Midwife-led births seen as safe and cheap

Midwife-led births seen as safe and cheap
By Julie Robotham Medical Editor
May 10, 2006

BIRTHS supervised only by midwives are safe and popular and can cut health system costs by up to half, according to the first formal audit of two NSW pilot programs for healthy women at low risk of complications.

The surveys raise the stakes in the escalating war between doctors and the state health system over midwives' increasing involvement in the management of births. Doctors have consistently opposed midwife-only birth centres, saying they put mothers and babies at risk.

Among the first 245 women booked at a midwife-only centre at Ryde Hospital, which does not have an on-site doctor, 84 per cent went spontaneously into labour and had a normal vaginal birth.

One-third of the women who joined the program in the 14 months to October were transferred to larger hospitals either during pregnancy or labour, when the midwives detected medical difficulties that meant they needed more complex care.

But of the 179 women who gave birth at Ryde, two-thirds did not have any pain-relieving drugs. All the babies were born healthy.

The service was also 20 to 50 per cent cheaper per delivery than standard public hospital care, according to the analysis by Northern Sydney Central Coast Health.

It suggests most of the savings were attributable to midwives' increased productivity.

Midwives employed in the program take responsibility for individual women and manage their own workload. In the Ryde program, one midwife is employed for every 33 women, versus an average of one to 23 under normal public hospital rostering.

A report into the first seven months of a similar unit at Belmont, near Newcastle, found nearly half the women had to be transferred to John Hunter Hospital, but many of these needed antibiotics, which the Belmont midwives will be able to administer in future. The women used less pain relief compared with the state average, and their babies were more likely to be breastfed.

Sally Tracy, who established the Ryde service and is now a senior research fellow in the University of NSW's School of Women's and Children's Health, said a high proportion of the mothers came from non-English speaking backgrounds and appreciated the relationship with an individual midwife during their pregnancy.

"This level of support for people who would otherwise be lost within the system has quite far-reaching community effects," Professor Tracy said.

But Andrew Pesce, an obstetrician and a federal councillor of the Australian Medical Association, said the number of births so far at the units was too small to reveal any shortcomings. "We have one full-term unexpected foetal death in 2000 deliveries," Dr Pesce said. "If they can keep this up for 10 years then that's good. It's too early to make any comment about the relative safety [of midwife-only units and standard maternity hospitals].

"Intuitively I'm worried about that I don't see the rationale when there are tertiary referral centres [nearby] that can do everything."

The NSW Minister for Health, John Hatzistergos, said the reports represented, "an encouraging start," to the wider availability of midwife-led births.

"The two models are still relatively small there'll be ongoing evaluation, but we're pleased with the outcomes."