I invite you, dear reader, to lead your reading to the last line of this article to share the understanding of the statement of medical authority:
"Epidurals are completely safe, but They are linked with a small Increase in instrumental birth"
Women who give birth under the primary care of a midwife are more likely to have full-term births and fewer medical interventions, a major review has found.
The results have led the highest international authority for assessing medical evidence, the Cochrane Collaboration, to call for all women who are not at high risk of complications to be offered midwife-led care.
Australian obstetricians are rejecting the call, saying it is safest for women to be treated by midwives working in tandem with doctors.
The Cochrane review examined the evidence of 13 trials involving more than 16,200 women randomly assigned to either midwife-led care or other models, such as having an obstetrician in charge.
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It found several benefits of midwife-led care and no negative effects, concluding ''most women'' should be offered midwife-led care and be encouraged to ask for it.
Australian College of Midwives spokeswoman Hannah Dahlen said the high-level review was significant. "We are one of only two countries in the developed world that has such a huge amount of private obstetric care," she said. ''Yet this is high-level evidence … showing midwife-led care is linked to a significant reduction in pre-term birth.''
Women treated by midwives were 23 per cent less likely to give birth prematurely and foetal death before 24 weeks was 19 per cent less likely, the review found.
Premature birth is one of the leading causes of sickness and death in otherwise healthy babies in Australia. About 8 per cent of children are born early.
Professor Dahlen said what lowered the risk was not clear, but it could be related to continuity of care and midwives' emphasis on social and mental well-being.
''When you go into the hospital system it can be really scary,'' she said. ''But when you have that relationship, that assurance, and you feel safe, what we call the 'cascade of normal birth' kicks into place."
The review found midwife-led care was also linked to lower use of epidurals and forceps or vacuum use, and longer labour. There were no differences in caesarean rates, overall foetal death, labour induction or use of opiate painkillers.
Professor Dahlen, of the University of Western Sydney, said obstetricians were still very much needed, but should assist more high-risk and fewer low-risk births.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Michael Permezel said there was "nothing" within the review that indicated Australia should shift towards more midwife-led care.
"Good care involves collaboration," he said. "Up to 40 per cent of women identified as low risk during pregnancy develop complications so collaboration between midwife and obstetrician provides the best maternity care for all women."
He said the finding that pre-term birth was less likely under midwife-led care was "counter-intuitive" and there was ''no reason on earth'' for it.
But he said the review was otherwise unsurprising.
"What this review is showing is that midwives don't encourage pain relief, whereas obstetric staff are more accepting of the patient's request to have epidural pain relief," Professor Permezel said. "Epidurals are completely safe, but they are linked with a small increase in instrumental birth."
Read more: http://www.smh.com.au/national/health/mothers-urged-to-call-the-midwife-20130821-2sbn0.html#ixzz2cjMng0Hb
