Jane Sandall, RM, RN, MSc, PhD, is a professor of Social Science and Women's Health and Innovations Programme Director, King's Patient Safety and Service Quality Research Centre, King's College London, London, UK.
Improving Quality and Safety in Maternity Care: The Contribution of Midwife-Led Care
Article first published online: 24 DEC 2010
2010 American College of Nurse Midwives
Journal of Midwifery & Womens Health
Volume 55, Issue 3, pages 255–261, May-June 2010
How to Cite
Sandall, J., Devane, D., Soltani, H., Hatem, M. and Gates, S. (2010), Improving Quality and Safety in Maternity Care: The Contribution of Midwife-Led Care. Journal of Midwifery & Womens Health, 55: 255–261. doi: 10.1016/j.jmwh.2010.02.002
- Issue published online: 24 DEC 2010
- Article first published online: 24 DEC 2010
- humanized care;
- midwife-led care;
- physiologic birth;
This article draws on findings from a recent Cochrane systematic review of midwife-led care and discusses its contribution to the safety and quality of women's care in the domains of safety, effectiveness, woman-centeredness, and efficiency. According to the Cochrane review, women who received models of midwife-led care were nearly eight times more likely to be attended at birth by a known midwife, were 21% less likely to experience fetal loss before 24 weeks' gestation, 19% less likely to have regional analgesia, 14% less likely to have instrumental birth, 18% less likely to have an episiotomy, and significantly more likely to have a spontaneous vaginal birth, initiate breastfeeding, and feel in control. In addition to normalizing and humanizing birth, the contribution of midwife-led care to the quality and safety of health care is substantial. The implications are that policymakers who wish to improve the quality and safety of maternal and infant care, particularly around normalizing and humanizing birth, should consider midwife-led models of care and how financing of midwife-led services can support this. Suggestions for future research include exploring why fetal loss is reduced under 24 weeks' gestation in midwife-led models of care, and ensuring that the effectiveness of midwife-led models of care on mothers' and infants' health and well-being are assessed in the longer postpartum period.