Comparison of maternal and neonatal outcomes of midwifery-led care with routine midwifery care: a retrospective cohort study.

Abstract

Introduction: Globally, the management of low-risk pregnancies by midwives often leads to a more natural childbirth process, which enhances physical and psychological outcomes for mothers and their babies. Midwives implement various models of maternal care in practice. This study investigates and compares maternal and neonatal outcomes associated with midwifery-led care versus routine midwifery care in private hospitals in Iran.

Methods: This retrospective cohort study was conducted in Iran in 2022. The study population consisted of two groups including 387 women in the Routine Care Group (RCG) and 397 women in the Private Care Group (PCG). Participants were selected through continuous sampling in accordance with the inclusion criteria. The two groups were compared in terms of some maternal and neonatal outcomes. The research data collection tool was a researcher-made checklist with variables adjusted according to the 'Iman' system of the Iran Ministry of Health. Based on this tool, the data were extracted from the mentioned system and analyzed with SPSS software.

Findings: The results indicated no significant difference between the two groups in terms of the type of delivery (p = 0.999), the use of forceps or vacuum (P = 0.5) and transferring the mother to the operating room (OR) or the intensive care unit (ICU) immediately after delivery (P = 0.744). However, there was a statistically significant difference between the two groups in terms of labor pain control (P < 0.001), induction of labor (P < 0.001), and the use of episiotomy (P < 0.001). Regarding neonatal outcomes, there was no statistically significant difference between the two groups in relation to the average infant weight (P = 0.46), Apgar score (P = 0.75), need for resuscitation (P = 0.999), skin-to-skin contact (P = 0.626), initiation of breastfeeding (P = 0.241) and admission to the neonatal intensive care units (NICU) (P = 0.66).

Conclusion: Given the positive impact of private care on key maternal outcomes, it is recommended that health policymakers create the conditions necessary for establishing a continuous midwifery care model in both governmental and private hospitals. Besides, more quantitative, qualitative, and especially mixed methods research should be conducted to explore the challenges and facilitators of this model across various settings.