Intrapartum Care and Experiences of Women with Midwives Versus Obstetricians in the Listening to Mothers in California Survey.
Eugene R Declercq, Candice Belanoff, Carol Sakala
PMID 31448884WHAT IT FOUND
Women who gave birth in hospital with a midwife rather than an obstetrician self-reported fewer selected medical interventions, more comfort measures, less pressure for procedures, and more encouragement to decide.
Key findings
01After adjustment, midwife-attended vaginal births were linked to lower risk of labor induction, augmentation, pharmacologic pain relief, intravenous fluids, and epidural analgesia.
02Midwife-attended births were linked to greater use of nonpharmacologic comfort measures, narcotics, nitrous oxide, and patient-reported staff support for decisions.
03Midwife-attended births were linked to less reported pressure to accept induction or epidural analgesia.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational and self-reported, so it shows association between birth attendant and reported experience, not that midwifery care caused the differences. Women chose their provider, and those who chose midwives may have preferred less intervention; adjustment for one attitude item may not fully remove this bias. The analysis included only hospital vaginal births, so it does not describe cesarean births, home births, or freestanding birth-center births. Data were from California only, and the sample included more Hispanic or Latina respondents than the US birthing population. The survey did not know whether the birth attendant changed during labor, so it could not separate early labor care from care at birth. Women reported experiences 2 to 11 months after birth, so recall may be imperfect.
Declared interests
The authors declared no conflicts of interest. The study was funded by the California Health Care Foundation.
The easy way to misread this
Do not conclude that midwifery care causes fewer interventions or better birth experiences. This is a self-report survey of women's experiences, not a trial assigning providers, and it cannot separate the contribution of the birth attendant from hospital staff or other providers.