patients have fewer tears (notes more use of
alternate position in the midwife group):
Klin Wochenschr. 2004 Jun 30;116(11-12):379-84.
Related Articles, Links
Wien Klin Wochenschr. 2004 Jun 30;116(11-12):347-9.
of the birth attendant on maternal and neonatal outcomes during
normal vaginal delivery: a comparison between midwife and physician
B, Bodner K, Kimberger O, Lozanov P, Husslein P, Mayerhofer
of Obstetrics & Gynecology, University of
Vienna Medical School, Vienna, Austria.
The purpose of this study was to compare the obstetric outcome
of low-risk maternity patients attended by certified midwives
with that of low-risk maternity patients attended by obstetricians.
PATIENTS AND METHODS: Obstetric outcome of 1352 midwife
patients was compared with that of 1352 age- and parity-matched
physician patients with normal spontaneous vaginal delivery
at the Department of Obstetrics and Gynecology of the University
Hospital Vienna during the period from January 1997 to July
2002. Our analysis was restricted to a sample of low-risk pregnant
women. Women with medical or obstetric risk factors were excluded.
RESULTS: A significant decrease in the use of oxytocin
(p=0.0001) was observed in women who selected a midwife as their
primary birth attendant compared with women in the physician
group. In both groups most women gave birth in a supine position;
however, significantly more alternative birth positions were
used by midwife patients (p = 0.0001). Concerning perineal trauma,
a significantly lower rate of episiotomies (p = 0.0001) and
perineal tears of all degrees (p=0.006) were found in midwife
patients. When analyzing severe postpartum hemorrhage and postpartum
infections, there were no significant differences between the
two groups (p > 0.05). Concerning neonatal outcome, there
were no significant differences in APGAR score < 7 at 5 minutes
(p > 0.05). Our data clearly show the ability of certified
midwives to successfully provide prenatal care and delivery
to low-risk maternity patients, with neonatal outcomes comparable
to those of physician patients. The use of certified midwives
supervised by obstetricians may provide the optimum model for
perinatal care, particularly for those women who are low-risk
maternity patients, leaving physicians free to attend to the
high-risk elements of care.