Level 1: Likely reliable evidence

A recent Cochrane review of 11 randomized trials involving 12,276 pregnant women has recommended midwife-led care as a safe and effective option for childbirth (Cochrane Database Syst Rev. 2008;[4]:CD004667; accessed April 8, 2009). Compared with other models, midwife-led care was associated with significantly lower rates of antenatal hospitalization, instrument birth, episiotomy and regional analgesia, and anesthesia use. Rates of neonatal death and fetal loss before 24 weeks’ gestation were also lower in midwife-care groups. Women under midwife-led care were more likely to experience spontaneous vaginal birth, have a high perception of control during labor and childbirth, and be attended at the birth by a care provider they knew. Midwife-led care was also associated with higher rates of anesthesia-free delivery and breastfeeding initiation and with shorter mean hospital stays for infants.