Table 1.

Midwifery Outcomes: Clinical and Affective Domains

Reference	Setting and Study design	Perinatal health outcomes
(Neal et al., 2019)	USA Retrospective cohort study Low-risk parous women Inter-professional care (n = 12 125) vs non-inter-professional care centres (n = 8996)	Reduced use of selected labour and birth interventions (caesarean delivery, vacuum-assisted delivery, epidural anaesthesia, labour induction and cervical ripening) Reduced maternal duration of stay Reduced overall costs associated with Certified Nurse-Midwives (CNM)-led care relative to OB-GYN-led care
(Thornton, 2017)	USA Retrospective cohort study Vaginal births Midwives attended births (n = 294 604) vs physicians attended (n = 2 117 376)	Less epidural analgesia use (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.53–0.54) Significantly fewer labour inductions (OR, 0.76; 95% CI, 0.76–0.77) Significantly fewer third- or fourth-degree lacerations (OR 0.81; 95% CI 0.78–0.84) No differences in 5-min Apgar scores, neonatal seizures, anomalous neonates or those no longer living at the time of data collection
(Attanasio and Kozhimannil, 2017)	USA Retrospective, cross-sectional analysis Association between hospital-level percentage of midwives and perinatal outcomes (n = 164 653)	Lower odds of giving birth by caesarean (e.g. adjusted OR [aOR], 0.70; 95% CI 0.59–0.82 at a hospital with 15–40% of births attended by midwives, compared with no midwife-attended births) Lower odds of episiotomy (e.g. aOR, 0.41; 95% CI 0.23–0.74 at a hospital with more than 40% of births attended by midwives, compared with no midwife-attended births)
(Hatem et al., 2009)	Cochrane Review, including 11 trials (n = 12 276) Midwife-led vs other models of care for childbearing women	Fewer antenatal hospitalizations (Risk ratio [RR] 0.90; 95% CI 0.81–0.99) Fewer instrumental vaginal deliveries (RR 0.86, 95% CI 0.78–0.96) Less regional analgesia (RR 0.81, 95% CI 0.73–0.91) More spontaneous vaginal births (RR 1.04, 95% CI 1.02–1.06) Less likely to experience foetal loss before 24 weeks gestation (RR 0.79, 95% CI 0.65–0.97) More likely to breastfeed (RR 1.35, 95% CI 1.03–1.76)
(Sandall et al., 2016)	Cochrane Review, including 15 trials (n = 17 674 women) Midwife-led continuity models vs other models of care for childbearing women	Less likely to experience preterm birth less than 37 weeks (average RR 0.76; 95% CI 0.64-0.91; n = 13 238; studies = 8; high quality) Less likely to experience instrumental vaginal birth (average RR 0.90; 95% CI 0.83–0.97; n = 17 501; studies = 13; high quality) Less likely to experience foetal loss before and after 24 weeks plus neonatal death (average RR 0.84; 95% CI 0.71–0.99; n = 17 561; studies = 13; high quality) Women who had midwife-led continuity models of care were more likely to experience spontaneous vaginal birth (average RR 1.05; 95% CI 1.03–1.07; n = 16 687; studies = 12; high quality) No differences between groups for caesarean births or intact perineum
(Johantgen et al., 2012)	USA Systematic review of 21 articles describing 18 studies Comparison of labour and delivery care provided by CNMs and physicians	Higher breastfeeding rates among women cared for by CNMs compared with physician Fewer episiotomies, fewer labour inductions and fewer perineal lacerations
(Souter et al., 2019)	USA Retrospective cohort study Comparing midwife (n = 3816) vs obstetrician (n = 19 284) labour and birth outcomes in low-risk hospital birth cohort	Midwifery care: lower risk of caesarean delivery among nulliparous (aRR 0.68; 95% CI 0.57–0.82) and multiparous (aRR 0.57; 95% CI 0.36–0.89) patients Lower likelihood of induction of labour (RR 0.72; 95% CI 0.64–0.81) and episiotomy (RR: 0.57; 95% CI 0.43–0.74) among nulliparous women compared with obstetrician group Lower risk of operative vaginal birth in nulliparous (aRR 0.73; 95% CI 0.57–0.93) and multiparous people (aRR 0.30; 95% CI 0.14–0.63) compared with obstetrician group
