Midwife-led care versus obstetrician-led care for childbearing women in early labor: A systematic review.

INTRODUCTION

Women admitted to the hospital early in labor face an increased intrapartum intervention rate, possibly resulting in negative obstetric outcomes. It is well documented that women receiving midwife-led care receive fewer unnecessary medical interventions. However, the impact of midwife-led care during early labor remains poorly understood. The aim of this study was to evaluate the effect of midwife-led care compared to obstetrician-led care regarding medical interventions during early labor.

METHODS

A systematic review of literature published until June 2024 was performed in PubMed, CINAHL Complete, Web of Science Core Collection, and the Cochrane Library following Cochrane guidelines. PICO criteria included the keywords pregnant women, midwife-led care, obstetrician-led care and medical interventions during early labor. Quality was assessed using the RoB 2-tool and the ROBINS-I-tool. Data were extracted by using a purposively designed extraction template and then analyzed descriptively.

RESULTS

Of 1057 identified studies, four studies were eligible and included in this review, including two randomized controlled trials and two observational studies. The results regarding birth mode are not entirely clear. Most studies reported that women who receive midwife-led care during the early stages of labor are more likely to have a vaginal birth and less likely to require a cesarean section. However, one study could not find a statistically significant difference regarding birth mode and care model received in early labor. Another study showed increased use of labor augmentation among women receiving obstetrician-led care.

CONCLUSIONS

There remains a lack of knowledge about the role of midwife-led care during early labor and its impact on early labor interventions and subsequent birth outcomes. More attention should be focused on early labor care to improve outcomes for laboring women and their partners. Recognizing the potential benefits of midwife-led care during this phase could lead to initiatives aimed at promoting such care across various settings.