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NHS and Midwife Births Have Their Share of Problems

Clinical outcomes of both point to a need for review

FRIDAY, June 12 (HealthDay News) -- The outcomes of births in Great Britain's National Health Service (NHS) and those managed by an independent midwife point to a need for a review of both practices, according to a study published online June 11 in BMJ.

Andrew Symon, Ph.D., and colleagues at the University of Dundee in the United Kingdom compared the outcomes of births by 8,676 women, of whom 7,214 were NHS patients matched on a ratio of one to five with 1,462 women who employed an independent midwife.

While 96.6 percent of the women with independent midwives had spontaneous onset of labor, and 77.9 percent had an unassisted vertex delivery, the rates for NHS patients were only 74.5 and 54.3 percent, respectively, the investigators discovered. However, the stillbirth and neonatal death rate was higher in the independent midwife group at 1.7 percent versus 0.6 percent for the NHS patients. In addition, prematurity, low birth weight, and admission to neonatal intensive care units were higher in the NHS group.

"While clinical outcomes across a range of variables are much better for women using an independent midwife, the significantly higher perinatal mortality rate, particularly in higher risk women, indicates the need for a full review of case notes to identify possible causative factors," the authors write. "A full review of these cases could help to explain the higher perinatal mortality rate in higher risk women and thereby provide women with further evidence on which to base their decisions about pregnancy care and delivery."

One of the authors is an honorary member of the Independent Midwives' Association.

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