Midwife-Led Care Safely Manages 44.6 Percent of Low-Risk Births, Cuts Episiotomy Rates: Study

Midwife-led care is increasingly advocated in India to enhance maternal-neonatal health and curb unwarranted clinical interventions in high-volume settings, yet long-term comparative evaluation against obstetrician-led care has remained a critical knowledge gap. To address this gap, Pragati Sharma, Pallavi Chandra Ravula, Inderjeet Kaur, Radha Reddy, and Evita Fernandez from the Fernandez Foundation conducted an eleven-year investigation aiming to describe trends, clinical characteristics, and maternal-neonatal outcomes of midwife-attended births compared with doctor-attended deliveries.

Therefore, the 11-year retrospective study analyzed 36,204 low-risk vaginal births at a high-volume Indian maternity center to compare outcomes between midwife- and doctor-led deliveries. Focusing on spontaneous labor while excluding non-vaginal deliveries, the analysis evaluated key maternal outcomes—including episiotomy, intact perineum, and postpartum hemorrhage—alongside neonatal safety metrics.

The key clinical findings of the study include:

• Perineal Trauma Reduction: Analysis demonstrated that midwife-led deliveries achieved a substantially lower episiotomy rate of 13.5% compared to 42.4% in doctor-led deliveries.

• Intact Perineum Enhancement: Cohort data revealed that midwife-attended births yielded a significantly higher proportion of intact perineum outcomes at 14.4% versus 6.5% for physician-attended cases.

• Postpartum Hemorrhage Mitigation: Research showed a marked decrease in atonic PPH among midwife-led births at 4.7% compared to 7.7% in doctor-led care.

• Obstetric Triage Alignment: Investigationally, midwives predominantly managed low-risk women presenting with spontaneous labor in Robson groups 3 and 4, whereas physicians attended 55.4% of total births, handling higher proportions of previous cesarean deliveries and labor inductions.

• Neonatal Safety Equivalence: Findings confirmed that neonatal outcomes, including infants appropriate for gestational age and overall low incidence of serious adverse events, remained comparable between midwife and physician groups.

The results suggest that midwife-led care expanded substantially from approximately one-third of vaginal births in 2013 to nearly half (44.6% overall) by 2023, delivering maternal and neonatal outcomes fully comparable to doctor-led care for appropriately selected low-risk women.

Thus, the study concludes that clinicians and healthcare administrators may consider these findings as supporting the gradual integration and scaling of professional midwifery within maternity services to optimize low-risk birth practices.

While the single-center retrospective design represents an observational scope, expanding future multi-center research across diverse clinical settings will further validate the broader scalability of professional midwifery models.

Reference

Sharma P, Ravula PC, Kaur I, Reddy R, Fernandez E. Transforming Maternity Care: Insights from India’s First Decade Long Midwifery-Led Birth Cohort (2013–2023). The Journal of Obstetrics and Gynecology of India. Published online September 1, 2026.