Researchers compared pregnancy outcomes in low-income women receiving prenatal care from midwives or doctors to investigate the benefits of a midwife.
Previous research has shown that pregnant women from low-income groups are at an increased risk of poor pregnancy outcomes such as premature labor, low birth weight babies, or small-for-age babies. In Canada, pregnant women can receive prenatal care from midwives, primary care physicians (GPs), or obstetricians. Each type of practitioner provides a different style of care that may be appropriate for the needs of different women. Researchers in British Columbia compared the pregnancy outcomes for women in low-income groups, receiving care from midwives or doctors, to investigate the possible benefits of a midwife in prenatal care. They recently published their findings in BMJ Open.
Studying the benefits of a midwife in 57,000 women in low-income groups
The study included over 57,000 pregnant women of low-to-moderate obstetric risk, from low-income groups in British Columbia, Canada, treated between 2005-2012. The researchers collected data on pregnancy outcomes from medical records. Using statistical analysis, they compared the odds of premature birth, low birth weight babies and small-for-gestational-age babies in women receiving prenatal care from midwives, GPs or obstetricians.
There were 4,705 midwifery patients, 45,114 GP patients and 8,053 obstetrician patients. Those receiving prenatal care from a midwife had a 29% lower odds of a small-for-gestational-age baby compared to women who received care from a GP, and a 41% reduction in odds of a small-for-gestational-age baby compared to those cared for by an obstetrician. The odds of preterm labor and low birth weight were also lower in women cared for by midwives, than those cared for by GPs or obstetricians.
Midwifery care should be more widely available to low-income groups
This study provides evidence that midwife-led prenatal care is safe and also may lead to better pregnancy outcomes for women in low-income groups. The researchers suggest that this may be because midwives are able to spend more time giving health and self-care advice and this could be particularly helpful for more vulnerable women. Unfortunately, midwifery prenatal care is not available in all parts of Canada at present. The researchers suggest that public health policy should allow midwife-led prenatal care to be more widely available, in particular to women in low-income groups.
Written by Julie McShane, Medical Writer
- McRae DN, Janssen PA, Vedam S, et al. Reduced prevalence of small-for-gestational-age and preterm birth for women of low socioeconomic position:a population-based cohort study comparing antenatal midwifery and physician models of care. BMJ Open 2018;8:e022220. Doi:10.1136/bmjopen-2018-022220
- University of British Columbia. Midwifery linked to lower odds of birth complications for low-income women. 3rd Oct 2018 https://www.eurekalert.org/pub_releases/2018-10/uobc-mlt100218.php