Bad outcomes for new babies more likely with midwife, research shows

MORNING REPORT/Radio New Zealand

An Otago university study has found babies are more at risk during birth if a midwife rather than a doctor is in charge.

Bad outcomes for new babies are more likely when a mother's chosen maternity carer is a midwife, as opposed to a medical specialist, research shows. 

The University of Otago research project 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.

New Zealand favours midwives over doctors in childbirth, but new research suggests that's not safest for baby.
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New Zealand favours midwives over doctors in childbirth, but new research suggests that's not safest for baby.

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

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New Zealand College of Midwives chief executive Karen Guilliland said it was not a fair comparison. The study did not say why the babies were unwell.  

MORNING REPORT/Radio New Zealand

The College of Midwives responds to a new study showing babies are at significantly more risk if delivered by a midwife rather than a doctor. The chief executive of the College of Midwives, Karen Guilliland says

It did find babies with medical carers had 55 per cent lower odds of oxygen deprivation during the delivery and were 39 per cent less likely to develop a condition called neonatal encephalopathy – a condition that can result in brain injury.

Sally Foley believed the support of a medical specialist could have saved her son's life.

Baby Maika died from birth asphyxia at Christchurch Women's Hospital on January 26, 2005. 

Angela Pollard thinks midwives are great. She is surrounded by her children, clockwise from left Caleb, 15, Nathanael, ...
DAVID WALKER/FAIRFAX NZ

Angela Pollard thinks midwives are great. She is surrounded by her children, clockwise from left Caleb, 15, Nathanael, 11, Shontelle, 13, Leah-Grace, 6, Malachi, 4, and Rebekah, 8.

A hospital review found his birth was plagued by problems, such as delays in the arrival of specialist paediatric help.

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After a relatively straight forward but long birth Foley's labour stalled. Maika's shoulder had become stuck.

Foley knew something was wrong and called for help. Her midwife told her everything was normal.

She asked for an episiotomy but the midwife refused.

"I felt like it was because she didn't feel confident doing one. Like she wasn't sure what she doing.

"This was my third baby. I knew something was wrong. My husband knew something was wrong. But you feel like she is the expert so she must know what she is doing."

Maika was finally born, but was unresponsive. He never regained consciousness. 

"There was a specialist on the ward during my labour. She was available and wasn't busy," Foley said. 

"If she had been called she could have done certain things that could have saved his life. Things the midwife could never have done because she wasn't trained to do them.

"I feel in my heart that if she had been called he wouldn't have died. I really do believe that."

Mum-of-six Angela Pollard had a different experience. She had a midwife as her lead-maternity-carer for all of her six pregnancies and used the same woman for her last three.

"They are truly amazing. And they don't get the recognition they should," Pollard said. 

"I always felt so supported. She knew exactly what she was doing.

"I think sometimes medical professionals can cause unnecessary stress. They have their place but I would always recommend using a midwife."

Guilliland said there could be any number of reasons behind the data.

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."

The authors said they assessed the likelihood that distance to hospital could explain the results (or any other unmeasured confounding factor) but found this to be "exceptionally unlikely".

The researchers said New Zealand's rate of adverse outcomes was low and comparable to other developed countries but their findings suggested some avoidable adverse outcomes were occurring.

They called for further research to better understand why.

Ministry of Health principal advisor maternity Bronwen Pelvin said the findings of the study were unexpected, given international evidence showed that a midwifery-led maternity system leads to similar outcomes for women and their babies.

"The findings are being taken seriously, and require further investigation," she said.

Pelvin said the study was referred to the National Maternity Monitoring Group for advice on whether further research needs to be undertaken.

She said further research could "help us better understand whether the findings reflect something about the way the study was done, differences in the maternity care provided by midwives and doctors, and whether there are things we can change to get better outcomes for women and their babies".

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

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.

 - Stuff

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