The outcome of midwife-led labor in low-risk women within an obstetric referral unit

Enrico FerrazziDepartment of the Women, Mother and Neonate, Buzzi Mother and Child Hospital, Medical School of Biomedical and Clinical Sciences, University of Milan, Milan, ItalyCorrespondence[email protected]

Elena ViscontiDepartment of the Women, Mother and Neonate, Buzzi Mother and Child Hospital, Medical School of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

Andrea M. PaganelliDepartment of the Women, Mother and Neonate, Buzzi Mother and Child Hospital, Medical School of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

Carmen M. CampiDepartment of the Women, Mother and Neonate, Buzzi Mother and Child Hospital, Medical School of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

Cristina LazzeriDepartment of the Women, Mother and Neonate, Buzzi Mother and Child Hospital, Medical School of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

Federico CirilloDepartment of the Women, Mother and Neonate, Buzzi Mother and Child Hospital, Medical School of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

Stefania LivioDepartment of the Women, Mother and Neonate, Buzzi Mother and Child Hospital, Medical School of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

Cinzia PiolaDepartment of the Women, Mother and Neonate, Buzzi Mother and Child Hospital, Medical School of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

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Abstract

Objective: To analyze maternal and neonatal outcomes of midwife-led labor in low-risk women at term.

Methods: Prospective observational cohort of 1788 singleton low-risk pregnancies in spontaneous term labor, managed according to a specific midwife-led labor protocol. Primary outcomes were mode of delivery, episiotomy, 3rd–4th degree lacerations, post-partum hemorrhage (PPH), need for blood transfusions, pH and Apgar score and NICU admissions.

Results: A total 1754 low-risk women (50.3% of all deliveries) were included in the analysis. Epidural analgesia was performed in 29.8% of cases. The rate of cesarean section was 3.7%. Episiotomy was performed in 17.6% of women. PPH > 1000 ml occurred in 1.7% of cases. 3.2% and 0.3% of the cases had an Apgar score <7 and pH < 7.10, respectively, while 0.3% of the newborns were admitted to NICU. Consultant-led labor was required for emerging risk factors during 1st and 2nd stage of labor in 16.1 and 8.6% of cases, respectively. Although maternal outcome were worse in women with emerging risk factors in labor, while neonatal outcomes were not affected by the presence these complications.

Conclusions: In hospital settings, midwife-led labor in low-risk women might unfold its major advantages without additional risks of medicalization for the mother and the neonate.

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Declaration of interest

No conflict of interest is reported.

We are grateful to the Giorgio Pardi Research Foundation, and the CURE-onlus research Foundation for supporting this study.

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The outcome of midwife-led labor in low-risk women within an obstetric referral unit

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