(Hodnett et al., 2012)	Systematic review Effects of care in an alternative institutional birth environment (i.e. hospital birth centres usually staffed by midwives) compared with care in a conventional setting 10 trials n = 11 795 women	The alternative institutional setting was associated with a higher likelihood of spontaneous vaginal birth (eight trials; n = 11 202; RR 1.03; 95% CI 1.01–1.05); breastfeeding at 6–8 weeks (one trial, n = 1147; RR 1.04; 95% CI 1.02–1.06); very positive views of care (two trials, n = 1207; RR 1.96; 95% CI 1.78–2.15) Lower likelihood of epidural analgesia (eight trials, n = 10 931; RR 0.80, 95% CI 0.74–0.87); oxytocin augmentation of labour (eight trials, n = 11 131; RR 0.77; 95% CI 0.67–0.88); instrumental vaginal birth (eight trials, n = 11 202; RR 0.89; 95% CI 0.79–0.99) and episiotomy (eight trials, n = 11 055; RR 0.83, 95% CI 0.77–0.90)
(McRae et al., 2018)	British Columbia (BC), Canada Retrospective cohort study n = 57 872 pregnant women, with low socio-economic position	Odds of small for gestational age birth were reduced for patients receiving antenatal midwifery vs General practice physician (GP) care (aOR 0.71; 95% CI 0.62–0.82) or OB care Odds of PTB were lower for antenatal midwifery vs GP care (aOR 0.74; 95% CI 0.63–0.86) or OB patients (aOR 0.53; 95% CI 0.45–0.62) Odds of LBW were reduced for midwifery vs GP care (aOR 0.66; 95% CI 0.53–0.82) or OB patients (aOR 0.43; 95% CI 0.34–0.54)
Experience of care domains
(Sandall et al., 2016)	See above	Greater overall satisfaction with care
(Hatem et al., 2009)	See above	More likely to feel in control during labour and childbirth (RR 1.74; 95% CI 1.32–2.30)
(McLachlan et al., 2016)	Australia randomized controlled trial (RCT) n = 1156 allocated to caseload midwifery, n = 1158 to standard care (i.e. midwifery-led care with varying levels of continuity, junior obstetric care or community-based medical care)	Women in the caseload group were more positive about their overall birth experience (aOR 1.50; 95% CI 1.22–1.84) They also felt more in control during labour, less anxious and more likely to have a positive experience of pain
(Vedam et al., 2017a)	BC, Canada Cross-sectional survey Sample 1 (n = 1344) Sample 2 (n = 571) Sample 3 (n = 190)	Higher satisfaction with decision-making ability during pregnancy, birth, after birth and with respect to newborn care among midwifery clients compared with people with GP or OB care Higher scores on measure of agency and autonomy in decision-making using reliable and valid 7-item scale
(Vedam et al., 2019a)	BC, Canada Cross-sectional survey Mixed effects analysis n = 2051	Midwifery clients had higher scores on measure of agency and autonomy in decision-making compared with people with GP or OB care
(Vedam et al., 2019b)	USA Cross-sectional survey n = 2700	Lower likelihood of mistreatment among people who received prenatal midwifery care (OR 0.31; 95% CI 0.25–0.40)
(Vedam et al., 2017b)	Cross-sectional survey Canada (n = 2271) and USA (n = 1613)	More respectful care experienced by service users who had midwifery vs GP or OB care. Respectful care was measured with reliable and valid 14-item scale
(Logan et al., 2022)	USA Cross-sectional survey n = 2700	Overall significant differences in pressure and non-consent to range of obstetric interventions by type of provider; midwife-led care improved clinical and care experience Stratified by race, both white (aOR 3.02; 95% CI 1.97–4.63) and Black, Indigenous and people of colour (aOR 1.98; 95% CI 1.10–3.57) were more likely to experience non-consent during perinatal care if they had a health care provider other than a midwife during birth
(Butler et al., 2015)	Ireland Mixed methods design n = 186	Clients who received midwife-led care had higher scores on measures of satisfaction and treatment from providers, compared with obstetrician-led antenatal clinics