Comparing midwife-led and doctor-led maternity care: a systematic review of reviews

Authors

  • Katy Sutcliffe,

    1. Katy Sutcliffe BA MSc PhD Research Officer Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI Centre), Social Science Research Unit, Institute of Education, University of London, UK
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  • Jenny Caird,

    1. Jenny Caird BSc MA Research Officer Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI Centre), Social Science Research Unit, Institute of Education, University of London, UK
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  • Josephine Kavanagh,

    1. Josephine Kavanagh BA MA Research Officer Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI Centre), Social Science Research Unit, Institute of Education, University of London, UK
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  • Rebecca Rees,

    1. Rebecca Rees MA MSc FHEA RCUK Academic Fellow Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI Centre), Social Science Research Unit, Institute of Education, University of London, UK
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  • Kathryn Oliver,

    1. Kathryn Oliver MSc Post Graduate Research Student Centre for Occupational and Environmental Health, University of Manchester, UK
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  • Kelly Dickson,

    1. Kelly Dickson BSc MSc Research Officer Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI Centre), Social Science Research Unit, Institute of Education, University of London, UK
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  • Jenny Woodman,

    1. Jenny Woodman BA MA MSc PhD Research Student Institute of Child Health, University College London, UK
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  • Elaine Barnett-Paige,

    1. Elaine Barnett-Paige BA MA Research Officer Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI Centre), Social Science Research Unit, Institute of Education, University of London, UK
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  • James Thomas

    1. James Thomas MA PhD Mmus Social Science Research Unit Assistant Director Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI Centre), Social Science Research Unit, Institute of Education, University of London, UK
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K. Sutcliffe: e-mail: k.sutcliffe@ioe.ac.uk

Abstract

sutcliffe k., caird j., kavanagh j., rees r., oliver k., dickson k., woodman j., barnett-paIge e. & thomas j. (2012) Comparing midwife-led and doctor-led maternity care: a systematic review of reviews. Journal of Advanced Nursing68(11), 2376–2386.

Abstract

Aims.  A report of a systematic review of reviews which examines the impact of having midwives-led maternity care for low-risk women, rather than physicians.

Background.  A rising birth rate, increasing complexity of births, and economic constraints pose difficulties for maternity services in the UK. Evidence about the most effective, cost-effective, and efficient ways to give maternity services is needed.

Data sources.  Searches were carried out in August–September 2009 of ten electronic databases, 16 key nursing and research websites, and reference lists of 56 relevant reviews. We also contacted 38 experts for information. No date restrictions were employed.

Review methods.  A narrative review of systematic reviews or ‘meta review’ was conducted using transparent and systematic procedures to limit bias at all stages. Systematic reviews that compared midwife-led care during pregnancy and birth with physician-led care were eligible for inclusion.

Results.  Three meta-analytic reviews were included. Midwife-led care for low-risk women was found to be better for a range of maternal outcomes, reduced the number of procedures in labour, and increased satisfaction with care. For some maternal, foetal, and neonatal outcomes reviews found no evidence that care led by midwives is different to that led by physicians. No adverse outcomes associated with midwife-led care were identified.

Conclusions.  For low-risk women, health and other benefits can result from having their maternity care led by midwives rather than physicians. Moreover, there appear to be no negative impacts on mothers and infants receiving midwife-led care.

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