What is the recommended model of care for women with low-risk pregnancies?

Midwifery Model of Care for Low-Risk Pregnancies

For women with low-risk pregnancies, midwife-led care is the recommended model of care, as it reduces unnecessary interventions while maintaining favorable maternal and neonatal outcomes. 1

Evidence Supporting Midwifery Care

Improved Maternal Outcomes

• Midwife-led care is associated with lower rates of unplanned cesarean sections and instrumental vaginal deliveries compared to obstetrician-led care 1
• Women receiving midwife-led care have shorter hospital stays and lower risks of infection, manual removal of placenta, blood transfusion, and ICU admission 1
• Midwifery care reduces the need for interventions such as labor augmentation, epidural/spinal analgesia, episiotomy, and active management of the third stage of labor 1
• Midwife-led care shows a significantly reduced risk of emergency cesarean section (OR = 0.49) and decreased use of episiotomy (OR = 0.46) 2

Improved Neonatal Outcomes

• Neonates delivered under midwife-led care have lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission 1
• Midwifery care is associated with decreased average neonatal admission time in neonatal intensive care units 2
• Important outcomes such as APGAR scores <7 and perineal tears are comparable between midwife-led and obstetrician-led care 1

Patient Satisfaction

• Continuity of care by a primary midwife increases women's satisfaction with antenatal, intrapartum, and postpartum care 3
• The woman-midwife partnership builds relationships, trust, confidence, and advocacy, resulting in women feeling safer, less stressed, and more respected 4

International Guidelines and Practice Patterns

International guidelines show significant variation in prenatal care delivery models, with most countries recommending midwifery care for low-risk pregnancies:

• Most countries (6 out of 9) recommend that low-risk women see only general practitioners or midwives for prenatal care 5
• The United States and Canada recommend that pregnant women have the option to see an obstetrician-gynecologist, general practitioner, or midwife 5
• Japan is the only country that specifically recommends obstetrician-gynecologists as primary maternity care providers for low-risk women 5

Visit Frequency and Care Structure

• The U.S. recommends more prenatal visits (median 13) compared to other countries like France and the Netherlands (7.5 visits) 5
• Peer countries generally recommend fewer visits, longer intervals between visits, and less reliance on obstetrician-gynecologists for routine, low-risk prenatal care 5

Implementation Considerations

Risk Assessment

• Proper risk assessment is essential to identify truly low-risk pregnancies appropriate for midwifery care 1, 2
• Women with high-risk pregnancies, cardiovascular diseases requiring specialized care, or conditions necessitating continuous monitoring should follow appropriate delivery recommendations specific to their conditions 6

System Requirements

• Organizational infrastructure, innovative partnerships, and robust community systems are crucial to overcome barriers and address women's complex needs 4
• Health systems should allow for smooth transfer to specialist care when complications arise 1

Continuity of Care

• Caseload midwifery models that provide continuity throughout antenatal, intrapartum, and postpartum periods show the best outcomes 3
• Building relationships between women and midwives creates opportunities for early prevention and diagnosis of complications 4

Common Pitfalls and Considerations

• Despite evidence supporting midwifery care for low-risk pregnancies, there may be a slightly increased risk of shoulder dystocia in multiparous women (aRR 1.42) 7
• Successful implementation requires compliance with guidelines and effective management protocols 4
• Ensuring quality of care through proper training and supervision of midwives is essential to reduce the risk of preterm birth and other adverse outcomes 4