Midwife with the personal touch is best

Women cared for by midwives on a one-to-one basis need fewer epidurals or other pain relief during childbirth, according to a new survey.

The report looked at 1,400 women, half cared for by traditional midwives and half cared for by midwives in the One-to-One project. In the National Health Service a woman can have up to 40 different people caring for her during her pregnancy and is unlikely to have her baby delivered by a midwife. Three out of four babies are delivered by a stranger.

In the One-to-One study, which has been running for three years, the woman has a named midwife and one back-up so she will give birth in the presence of someone she knows well. Being community-based, the midwife carries out more of the ante- and post-natal care in the mother's home. The scheme has been pioneered by Lesley Page, the Queen Charlotte's Professor of Midwifery Practice at the Wolfson School of Health Science.

In the One-to-One group, 52 per cent of women had an epidural compared with 67 per cent in the traditional group - a "very significant finding", Professor Page said. Half as many got through childbirth without any recourse to pain relief in the traditional group as in the One to Ones. And fewer than one in five One-to-Ones had an episiotomy compared with 30 per cent cared for traditionally.

Both midwives and mothers said that it was easier to work as a partnership and mothers also said they benefitted from a higher level of care in terms of the information and advice they received and in the amount of emotional support. They were also twice as likely to receive constant attendance during labour and were less likely to need continuous electro- nic monitoring during the birth.

"Women want to have their baby delivered by a midwife whom they have grown to know and trust," Professor Page said. "It's of huge psychological benefit which, in the majority of cases, makes for an easier birth ... In practical terms what's really important is that on the basis of our study this service does not cost the NHS any more than the traditional style of midwifery practice."

At present One to One operates at Hammersmith, Queen Charlotte's and Chelsea hospitals in London and centres in Leicester and Shrewsbury.

A spokeswoman for the Royal College of Midwives said that they welcomed the report. "We have always known that one-to-one support is beneficial. We have just one proviso. Zero cost implications may well be the case when the service is up and running, but for a major service change ... money is needed to equip the midwives."