Midwives can handle higher risk pregnancies than you might think: B.C. study

A retrospective study of births in British Columbia shows that people who had a midwife as a primary provider had similar birth outcomes to those who had a physician or obstetrician as their primary provider during pregnancy and birth. This was seen across all levels of obstetrical risk. “The study provides evidence that midwifery care in B.C. is a safe and effective option for childbearing people, regardless of medical risk,” said Kathrin Stoll, lead author of the study and a research associate at the University of British Columbia's department of family practice, in a press release. The researchers examined births in British Columbia’s perinatal data registry from 2008 and 2018. During that time, the proportion of births that had a midwife as a primary provider increased from 9.2% to 19.8% Of the 425,056 births included in the study, 14.9% had a midwife, 44.6% had a family physician and 40.5% has an obstetrician as the primary provider. The remaining births had a maternal-fetal specialist or another provider. Read: Birth in bomb shelters: Ukrainian midwives look to Canada for training Of those pregnancies cared for by a midwife, 73.8% were low-risk 24.4% were moderate risk 1.7% were high-risk The data show that both midwives and family physicians collaborate with obstetricians when necessary. For high-risk pregnancies, 48.3% of births cared for by a midwife and 51.2% of births cared for by a family physician were delivered by an obstetrician. For moderate-risk pregnancies, 22.3% of births cared for by a midwife and 28% of births cared for by a family physician were delivered by an obstetrician. “As medical risk increases, midwives and family physicians collaborate with obstetrician specialists to ensure that birthing people are receiving safe and appropriate care that is right for them,” Stoll said. Rates of cesarean delivery and assisted vaginal births were lower for patients with a midwife as a primary provider compared to patients who had a family physician or obstetrician as primary provider. Those who had a midwife as a primary provider were significantly more likely to have a spontaneous vaginal birth or vaginal birth after cesarean across all levels of risk compared to a physician as the primary provider. Among those with a high-risk pregnancy, there was a higher risk of oxytocin induction among patients who had a midwife compared to a physician as a primary provider. The study was published in the Canadian Medical Association Journal (CMAJ). In an editorial in the same issue of the CMAJ, Dr. Shannon Charlebois, the journal's medical editor and a family physician, noted that the findings can’t be generalized to all areas in Canada. The availability and regulation of midwifery care varies across the country. For example, while midwifery has been regulated in B.C. since 1998, it was only regulated in Prince Edward Island in 2022. “As the midwifery profession continues to grow in Canada, it holds potential for meeting national mandates to lower obstetric intervention rates and to increase access to midwifery care to under-served communities,” said Luba Butska in a press release. Butska is the senior author of the study and an assistant professor at UBC’s midwifery program in the department of family practice. “It’s the combination of good outcomes and lower intervention rates that make midwifery a great public health strategy because it’s saving the health system money and resulting in good outcomes for both babies and childbearing people.” Read: The other side of Roxham Road

Midwives can handle higher risk pregnancies than you might think: B.C. study

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