Antheunis ML, Tates K, Nieboer TE Patients’ and health professionals’ use of social media in health care: Motives, barriers and expectations. Patient Educ Couns. 2013; 92:(3)426-31

Bero L, Rennie D The Cochrane CollaborationPreparing, Maintaining, and Disseminating Systematic Reviews of the Effects of Health Care. JAMA. 1995; 274:(24)1935-8

Changing Childbirth.London: HSMO; 1993

Gao L, Larsson M, Luo S Internet use by Chinese women seeking pregnancy-related information. Midwifery. 2013; 29:(7)730-5

Hatem M, Sandall J, Devane D, Soltani H, Gates S Midwife-led versus other models of care for childbearing women. Cochrane Database Syst Rev. 2008; 4

Health and Social Care Information Centre. Hospital Episode Statistics. 2013. (accessed 5 December 2014)

Houghton G, Bedwell C, Forsey M, Baker L, Lavender T Factors influencing choice in birth place - an exploration of the views of women, their partners and professionals. Evidence Based Midwifery. 2008; 6:(2)59-64

Howard DL, Wall J, Strickland JL Physician Attitudes Toward Over the Counter Availability for Oral Contraceptives. Matern Child Health J. 2013; 17:(10)1737-43

Lagan BM, Sinclair M, Kernohan WG A web-based survey of midwives’ perceptions of women using the Internet in pregnancy: a global phenomenon. Midwifery. 2011; 27:(2)273-281

Larsson M A descriptive study of the use of the Internet by women seeking pregnancy-related information. Midwifery. 2009; 25:(1)14-20

Lavender T, Chapple J How women choose where to give birth. Pract Midwife. 2005; 8:(7)10-5

Intrapartum care - care of healthy women and their babies during childbirth. CG55.London: RCOG Press; 2007

Intrapartum care - care of healthy women and their babies during childbirth. CG190.London: NICE; 2014

Office for National Statistics. 2011. (accessed 5 December 2014)

Office for National Statistics. 2013a. (accessed 5 December 2014)

Office for National Statistics. 2013b. (aaccessed 5 December 2014)

Pitchforth E, van Teijlingen E, Watson V ‘‘Choice’’ and place of delivery: a qualitative study of women in remote and rural Scotland. Qual Saf Health Care. 2009; 18:42-48

Sandall J, Hatem M, Devane D, Soltani H, Gate S Discussions of findings from a Cochrane review of midwife-led versus other models of care for childbearing women: continuity, normality and safety. Midwifery. 2009; 25:(1)8-13

Sandall J, Devane D, Soltani H, Haten M, Gate S Improving quality and safety in maternity care: the contribution of midwife-led care. J Midwifery Womens Health. 2010; 55:(3)255-61

Sandall J, Soltani H, Gates S, Shennan A, Devane D Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2013; 8

Schroeder E, Petrou S, Patel N Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study. BMJ. 2012; 344

Simkin P Just another day in a woman's life? Part II: Nature and consistency of women's long-term memories of their first birth experience. Birth. 1992; 19:(2)64-81

Soltani H, Sandall J Organisation of maternity care and choices of mode of birth: a worldwide view. Midwifery. 2012; 28:(2)146-9

Soltani H, Dickinson FM Exploring women's views on information provided during pregnancy. Br J Midwifery. 2005; 13:(10)633-636

Tomeo CA, Rich-Edwards JW, Michels KB Reproducibility and validity of maternal recall of pregnancy-related events. Epidemiology. 1999; 10:(6)774-7

Zadoroznyj M Midwife-led maternity services and consumer ‘choice’ in an Australian metropolitan region. Midwifery. 2000; 16:(3)177-85

Exploring health professionals’ and women's awareness of models of maternity care evidence

02 January 2015
Volume 23 · Issue 1


A Cochrane systematic review has shown midwifery-led continuity models of care provide explicit benefits for mothers and babies compared with other models of maternity care, with a comparable level of safety. This study explored the local impact of the review, alongside other midwifery-led care evidence and guidelines. Electronic surveys were undertaken exploring women's and health professionals’ awareness of models of maternity care evidence, including midwifery-led care and homebirth, and how they use evidence to guide their choices and practice.

A low awareness of much of the available evidence was shown among the women and the professionals. There is a need for better dissemination of information to professionals as they are women's preferred source of information about the options available for place of birth and midwifery-led care.

The organisation of maternity care is paramount in providing safe, cost effective and normalised care for women (Sandall et al, 2010). Maternity care can be delivered using different models. These include midwife-led care—where a midwife is the lead professional but one or two consultations with an obstetrician or a physician is part of routine care; medical-led care—where an obstetrician or physician are the primary care providers; or shared care—where responsibility is shared among different health professionals.

Evidence for the safety and effectiveness of midwifery-led care has been available in various formats including primary research, reviews and guidelines (National Institute for Health and Care Excellence (NICE), 2007; Hatem et al, 2008; Sandall et al, 2010; Sandall et al, 2013). In their Cochrane review, Sandall et al (2013) demonstrated explicit benefits for mothers and babies receiving midwifery-led care compared with other models of maternity care, with a comparable level of safety. The review included 13 trials, involving 16 242 women, from the UK, Australia, Canada, Ireland and New Zealand. Women receiving midwifery-led continuity models of care were less likely to experience regional analgesia, episiotomy and instrumental birth, and more likely to have a spontaneous vaginal birth, a known midwife attending the birth, no intrapartum analgesia and a longer mean length of labour. There were no differences between groups for caesarean births. Women who were randomised to midwifery-led continuity models of care were also less likely to experience preterm birth and fetal loss before 24 weeks’ gestation, although no differences in fetal loss and/or neonatal death after 24 weeks or overall were found. The majority of studies within the review also reported a higher rate of maternal satisfaction in the midwifery-led continuity care model. It is speculated that the main contributing factors to the observed differences lie in the philosophy of care behind each model (Soltani and Sandall, 2012). Midwifery-led care is based on the belief of normality in childbirth, continuity, advocating autonomy and building relationships with mothers, whereas in the medical model there may be an over-reliance on technology and preference for medical interventions. The Cochrane review (Sandall et al, 2013) concluded that the majority of women should be offered midwifery-led models of care, although caution should be applied with women with substantial medical or obstetric complications.

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