Turn to midwives to reduce rising rate of C-sections

Midwife-led care through pregnancy and childbirth could be key to reducing an increasing number of avoidable caesarean births.

A first-of-its-kind systematic review, Organisational interventions to reduce non-medically indicated caesarean section rates: A systematic review and meta-analyses, evaluated international research on a range of organisational interventions to reduce caesarean sections.

It found that a midwifery-led model – where a midwife provides continuity of care through pregnancy and childbirth – had the most positive effect on reducing the number of planned caesareans and C-section rates overall.

Women allocated to midwife-led models of care, which were implemented across pregnancy, labour and birth, and the postnatal period, were, on average, significantly less likely to experience planned caesarean sections and caesarean sections overall, when compared to women who received routine care.

Women allocated to midwife-led models of care were also significantly less likely to experience an episiotomy, when compared to women receiving usual care.

Lead researcher Alfred Deakin Professor Alison Hutchinson, Director of the Institute’s Centre for Quality and Patient Safety Research, said caesarean rates in Australia had grown from 31% in 2006 to 34% in 2016 and this was worrying, as caesarean sections without medical reasons put women and babies at a greater risk of harm.

Despite emerging evidence of the benefits, and the cheaper cost of birthing when compared to caesarean section, a midwife-led model is not the norm in Australia. At current estimates, less than a quarter of women have access to midwife-led care models and intervention rates in Australia are higher among women with private health insurance.

Professor Hutchinson said her team’s research showed that a midwife-led model was a good way of helping to avoid interventions that may not be needed and that this should be used as a strategy to reduce caesarean sections. The researchers recommended that maternity service leaders consider the implementation of midwife-led models of care from pregnancy to after the baby is born, particularly for women classified as low-risk.

This work was undertaken by Alfred Deakin Professor Alison Hutchinson, Dr Anna Chapman, Professor Cate Nagle, Professor Debra Bick, Dr Rebecca Lindberg, Professor Bridie Kent and Justin Calache with partners Monash Health, QPS, The Institute for Health Transformation, Deakin University, James Cook University, University of Warwick and University of Plymouth.