Maternity care that involves a midwife as the main care provider leads to better outcomes for most women, compared with shared care or medical-led approaches, according to a systematic review published in The Cochrane Library.

The researchers, from Shefeld Hallam University, The University of Warwick and National University of Ireland Galway, reviewed data from 13 trials involving a total of 16,242 women and looked at outcomes for both mothers and babies following different models of care. When midwives were the main providers of care throughout, women were less likely to give birth before 37 weeks or lose their babies before 24 weeks, compared with those given shared care. They were also happier with the care they received, had fewer epidurals, fewer assisted births, and fewer episiotomies.

The authors point out that midwifeled care places an emphasis on normality and continuity of care. This contrasts with medical-led models of care, where an obstetrician or family doctor is primarily responsible for care, and with shared-care, where responsibility is shared between different healthcare professionals.

The issue of whether a midwife-led model of care is more effective has been the subject of debate. But based on their ndings, the authors conclude that all women should be offered midwife-led continuity of care, unless they have serious medical or obstetric complications.