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Table 5 Impact of training professional midwives on stillbirths and perinatal mortality

From: Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand

Source Location and Type of Study Intervention Stillbirths/Perinatal Outcomes
Reviews and meta-analyses
Hodnett 2000 [161] UK (London) and Australia (New South Wales).
Meta-analysis (Cochrane). 2 RCTs included (N = 1815 participants).
Assessed the effects of antenatal, intrapartum and postpartum care by midwives (intervention) vs. usual care by multiple caregivers (controls). SBR/NMR: OR = 1.96 (95% CI:: 0.83–4.63) [NS].
[14/908 vs. 7/907 in intervention and control groups, respectively].
Hodnett et al. 2003 [55] Australia, US (South Carolina), UK and France.
Meta-analysis (Cochrane). 11 RCTs included (N = 9507 participants).
Assessed the effects of social support from midwives (intervention) vs. usual care (controls) antenatally for pregnancies at risk of low birth weight. SBR/NMR: RR = 1.15 (95% CI: 0.89–1.51) [NS].
[112/4778 vs. 96/4729 in intervention and control groups, respectively].
Villar et al.
2001 [162]
UK and Scotland.
Meta-analysis (Cochrane). 2 RCTs included (N = 2890 low-risk women).
Assessed the effects of midwife/general practitioner managed care (intervention) vs. obstetrician/gynecologist led shared care with midwives (controls) on perinatal mortality. PMR: OR = 0.59 (95% CI: 0.28–1.26) [NS].
[10/1447 vs. 17/1443 in intervention and control groups, respectively].
Intervention studies
Ibrahim et al. 1992 [66] Sudan. Community-based (48 rural villages).
Prospective before-after study spanning three years (March 1985–April 1988). N = 6275 deliveries monitored by 40 village midwives, of which 150 were stillbirths and 167 neonatal deaths.
Assessed the impact of training and upgrading of the skills of village midwives (licensed, with 1 year of midwifery training) starting from the middle of the second year of the study. SBR: 43/1845 (2.3%) vs. 55/2132 (2.6%) vs. 48/2298 (2.1%) in 1985–86, 1986–87 and 1987–88 respectively.
SBR+NMR: RR = 0.75 in the third year in comparison with the first two (P < 0.05).
Theron et al. 2000 [64] South Africa (Eastern Cape Province).
Prospective, controlled trial. N = 73 midwives (N = 34 in the study town, N = 39 in the controls).
The practical skills of midwives caring for pregnant women were determined before and after the introduction of training via Maternal Care Manual in the study town. No training was given in the control towns. Distribution of marks: a significant (P < 0.001) improvement occurred in the study town between pre- and postintervention periods, whereas the control towns showed no change.
The mean improvement in the study town was 3.5 marks (36.6% improvement) vs. 0.1 marks (1.1% improvement) in the control towns.
Observational studies
Montero-Mendoza et al. 2000 [163] Mexico (Chiapas). Rural and urban area.
Cross-sectional study. N = 670 women between 15 to 49 years old with N = 1,382 pregnancies from 1987 to 1996.
Compared the impact of birth assistance by a midwife (study group) vs. a relative of the pregnant woman, her husband or herself (controls). PMR: OR = 0.30 in study vs. control groups, P < 0.01.
(36.2/1000 live births)