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Academic urges caution after release of midwifery study - News - Nurses Arena Forum

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Academic urges caution after release of midwifery study by Idowu Olabode : October 02, 2016, 02:36:21 PM
A professor has urged caution regarding a research paper suggesting poor outcomes were more likely for babies born using a midwife.

A University of Otago research project, released on Wednesday, examined major adverse perinatal outcomes of 240,000 babies born between 2008 and 2012.

It found that babies were less likely to encounter problems during and after giving birth when their mother's carer was a specialist obstetrician or general practitioner.

The study found "an unexplained excess of adverse events" in midwife-led births compared to medically-led deliveries, where midwives were practising autonomously.

But Professor Lesley McCowan, head of Auckland University's obstetrics and gynaecology department, said on Sunday that it could not be concluded from the research that the increased adverse outcomes were because of the model of care.

The rates of many pregnancy risk factors including obesity and smoking were higher among the woman who booked with self-employed midwives as well.

"The authors have done their best to control the differences between the two groups using statistical methods, but it is inevitable that differences will remain between such disparate groups," McCowan said.

Findings in the paper had come as a surprise to New Zealand practitioners and were also different from the findings of trials in other countries, she said.

"They are also out of keeping with recent New Zealand perinatal mortality data which shows an encouraging reduction in stillbirths after 28 weeks and in particular a reduction in deaths of babies who died in labour.

"Reduction in baby deaths in labour in New Zealand is at least in part attributable to high quality midwifery care."

While the paper raised important points, further research and clarification was needed as was information including the mode of birth and admission of babies to neonatal units, she said.

After the report's release New Zealand College of Midwives chief executive Karen Guilliland said the comparison between the two modes of care was not a fair comparison as it did not explain why the babies were unwell.

Midwives were more likely to look after young women, rural women and sick women. Those factors alone could result in adverse outcomes during childbirth, she said.

"If we are being compared to an obstetrician than we know that none of those obstetrician clients would be rural, they won't be [living] three hours away from a hospital."

Study author Ellie Wernham said, as a former midwife, she was able to identify aspects of the maternity system where improvements were needed.

Her aim was to provide "better outcomes for babies".

Wernham said the findings needed to be interpreted in the context of New Zealand's good overall birth outcomes.

New Zealand adopted a midwife-led model of maternity care in 1990.

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