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Lancet Series on Midwifery Sure to Induce Controversy — Physician’s First Watch

Medical News |
June 23, 2014

Lancet Series on Midwifery Sure to Induce Controversy

By Joe Elia

Edited by Susan Sadoughi, MD, and Jaye Elizabeth Hefner, MD

There will likely be water-cooler chats about a four-article Lancet series on midwifery.

The series' executive summary declares that the central strategy for achieving high-quality care is providing midwifery "for every woman and every newborn infant." The analysis doesn't spare the feelings of physician providers: it finds evidence that "midwife-led care is a more cost-effective option than medically-led care."

Greater use of midwives in high-income countries would likely affect morbidity more than mortality. Why? because of exposure to "unnecessary interventions used routinely," including episiotomy and cesarean sections.

Reader Comments (5)

Professor Sally K Tracy DMID RM Other Healthcare Professional, Other, Professor of Midwifery, University of Sydney, Australia

The series more appropriately describes ‘a new quality framework for maternal and newborn care’ involving multidisciplinary and inter-professional collaboration. The entire series was based on a definition of midwifery as a “package of care” “taking account of skills, attitudes and behaviours rather than specific professional roles”. Such a definition in effect renders the midwife in her professional capacity completely redundant.

Nancy Brannin, CNM, ND Other Healthcare Professional, Obstetrics/Gynecology

Could you please say more about this? Here in the USA, midwives are the only providers specifically educated in the entire package of skills included in midwifery care as described in the series. And the series also refers to studies of the effectiveness of midwife-led care.

David Foster, MD Physician, Family Medicine/General Practice, Oregon

The hypocrisy in health care is enormous. Physicians are sued for tens of millions over cerebral palsy (that is typically a second trimester problem) and then vilified when a C-section is performed to reduce risk. Will midwife care reduce costs? Only is the midwives don't have the "deep pockets" that physicians have. If you want to REALISTICALLY reduce costs, the solution is Tort Reform, prohibiting contingency fees, and prohibit advertising for professionals (esp. doctors and lawyers).

Nancy Brannin, CNM, ND Other Healthcare Professional, Obstetrics/Gynecology

Midwives actually are the "deep pockets" in states where we are not included in requirements for review panels or in caps on claims. We all need tort reform to function effectively and should work together on this.

JORGE JIMENEZ MD MPH Physician, Health Law/Ethics/Public Policy, Pontificia Universidad Catolica de Chile

Midwives were critical in the 1969 s in Chile when family planning and professional birth care was introduced and reinforced. They were crucial for the 90% fall in maternal mortality and infant mortality.

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