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Improving Quality and Safety in Maternity Care: The Contribution of Midwife-Led Care


  • Jane Sandall RM, RN, MSc, PhD,

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    • 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.

  • Declan Devane RM,

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    • Declan Devane, RM, is a senior lecturer in the School of Nursing and Midwifery, Áras Moyola, National University of Ireland, Galway, Galway, Ireland.

  • Hora Soltani RM, MMedSci, PhD,

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    • Hora Soltani, RM, MMedSci, PhD, PG Dip (Health Care Education), is a reader in the Centre for Health and Social Care Research at the Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.

  • Marie Hatem RM, PhD,

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    • Marie Hatem, RM, PhD, is a professor in the Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada.

  • Simon Gates PhD

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    • Simon Gates, PhD, is a Principal Research Fellow at the Health Sciences Research Institute, Warwick Medical School Clinical Trials Unit, Warwick University, Warwick, UK.

Department of Primary Care and Public Health Sciences, King's College London, 42 Weston St., London SE1 3QD. E-mail:


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.