Best Practice Maternity Care

Choosing one-to-one continuous midwifery care could be the most important step you take in Awakening Your Birth Power.

It is a little known fact in Australia and the US that the majority of women will have the best possible birth outcomes by receiving one-to-one midwifery care. This means that the same midwife provides all your antenatal, labour, birth and postnatal care.

This model of care is considered international best practice care by the World Health Organisation for the majority of women and has been supported by numerous studies and reports around the world.

Consider this excerpt from the National Maternity Action Plan (see the full paper at www.maternitycoalition.org.au):

“Normal birth is more likely to be achieved when a woman has access to ‘continuity of carer’ or ‘continuity of care’ from a midwife who is responsible for her care throughout pregnancy, labour and birth, and the postnatal period. ‘The systematic review comparing continuity of midwifery care with standard maternity services including data from all Australian trials shows that continuity of midwifery care is associated with lower intervention rates than standard maternity care, and that midwifery models of care are as safe as the existing standard services.’ (Waldenstrom and Turnbull 1998). The continuity of carer model of care has been proven to reduce the use of obstetric interventions in labour and birth, including the need for pharmacological pain relief, inductions, augmentations, instrumental deliveries, episiotomies and caesarean sections (Hodnestt 1999, Homer et al 2001, Rowley et al 1995).

This conclusion is strongly reinforced by the authors of Effective Care in Pregnancy and Childbirth. These researchers included not only an international search of all trials that met their strict criteria but all relevant medical journals from the 1950s onwards, writing to over 40,000 obstetricians in 18 countries to identify unpublished studies. Their research has been incorporated into the Cochrane database. After critical evaluation of studies comparing one-to-one continuous midwifery care with medical models of care they conclude:

Evidence from controlled trials shows that women who had continuity of caregivers were less likely to use pharmacological analgesia or anesthesia during labour and birth, to have labour augmented with oxytocin, to have a labour length of more than 6 hours, or to have a baby with a 5 minute Apgar score below 8. They were also more likely to feel well prepared for labour, perceive the labour staff as caring, feel in control during labour and feel well prepared for childcare. (Chalmers et al 1996, p15-16)

Chalmers et al identify continuity of care from a qualified midwife as best practice for the healthy majority of women:

as technical advances became more complex, care has come to be increasingly controlled by, if not carried out by, specialist obstetricians. The benefits of this trend can be seriously challenged. Direct comparisons of care given by a qualified midwife with medical back-up with medical or shared care show that midwifery care was associated with a reduction in a range of adverse psychosocial outcomes in pregnancy, and with reductions in the use of acceleration of labour, regional analgesia/anesthesia, operative vaginal delivery and episiotomy, fewer babies weighing less than 2500 grams, needing resuscitation or needing admission to special care units. (Chalmers et al 1996, p15)

The effectiveness of midwifery continuity of care largely stems from the relationship of mutual trust built up between a midwife and her client during the antenatal period. The establishment of this relationship, typically developed through extensive contact in the antenatal period, enables the midwife to provide care in a way that meets the individual woman’s emotional, psychological, cultural and physical needs, as well as her medical needs.

This model of care has also been found to produce better outcomes for both mothers and babies, and to assist in mother/baby attachment or bonding (EAC 2001, McCourt & Page 1996). Further, it has been shown that one-to-one midwifery care is beneficial beyond the birth episode, assisting in the establishment of long-term breastfeeding and reducing post natal depression rates (HIldingsson & Haggstrom 1999, Littlewood & McHugh 1997, Fisher et al 1997). Community based midwives are also more likely to identify the need to implement early intervention strategies in relation to a range of issues that may affect a family’s ongoing wellbeing, as they have access to the familial environment.

Indeed, such are the demonstrated benefits of one-to-one continuous midwifery care to birthing women and their babies that Chalmers et al actually conclude that ‘it is inherently unwise, and perhaps unsafe, for women with normal pregnancies to be cared for by obstetric specialists, even if the required personnel are available’ (Chalmers et al 1996).”

Midwifery care is readily available in countries like New Zealand, the UK, and Canada, yet remains almost completely unavailable in the US and Australia.

The links below will help you find out more about Awakening Your Birth Power through accessing and/or becoming an advocate for midwifery care.

In Australia:

The Maternity Coalition
Midwives in Private Practice
Australian Society of Independent Midwives
Homebirth Australia
Australian College of Midwives

In the USA:

Citizens for Midwifery
Midwives Alliance of North America
Foundation for the Advancement of Midwifery