJPH; Johnson, 2005; Law, 1999; Oakley, 1995; Turnbull, 1996; Walsh, 2004). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| ○ fewer 3rd- and 4th-degree lacerations (Fraser, 2000; Oakley, 1996; Woodcock, 1994). | Quality: | A |
| Quantity: | A | |
| Consistency: | B (One study found equivalent rates of 3rd- and 4th-degree tears with midwifery care.) | |
| ○ more intact perineums (Bodner-Adler, 2004; Campbell, 1999; Turnbull, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | A | |
| • lower or equivalent incidence of shoulder dystocia (Blanchette, 1995; Woodcock, 1994). | Quality: | B |
| Quantity: | B | |
| Consistency: | A | |
| • lower incidence of retained placenta (Woodcock, 1994). | Quality: | B |
| Quantity: | B | |
| Consistency: | NA* | |
| • fewer or equivalent postpartum hemorrhages (Blanchette, 1995; Bodner-Adler, 2004; Fraser, 2000; Law, 1999; Oakley, 1996; Turnbull, 1996; Woodcock, 1994). | Quality: | A |
| Quantity: | A | |
| Consistency: | C (One study found an increase in postpartum hemorrhages with midwifery care in Australia.) | |
| • lower or comparable incidence of maternal infection or need for antibiotics after birth (Blanchette, 1995; Fraser, 2000; Jackson, 2003 AJPH; Oakley, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | B | |
| Compared with physicians caring for similar populations, care by professional midwives results in the following perinatal outcomes: | ||
| • more infants exclusively breastfeeding at birth (De Koninck, 2001; Oakley, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | A | |
| • more infants exclusively breastfeeding 2–4 months after birth (De Koninck, 2001). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| • more infants remaining with the mother throughout hospital stay (Oakley, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| • fewer or equivalent number of preterm births (Fraser, 2000; Jackson, 2003 AJPH; Tucker, 1996; Turnbull, 1996; Woodcock, 1994). | Quality: | A |
| Quantity: | B | |
| Consistency: | B | |
| • fewer or equivalent number of low-birthweight infants (Blanchette, 1995; Davis, 1994; Fraser , 2000; Hueston, 1993; Jackson, 2003 AJPH; MacDorman, 1998; Turnbull, 1996; Woodcock, 1994). | Quality: | A |
| Quantity: | A | |
| Consistency: | B | |
| • lower incidence of fetal distress (Jackson, 2003 AJPH). | Quality: | A |
| Quantity: | C | |
| Consistency: | NA* | |
| • lower or equivalent incidence of infant acidemia when compared with physician care (Bodner-Adler, 2004; Davis, 1994). | Quality: | B |
| Quantity: | C | |
| Consistency: | B | |
| • fewer infants requiring resuscitation at birth (Hodnett, 2000; Woodcock, 1994). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • fewer infants with birth trauma (Woodcock, 1994). | Quality: | B |
| Quantity: | B | |
| Consistency: | NA* | |
| • fewer or equivalent number of infants admitted to intensive care units after birth (Harvey, 1996; Jackson, 2003 AJPH; Law, 1999; Tucker, 1996; Turnbull, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | B | |
| • fewer infant sepsis workups for infection that requires treatment (Jackson, 2003 AJPH). | Quality: | A |
| Quantity: | C | |
| Consistency: | NA* | |
| • similar incidence of neonatal readmission (Jackson, 2003 AJPH). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| • fewer or comparable number of perinatal deaths (Durand, 1992; Johnson, 2005; MacDorman, 1998; Tucker, 1996; Woodcock, 1994). | Quality: | A |
| Quantity: | B | |
| Consistency: | B | |
| Care by professional midwives does not increase the incidence of adverse outcomes in women with risk factors such as poor access to care, low economic status, late entry to care, poor nutrition, substance abuse, and moderate to high medical risk factors. Instead, it results in fewer cesarean sections, fewer vaginal instrumental births, and more VBACs (Blanchette, 1995; Davidson, 2002; Mahoney, 2005). | Quality: | B |
| Quantity: | B | |
| Consistency: | B | |
| Women cared for by professional midwives report increased satisfaction in the following areas (De Koninck, 2001; Harvey, 2002; Hodnett, 2000; Hundley, 1997; Oakley, 1995; Shields, 1998; Turnbull, 1996): | Quality: | A |
| Quantity: | A | |
| Consistency: | B | |
| • relationship with their care provider (continuity of care, empathy, and the overall course of care) | ||
| • access to information and counseling | ||
| • quality of birth experience (feeling well prepared, feeling supported, enjoying the experience, participating in decisions, feeling care is personalized) | ||
| Professional midwifery care reduces costs when compared with physicians working with similar populations for the following reasons (Blanchette, 1995; Carr, 2000; Fraser, 2000; Harvey, 1996; Oakley, 1995; Oakley, 1996; Turnbull, 1996): | Quality: | A |
| Quantity: | A | |
| Consistency: | B (One study found equivalent rates of hospital stays and readmission rates with midwifery care.) | |
| • midwives use fewer antepartum and intrapartum tests and procedures | ||
| • women under the care of midwives experience fewer preterm births, fewer cesarean sections, and fewer vaginal instrumental births; thus, an attendant reduces incidence of the complications they may cause) | ||
| • women under the care of midwives experience shorter postpartum stays | ||
| • women under the care of midwives experience fewer hospital readmissions | ||
A = good, B = fair, NA = not applicable, PIH = pregnancy-induced hypertension, PET = preeclampsia toxemia, VBAC = vaginal birth after cesarean
Quality = aggregate of quality ratings for individual studies
Quantity = magnitude of effect, numbers of studies, and sample size or power
Consistency = the extent to which similar findings are reported using similar and different study designs
*
only one study