摘要：SummaryAim: To compare midwife-led with other models of care for childbearing women and their infants.Methods: We searched many sources (e.g. the Cochrane Pregnancy and Childbirth Group’s Trials Register) for all published and unpublished trials in which pregnant women are randomly allocated to midwife-led or other models of care during pregnancy. We evaluated methodological quality, double-checked the data extraction and entry, and sought additional information from trial authors.Results: Covered 11 trials (12,276 women). Women who had midwife-led models of care were less likely to experience: antenatalhospitalisation, [relative risk (RR) 0.90, 95% confidence interval (CI) 0.81; 0.99], use of regional analgesia (RR 0.81, 95% CI 0.73; 0.91), episiotomy (RR 0.82, 95% CI 0.77; 0.88), instrumental delivery (RR 0.86, 95% CI 0.78; 0.96), and fetal loss before 24 weeks’ gestation (RR 0.79, 95% CI 0.65; 0.97).They were more likely to experience: no intra-partum analgesia/ anaesthesia (RR 1.16, 95% CI 1.05; 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02; 1.06), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81), and to feel in control duringchildbirth (RR 1.74, 95% CI 1.32; 2.30). Their babies were more likely to have a shorter length of hospital stay (mean difference –2.00, 95% CI; 2.15 to;1.85). The results were consistent with the level of obstetrical risk, setting of practice and organisation of care.Conclusion: Most women should be offered midwife-led models of care and women should be encouraged to ask for this option. Caution should be exercised regarding women with medical or obstetric complications.Prat Organ Soins 2009;40(4):267-274
关键词：Midwifery practice ; care management ; continuity of patient care ; maternal health services ; outcome assessment (health care) ; patient satisfaction ; professional-patient relations.
