Editing Midwifery (section)

==Midwifery-led continuity of care==
[[File:Australian Clinical Midwifery Facilitator Florence West teaches training midwives at the Pacific Adventist University PAU, outskirts of Port Moresby, PNG. (10674496146).jpg|alt= Australian Clinical Midwifery Facilitator Florence West teaches training midwives at the Pacific Adventist University PAU, outskirts of Port Moresby, PNG.|thumb|Clinical midwifery facilitator training midwives]]
[[File:Cambodian Midwife Project (10678944753).jpg|thumb|"Babies" for student practice]]
Midwifery-led continuity of care is where one or more midwives have the primary responsibility for the [[continuity of care]] for childbearing women, with a multidisciplinary network of consultation and referral with other health care providers. This is different from "medical-led care" where an obstetrician or family physician is primarily responsible. In "shared-care" models, responsibility may be shared between a [[midwife]], an obstetrician and/or a family physician.<ref name="Sandall2013">{{cite journal|author=Sandall|first1=Jane|author-link=Jane Sandall|last2=Soltani|first2=Hora|last3=Gates|first3=Simon|last4=Shennan|first4=Andrew|last5=Devane|first5=Declan|year=2013|title=Midwife-led continuity models versus other models of care for childbearing women|journal=Cochrane Database Syst. Rev.|volume=8|issue=8|page=CD004667|doi=10.1002/14651858.CD004667.pub3|pmid=23963739}}</ref> The midwife is part of very intimate situations with the mother. For this reason, many say that the most important thing to look for in a midwife is comfort with them, as one will go to them with every question or problem.<ref>{{Cite news|url=https://www.thelocal.de/20101005/30273|title=The midwife: Your best friend in natal care|date=2010-10-05|access-date=2017-10-04|language=en|archive-date=2017-10-05|archive-url=https://web.archive.org/web/20171005052256/https://www.thelocal.de/20101005/30273|url-status=live}}</ref>

According to a [[Cochrane review]] of public health systems in Australia, Canada, Ireland, New Zealand and the United Kingdom, "most women should be offered midwifery-led continuity models of care and women should be encouraged to ask for this option although caution should be exercised in applying this advice to women with substantial medical or obstetric complications."  Midwifery-led care has effects including the following:<ref name=Sandall2013/>
* a reduction in the use of epidurals, with fewer episiotomies or instrumental births.
* a longer mean length of labour as measured in hours
* increased chances of being cared for in labour by a midwife known by the childbearing woman
* increased chances of having a spontaneous vaginal birth
* decreased risk of preterm birth
* decreased risk of losing the baby before 24 weeks' gestation, although there appears to be no differences in the risk of losing the baby after 24 weeks or overall
There was no difference in the number of [[Caesarean section]]s. All trials in the Cochrane review included licensed midwives, and none included lay or traditional midwives. Also, no trial included out of hospital birth.<ref name=Sandall2013/>

Compared to women in other care models, women in continuity models of midwifery care are more satisfied with their care. The updated version of the [[doi:10.1002/14651858.CD004667.pub5|Cochrane review]] also shows a cost-saving effect in continuity models, compared to other midwifery models of care.<ref>{{Cite journal |last1=Sandall |first1=Jane |last2=Soltani |first2=Hora |last3=Gates |first3=Simon |last4=Shennan |first4=Andrew |last5=Devane |first5=Declan |date=2016-04-28 |editor-last=Cochrane Pregnancy and Childbirth Group |title=Midwife-led continuity models versus other models of care for childbearing women |journal=Cochrane Database of Systematic Reviews |language=en |volume=2016 |issue=4 |pages=CD004667 |doi=10.1002/14651858.CD004667.pub5 |pmc=8663203 |pmid=27121907}}</ref>

In continuity models of midwifery care, the midwife-woman relationship is developing over time. The deepened relationship has shown to be of great importance and is in a [https://www.sciencedirect.com/science/article/pii/S0266613818301153?via%3Dihub systematic review] described as "the viechle through which personalised care, trust and empowerment are achieved in the continuity of care midwifery model".<ref>{{Cite journal |last1=Perriman |first1=Noelyn |last2=Davis |first2=Deborah Lee |last3=Ferguson |first3=Sally |date=2018-07-01 |title=What women value in the midwifery continuity of care model: A systematic review with meta-synthesis |url=https://www.sciencedirect.com/science/article/pii/S0266613818301153 |journal=Midwifery |language=en |volume=62 |pages=220–229 |doi=10.1016/j.midw.2018.04.011 |pmid=29723790 |s2cid=13659050 |issn=0266-6138}}</ref>

In some cultures, midwifery is the most traditional way of carrying out a pregnancy and childbirth, and it has been conducted for multiple generations. Child birthing women in these cultures, take Zimbabwe for example, feel that health facilities are not as comforting as cultural roots of care.<ref>{{Cite journal |last1=Musie |first1=Maurine R. |last2=Peu |first2=Mmapheko D. |last3=Bhana-Pema |first3=Varshika |date=2022-04-25 |title=Culturally appropriate care to support maternal positions during the second stage of labour: Midwives' perspectives in South Africa |url=http://dx.doi.org/10.4102/phcfm.v14i1.3292 |journal=African Journal of Primary Health Care & Family Medicine |volume=14 |issue=1 |pages=e1–e9 |doi=10.4102/phcfm.v14i1.3292 |pmid=35532110 |pmc=9082223 |issn=2071-2936}}</ref> Also, according to the World Health Organization, women should be able to have their children where ever they feel the most safe, so if having a midwife and proceeding with an at-home birth is what makes some women feel safe, then midwifery-led continuity of care might be the best option for them.<ref>{{Cite journal |last1=Meroz |first1=Michal (Rosie) |last2=Gesser-Edelsburg |first2=Anat |date=2015 |title=Institutional and Cultural Perspectives on Home Birth in Israel |url=http://dx.doi.org/10.1891/1058-1243.24.1.25 |journal=The Journal of Perinatal Education |volume=24 |issue=1 |pages=25–36 |doi=10.1891/1058-1243.24.1.25 |pmid=26937159 |pmc=4720861 |issn=1058-1243}}</ref>