Perinatal morbidity and mortality with midwives vs obstetricians

January 01, 0001

Perinatal morbidity and mortality with midwives vs obstetricians

With current pressures in healthcare systems, in many places there has been an increasing use of nurse midwives for low risk deliveries. These Dutch researchers endeavored to compare incidences of perinatal mortality and severe morbidity between low risk term pregnancies supervised in primary care by a midwife and high risk pregnancies supervised in secondary care by an obstetrician. They performed a prospective cohort study using aggregated data from a national perinatal register.

The researchers found: "During the study period 37,735 normally formed infants were delivered at 37 weeks’ gestation or later. Sixty antepartum stillbirths (1.59 per 1000 babies delivered), 22 intrapartum stillbirths (0.58 per 1000 babies delivered), and 210 NICU admissions (5.58 per 1000 live births) occurred, of which 17 neonates died (0.45 per 1000 live births). The overall perinatal death rate was 2.62 per 1000 babies delivered and was significantly higher for nulliparous women compared with multiparous women (relative risk 1.65). Infants of pregnant women at low risk whose labour started in primary care under the supervision of a midwife had a significant higher risk of delivery related perinatal death than did infants of pregnant women at high risk whose labour started in secondary care under the supervision of an obstetrician (relative risk 2.33). NICU admission rates did not differ between pregnancies supervised by a midwife and those supervised by an obstetrician. Infants of women who were referred by a midwife to an obstetrician during labour had a 3.66 times higher risk of delivery related perinatal death than did infants of women who started labour supervised by an obstetrician (relative risk 3.66) and a 2.5-fold higher risk of NICU admission (2.51)."

The researchers concluded: "Infants of pregnant women at low risk whose labour started in primary care under the supervision of a midwife in the Netherlands had a higher risk of delivery related perinatal death and the same risk of admission to the NICU compared with infants of pregnant women at high risk whose labour started in secondary care under the supervision of an obstetrician. An important limitation of the study is that aggregated data of a large birth registry database were used and adjustment for confounders and clustering was not possible. However, the findings are unexpected and the obstetric care system of the Netherlands needs further evaluation."

This study, although having significant limitations, raises concerns of the use of midwives in overseeing low risk pregnancies.

For the full abstract, click here.

BMJ 341:c5639, 2 November 2010 © 2010 Evers et al.
Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. Annemieke C C Evers, Hens A A Brouwers, Chantal W P M Hukkelhoven, et al. Correspondence to A C C Evers: [email protected]

Category: W. Pregnancy, Family Planning. Keywords: pregnancy, perinatal mortality, perinatal morbidity, midwives, obstetricians, prospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 23 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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