Dot writes: I was interested to note, on the website of my own university, a press release about a recent study investigating the comparative safety of two different models of maternity care. The finding is that midwife-led care is as safe as obstetrician-led care for low-risk women. The press release says that the study compared a “new” model of maternity care (which, it must be said, didn’t seem terribly new to me, just not the standard for Irish hospitals), in which women gave birth in midwife-led units within hospitals, to the traditional obstetrician-led model. The two study populations had equal numbers of babies needing resuscitation at birth, but the midwife-led unit showed lower rates of intervention, specifically the use of oxytocin drips, epidurals and breaking the waters. The women in the midwife-led unit had rooms with coffee and tea available, a birthing pool, and a pull-out bed for their partner, but this model still worked out on average to be cheaper.
I have a few reactions to this. First, it’s great that this study is endorsing the midwife-led units, because they are obviously an excellent facility and the Irish tend to be very conservative about wanting some authoritative, expensive man involved in the birth of their babies. But, second, the MLUs don’t represent such a vast departure from the existing standard model. The birth still takes place in a hospital, and in practice in the obstetrician-led model the obstetrician often isn’t there for much of it: it’s still midwives who give most of the care. There are midwife teams in Ireland offering a homebirth service, and it would be nice to see some level-headed evaluation of that service (which I know from experience to be excellent). Third, although the births in the MLU work out cheaper when the maths is done, I can’t see anyone providing the money up-front to fit out all those lovely rooms with birthing pools in other maternity hospitals across the country. Cuts and cancellations are the order of the day; no-one in government at the moment is prepared to invest to make anything at all better. Especially not something that is being presented as ‘just as safe as’ (not safer than) the prevalent practice, and as having its chief benefit in being what women would prefer. Sigh.