Midwife-led maternity care leads to increase in natural births

A pioneering midwife-led approach to maternity care in Southampton has led to a significant increase in natural births.

Since 2010, pregnant women at the city’s Princess Anne Hospital who have previously undergone caesarean sections are seen by midwives and not, as is standard practice in most units, obstetricians.

In a study published in the journal Birth, research led by Dr Helen White, a midwifery lecturer at the University of Manchester, reviewed the care and outcomes of 405 women who gave birth after previously having a caesarean.

Two hundred and nine gave birth in 2008 when antenatal care was still led by obstetricians and 196 in 2011 after the hospital had moved to midwife-led care.

The number of women who intended to give birth naturally – known as vaginal birth after caesarean (VBAC) – was 90% in the midwife-led group compared to 77% under obstetricians, with 61% of patients in the midwifery group achieving VBAC compared to 47% of obstetrician-led cases.

Caesarean sections account for around 26% of births in the UK and 23.5% in Southampton.

Although the surgery can be life-saving in emergencies, there is concern about the rising number of planned caesareans, with research increasingly linking the procedure to immune deficiencies, asthma, obesity and diabetes.

“Where it can be achieved safely, vaginal birth is preferable, but there’s a real issue with women who have had a caesarean once opting for the same again,” explained Dr White, who carried out the research while a consultant midwife trainee at the Princess Anne Hospital as part of her doctorate with the University of Southampton.

“There aren’t many initiatives out there to break this cycle, so this finding is important for providing evidence that midwives are best-placed to promote vaginal birth.

“There were few differences between the two groups of women we studied, so the main variance was the professional responsible for their care.”

She added: “The more we understand the role of the microbes living in the vagina, the more we are uncovering the protective effects of labour and natural birth against conditions such as diabetes and obesity.

“We are not proposing that women should reject caesarean birth when they are advised to do so, but suggest that midwives are important figures in promoting VBAC in suitable women.”

Dr Jane Rogers, a consultant midwife at the Princess Anne Hospital, said: “Southampton midwives have broken new ground because, elsewhere in the UK, women who have previously had a caesarean are usually asked to see an obstetrician in their pregnancy.

“Here they see their local midwife, who is well-informed about their needs as individuals and can support decision-making over a period of time.

“We are very proud of how well our midwives and the mothers have approached this and of our outstanding success in terms of numbers of women achieving a successful vaginal birth.”

Posted on Tuesday 17 May 2016