A new Canadian study shows that midwives are a safe and effective option for prenatal care, especially for women of low socioeconomic status.

Midwives, general practitioners (GPs) and obstetricians (OBs) are all qualified to provide safe prenatal care for women during their pregnancy, labor and birth, but each offers a different style of care that matches different women’s preferences and needs.

Midwives, in particular, are experts in the care of women and tend to spend more time with their patients. Their focus is on the overall physical, emotional and psychological well-being of mothers and their newborns.

For the study, researchers from the University of British Columbia (UBC) and the University of Saskatchewan found that low-income pregnant women who received care from a midwife were less likely to go into early labor, to have a low birth weight baby, or to have a small-for-gestational age birth, compared to women who saw a physician.

A small-for-gestational age birth refers to an infant that is smaller or less developed than normal for the number of weeks in pregnancy.

“Our findings show that women who are more vulnerable benefit from the care of a midwife, likely because they receive more time, counseling and education on how to care for themselves,” said the study’s lead author Dr. Daphne McRae, a postdoctoral research fellow at the UBC school of population and public health who conducted the study while she was a Ph.D. student at the University of Saskatchewan.

For the study, the researchers followed 57,872 women in British Columbia who were pregnant with a single baby, had low-to-moderate risk pregnancies and who were receiving medical insurance premium assistance sometime between 2005 and 2012.

The researchers looked at maternity, medical billing and demographic data to examine the odds of small-for-gestational age birth, preterm birth and low birth weight for low-income women receiving care from a midwife, GP or OB.

After controlling for differences such as age, previous pregnancies, place of residence and pre-existing medical conditions, the researchers found that low-income women who were receiving prenatal care from a midwife had 29 percent lower chance of a small-for-gestational age birth compared to women who received care from a GP.

In addition, compared to those receiving care from an OB, low-income women under the care of a midwife had a 41 percent reduced chance for small-for-gestational age birth.

McRae said the findings add new evidence in support of midwifery care and can assist in the development of policies to ensure that midwives are available and accessible, especially for low-income women. Midwifery is not available in all parts of the country.

“Wait-lists for midwives can be quite long, so women who are educated and health-conscious typically access midwives early on in their pregnancies,” said McRae. “But more vulnerable women might not be as aware of the services available to them, so expanding midwifery to make it available for all women is important.”

“Our research could help develop policies that make the service more accessible to low-income women,” added senior author Dr. Nazeem Muhajarine, a professor in community health and epidemiology at the University of Saskatchewan and McRae’s supervisor for her research.

The findings are published in the British Medical Journal Open.

Source: University of British Columbia