Sexual & Reproductive Healthcare 7 (2016) 1
Contents lists available at ScienceDirect
Sexual & Reproductive Healthcare j o u r n a l h o m e p a g e : w w w. s r h c j o u r n a l . o r g
Editorial
Midwife-led care before, during and after childbirth – the best option for most women and babies
In this issue of SRHC you can find the results from a Swedish study about women’s interest in continuity of care and in alternative care-models than the current hospital-based childbirth care offered in Sweden [1]. The authors conclude: “continuity with the same midwife throughout all episodes of care is important to pregnant women and models of care offering such continuity should be developed, since they promote normal birth and increase satisfaction”. There is global consensus that all care should be based on the best available evidence, and a Cochrane review from 2015 including 15 scientific studies with more than 17,000 women clearly advocates that healthy women should have access to midwife-led continuity models of care since they are associated with less medicalized births and higher satisfaction [2]. Another Cochrane review including ten randomized trials with more than 11,000 women showed that birth centre care was associated with more normal births, longer breast feeding and higher care satisfaction [3]. Women who gave birth in a birth centre used less pain relief and needed fewer interventions such as augmentation of labour, episiotomies and instrumental deliveries. No differences in medical outcomes for mother or child were found. The latest NICE (National Institute for Health and Care Excellence) guidelines in the UK recommend healthy women with a previous normal birth to opt for a homebirth or a birth in a midwifeled unit since it is medically safe and cost-effective [4]. For a woman’s first birth midwifery care in a hospital-based birth centre offering continuity of care is preferable, since a home birth may slightly increase the risk of an adverse outcome for the baby. How can then continuity of midwifery care be organized? There are several aspects of continuity. One is, of course, contact with the same carer throughout the entire process of pregnancy and birth. Given the fact that births are unpredictable and cannot be scheduled in the same way as antenatal consultations, such continuity requires a midwife on call day and night. Home birth midwives often work under these circumstances. But there are other ways of offering
http://dx.doi.org/10.1016/j.srhc.2016.01.002 1877-5756/© 2016 Elsevier B.V. All rights reserved.
continuity of care such as team midwifery or caseload midwifery. Team midwifery means that a group of midwives together care for a number of pregnant women. In caseload midwifery one midwife is responsible for a smaller number of women and commonly has one or two colleagues to cover for her during free time or in case she is already occupied with another birth. Continuity could also be enhanced by geographical continuity, meaning that women are cared for in their home or visit the same clinic/centre during pregnancy, birth and postpartum. SRHC is currently preparing a Special Issue focusing on Challenges to women’s sexual and reproductive health and we invite researchers from all over the world to submit papers. We believe that one important challenge is the organization of care in relation to pregnancy and birth, and the current increase in the proportion of caesarean sections in many countries calls for more investigations into alternative models of childbirth care. We therefore welcome submissions related to this topic. References [1] Hildingsson I, Haines H, Karlström A, Johansson M. Parents prefer continuity of midwifery care – time to change the Swedish system? A prospective longitudinal cohort study. Sex Reprod Healthc 2016;(in the current issue). [2] Sandall J, Soltani H, Gates S, Shennean A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2015;(9):CD004667. doi:10.1002/14651858-CD004667.pub4. [3] Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev 2012;(8):CD000012. doi:10.1002/ 14651858.CD000012.pub4. [4] National Institute for Health and Care Excellence (NICE). Intrapartum care: care of healthy women and their babies during childbirth. CG 190, December 2014.
Margareta Larsson * Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden * Tel.: + 46 7062 79076; fax: + 46 1850 8013. E-mail address: [email protected]
Contents lists available at ScienceDirect
Sexual & Reproductive Healthcare j o u r n a l h o m e p a g e : w w w. s r h c j o u r n a l . o r g
Editorial
Midwife-led care before, during and after childbirth – the best option for most women and babies
In this issue of SRHC you can find the results from a Swedish study about women’s interest in continuity of care and in alternative care-models than the current hospital-based childbirth care offered in Sweden [1]. The authors conclude: “continuity with the same midwife throughout all episodes of care is important to pregnant women and models of care offering such continuity should be developed, since they promote normal birth and increase satisfaction”. There is global consensus that all care should be based on the best available evidence, and a Cochrane review from 2015 including 15 scientific studies with more than 17,000 women clearly advocates that healthy women should have access to midwife-led continuity models of care since they are associated with less medicalized births and higher satisfaction [2]. Another Cochrane review including ten randomized trials with more than 11,000 women showed that birth centre care was associated with more normal births, longer breast feeding and higher care satisfaction [3]. Women who gave birth in a birth centre used less pain relief and needed fewer interventions such as augmentation of labour, episiotomies and instrumental deliveries. No differences in medical outcomes for mother or child were found. The latest NICE (National Institute for Health and Care Excellence) guidelines in the UK recommend healthy women with a previous normal birth to opt for a homebirth or a birth in a midwifeled unit since it is medically safe and cost-effective [4]. For a woman’s first birth midwifery care in a hospital-based birth centre offering continuity of care is preferable, since a home birth may slightly increase the risk of an adverse outcome for the baby. How can then continuity of midwifery care be organized? There are several aspects of continuity. One is, of course, contact with the same carer throughout the entire process of pregnancy and birth. Given the fact that births are unpredictable and cannot be scheduled in the same way as antenatal consultations, such continuity requires a midwife on call day and night. Home birth midwives often work under these circumstances. But there are other ways of offering
http://dx.doi.org/10.1016/j.srhc.2016.01.002 1877-5756/© 2016 Elsevier B.V. All rights reserved.
continuity of care such as team midwifery or caseload midwifery. Team midwifery means that a group of midwives together care for a number of pregnant women. In caseload midwifery one midwife is responsible for a smaller number of women and commonly has one or two colleagues to cover for her during free time or in case she is already occupied with another birth. Continuity could also be enhanced by geographical continuity, meaning that women are cared for in their home or visit the same clinic/centre during pregnancy, birth and postpartum. SRHC is currently preparing a Special Issue focusing on Challenges to women’s sexual and reproductive health and we invite researchers from all over the world to submit papers. We believe that one important challenge is the organization of care in relation to pregnancy and birth, and the current increase in the proportion of caesarean sections in many countries calls for more investigations into alternative models of childbirth care. We therefore welcome submissions related to this topic. References [1] Hildingsson I, Haines H, Karlström A, Johansson M. Parents prefer continuity of midwifery care – time to change the Swedish system? A prospective longitudinal cohort study. Sex Reprod Healthc 2016;(in the current issue). [2] Sandall J, Soltani H, Gates S, Shennean A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2015;(9):CD004667. doi:10.1002/14651858-CD004667.pub4. [3] Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev 2012;(8):CD000012. doi:10.1002/ 14651858.CD000012.pub4. [4] National Institute for Health and Care Excellence (NICE). Intrapartum care: care of healthy women and their babies during childbirth. CG 190, December 2014.
Margareta Larsson * Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden * Tel.: + 46 7062 79076; fax: + 46 1850 8013. E-mail address: [email protected]
