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Background: The optimum model of perinatal care for low-risk pregnancies has been a topic of debate. Obstetrician-led care tends to perform unnecessary interventions, whereas the quality of midwife-led care has been subject to debate. This review aimed to assess whether midwife-led care reduces childbirth intervention and whether this comes at the expense of maternal and neonatal wellbeing. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for relevant studies. Studies were checked for eligibility by screening the titles, abstracts, and full texts. We performed meta-analyses using the inverse variance method using RevMan software version 5.3. We pooled data using the risk ratio and mean difference with the 95% confidence interval. Results: This review included 44 studies with 1,397,320 women enrolled. Midwife-led care carried a lower risk of unplanned cesarean and instrumental vaginal deliveries, augmentation of labor, epidural/spinal analgesia, episiotomy, and active management of labor third stage. Women who received midwife-led care had shorter hospital stays and lower risks of infection, manual removal of the placenta, blood transfusion, and intensive care unit (ICU) admission. Furthermore, neonates delivered under midwife-led care had lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission. Postpartum hemorrhage, perineal tears, APGAR score < 7, and other outcomes were comparable between the two models of management. Conclusions: Midwife-led care reduced childbirth interventions with favorable maternal and neonatal outcomes in most cases. We recommend assigning low-risk pregnancies to midwife-led perinatal care in health systems with infrastructure allowing for smooth transfer when complications arise. Further research is needed to reflect the situation in low-resource countries.
Sriram et al. (Tue,) studied this question.