Births led by midwives rather than doctors linked to greater risks – NZ study

The health outcomes for babies born in New Zealand where primary care is led by midwives are significantly worse when compared with care led by doctors, a major new study has found.

New Zealand and the Netherlands are the only two western countries to operate under a midwife-led birthing system. Midwives are the dominant care-giver for four out of five births in New Zealand – from pregnancy through to delivery and post-natal care.

However a new study released today by The University of Otago has found health outcomes for babies cared for by a midwife rather than a GP or obstetrician are significantly worse. The ministry of health said in a statement the results of the study were “unexpected” and required further investigation.

The study examined 244,000 births in New Zealand between the years 2008 to 2012, and found an “unexplained excess of adverse events in midwife-led deliveries in New Zealand where midwives practice autonomously”.

The study found that mothers who had medical-led care had a 55% less chance of the baby suffering oxygen deprivation during the delivery, a 39% less chance of neonatal encephalopath (a condition that can result in brain injury) and a 48% lower chance of having a low Apgar score, which is a measure of infant wellbeing immediately post-delivery, with a low score being indicative of an unwell baby.

Lead researcher Ellie Wernham – a former midwife who is studying to be a doctor – said further study into the reasons for the discrepancies needed to be conducted immediately, and a detailed review should be led by the ministry of health.

“Contributing factors could include high-risk mothers receiving midwife care inappropriately, staffing issues, collaboration issues, the level of training midwives receive and delays in mothers being referred to a medical professional,” she said.

Sweeping health reforms in the early 1990s transitioned New Zealand mothers from medical-led births to midwife-led births. Wernham said the changes were designed to empower women and give them greater autonomy and be subject to less frequent medical intervention, but the “significant changes” had yet to be analytically studied, and a review was overdue.

However, Karen Guilliland, chief executive of The New Zealand College of Midwives, criticised the study, saying it lacked “high evidence” and did not take into account the added challenges midwives often faced with their patients.

“Essentially the study has compared midwife care with obstetrician care. And studies have found midwives are more likely to look after poorer, sicker patients, who may register later, smoke or are Maori or Pacific. If you can afford to have an obstetrician you are not in that demographic.” said Guilliland.

“Most of our maternity hospitals are understaffed and often struggle to provide immediate response when midwives request medical input. This means that often women in labour have to wait to see a specialist causing unacceptable delays for them and their babies. None of our main maternity hospitals have an obstetric consultant on site after hours or weekends which are when the majority of births occur.”

The ministry of health said in a statement that adverse outcomes for births in New Zealand are low, and comparable to countries like Australia and Britain. The statement said the ministry had referred the study to the national maternity monitoring group for advice.

It also said the study did not explore the reasons why higher adverse outcomes were recorder for midwife-led births, but contributing factors could include that women under the care of midwives were more likely to be “younger, overweight, non-European, to have higher deprivation and to smoke”.

Births led by midwives rather than doctors linked to greater risks – NZ study