Abstract

Since the beginning of the United States, midwives have been invaluable to maternal care in their scientific knowledge and holistic care of birthing people. However, midwives are not routinely included in obstetric care across hospitals and clinics, unlike other countries around the world. A collaborative model of care consists of a team of midwives, obstetricians, family medicine physicians, doulas, and other birth workers to provide the most comprehensive care during pregnancy, parturition, and postpartum. Our project aims to explore whether the integration of midwives into a collaborative care model, compared to standard obstetric care without midwife involvement, reduced the rates of C-sections and preterm births. A literature review was conducted in databases such as PubMed and CINAHL. Included articles were published within the past 10 years and studied C-sections or preterm births in their outcomes.

Twelve peer-reviewed studies were reviewed. Across the literature, midwifery-led care was consistently associated with lower rates of preterm delivery, cesarean birth, labor induction, and episiotomy when compared directly to physician-led care (Attanasio & Kozhimannil, 2018; Hamlin et al., 2021; Thiessen et al., 2016). Studies reported that individuals under midwifery-led models experienced fewer interventions and higher maternal satisfaction, while also achieving comparable or better neonatal outcomes, including reduced NICU admissions (Sandall et al., 2016; Thiessen et al., 2016). Hospitals systems with greater midwife involvement showed statistically significant reductions in cesarean births and obstetric procedures even when controlling for clinical and demographic risk factors, suggesting that provider type plays a meaningful role in shaping outcomes (Attanasio & Kozhimannil, 2018; Neal et al., 2019). In contrast, physician-led models were more likely to rely on interventions such as induction and augmentation of labor, contributing to higher cesarean rates, even in low-risk populations (Hamlin et al., 2021; Neal et al., 2019).

Despite strong evidence in favor of midwifery care, especially when contrasted with physician-only models, only a small number of studies examined true collaborative practices between midwives and obstetricians. Additionally, most available studies were observational and retrospective, limiting the ability to draw causal conclusions. The consistent trend supports expanding access to midwifery-led care as a strategy to improve birth outcomes, reduce unnecessary interventions, and promote equity in U.S. maternity care (Sandall et al., 2016; Attanasio & Kozhimannil, 2018; Neal et al., 2019).

Integrating midwives into collaborative care models has emerged as a transformative strategy in improving maternal and neonatal outcomes across diverse populations and care settings. Evidence consistently demonstrates that midwifery-led or midwifery-integrated care models are associated with significant reductions in cesarean birth rates, preterm deliveries, and medical interventions, particularly among low-risk birthing individuals (Sandall et al., 2016; Carlson et al., 2018; Souter et al., 2019). These models are grounded in a holistic, relationship-centered philosophy that prioritizes the physiological process of childbirth, judicious use of medical technology, and continuity of care, ultimately fostering safer, more satisfying birth experiences (Neal et al., 2019; Thiessen et al., 2016). These findings reinforce the importance of expanding the integration of midwives into hospital systems and community-based care alike. As healthcare systems continue to seek sustainable, equitable, and patient-centered models of maternity care, the expansion of midwifery within collaborative frameworks offers a powerful and evidence-based pathway forward.