Baby health concern
Newborns fared worse under care of midwives than doctors, says study
Babies born under the care of midwives have suffered higher rates of health damage than those whose mothers were looked after by doctors, according to new research.
The College of Midwives has attacked the findings, saying they simply show a rich-poor divide, but the researchers say this does not explain the different outcomes.
The University of Otago study of more than 244,000 babies born in New Zealand from 2008 to 2012 found mothers with medical-led care, such as by obstetricians or GPs, had babies with lower odds of some adverse health outcomes at birth.
These included 55 per cent lower odds of oxygen deprivation during delivery, 39 per cent lower odds of neonatal encephalopathy which can cause brain injury, and 48 per cent lower odds of poor health.
The report said it was not pos- sible to definitively determine whether one model of care was associated with fewer infant deaths during birth.
Co-authored by a former midwife, the research is the first major safety review of New Zealand’s autonomous midwife-led maternity system adopted in 1990.
Published in PLOS Medicine this week, it found that adverse health outcomes were substantially lower for babies born to mothers registered with medical-led maternity carers than those who had midwives as their LMC.
“These findings demonstrate a need for further research that investigates the reasons for the apparent excess of adverse outcomes in midwife-led care,” coauthor Professor Diana Sarfati said.
Co-author Ellie Wernham said as a former midwife she saw firsthand the benefits of a midwife-led model but the research showed aspects of New Zealand’s maternity system could be improved.
Action to Improve Maternity founder Jenn Hooper, whose 11-year-old daughter Charley was left severely brain damaged following a botched birth by midwives, welcomed the research and called for urgent investigation into the findings.
Hooper said the 700-plus families whose babies were damaged at birth that AIM has helped since it began eight years ago had “paid the price” for the midwife-led model.
Newly graduated midwives do not require nursing training and can be self-employed in the community.
Previous health minister Tony Ryall sought advice on hospital internships but current minister Dr Jonathan Coleman said last year he would not look again at mandatory training.
New Zealand College of Midwives chief executive Karen Guilliland said women under the care of midwives were more likely to be rural and remote, Maori, Pasifika, younger, smoke, obese, sicker and book late with an LMC.
“These are all well-known risk factors that cause the adverse
outcomes described. What we are likely to be comparing is the difference between women who live in big cities (mainly Auckland) and who can pay thousands of dollars and afford to have a private obstetrician.”
Guilliland said in Auckland’s DHB about 25 per cent of LMCs were obstetricians, something, she called “unusual” as 93 per cent of LMCs in the whole country were midwives.
The Ministry of Health’s Child and Youth Health chief adviser, Dr Pat Tuohy, said the “unexpected” differences could be the result of the way the study was done.
“We know the study looked at the LMC at the time of registration for maternity care, but it didn’t look at who else was involved in providing care, particularly at the birth.”
In response to Guilliland, Sarfati said she and Wernham had accounted for those differences in their research.
“In all cases those differences combined didn’t account for the difference in outcomes. “It didn’t even come close.” She said there were also problems in concentrating on the person who delivered the baby, as suggested by Tuohy.
“For example if a problem occurs and it’s missed and it’s missed and it’s missed, and then someone delivers the baby who is in a bad way, it wouldn’t be fair to say that was the fault of the person who delivered the baby.”