A Cochrane review [Abstract] 1 included 15 studies with a total of 17 674 subjects. Midwife-led care included care mainly by licensed midwives antenatally, during labour and postnatally and was compared with models of medical-led care and shared care. No trial included models of care that offered out of hospital birth. Women with midwife-led models were less likely to experience use of regional analgesia (RR 0.85, 95% CI 0.78 to 0.92; 14 trials, n=17 674), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; 8 trials, n=13 238), episiotomy (RR 0.84, 95% CI 0.77 to 0.92 participants = ; 14 trials, n=17 674), and instrumental delivery (RR 0.90, 95% CI 0.83 to 0.97 13 trials, n=17 501) and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.21, 95% CI 1.06 to 1.37; 7 trials, n=10 499), spontaneous vaginal birth (RR 1.05, 95% CI 1.03 to 1.07; 12 trials, n=16 687), attendance at birth by a known midwife and, a longer mean length of labour (hours). There were no statistically significant differences between groups for caesarean births, overall fetal loss/neonatal death.
Comment: The quality of evidence is downgraded by study quality (some limitations in intention-to-treat adherence and no blinding in several studies).
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