title: The outcome of midwife-led labor in low-risk women within an obstetric referral unit.
abstract: OBJECTIVE
  To analyze maternal and neonatal outcomes of midwife-led labor in low-risk women at term.
  
  
  METHODS
  Prospective observational cohort of 1788 singleton low-risk pregnancies in spontaneous term labor, managed according to a specific midwife-led labor protocol. Primary outcomes were mode of delivery, episiotomy, 3rd-4th degree lacerations, post-partum hemorrhage (PPH), need for blood transfusions, pH and Apgar score and NICU admissions.
  
  
  RESULTS
  A total 1754 low-risk women (50.3% of all deliveries) were included in the analysis. Epidural analgesia was performed in 29.8% of cases. The rate of cesarean section was 3.7%. Episiotomy was performed in 17.6% of women. PPH > 1000 ml occurred in 1.7% of cases. 3.2% and 0.3% of the cases had an Apgar score <7 and pH < 7.10, respectively, while 0.3% of the newborns were admitted to NICU. Consultant-led labor was required for emerging risk factors during 1st and 2nd stage of labor in 16.1 and 8.6% of cases, respectively. Although maternal outcome were worse in women with emerging risk factors in labor, while neonatal outcomes were not affected by the presence these complications.
  
  
  CONCLUSIONS
  In hospital settings, midwife-led labor in low-risk women might unfold its major advantages without additional risks of medicalization for the mother and the neonate.
authors.affiliation: a Department of the Women , Mother and Neonate, Buzzi Mother and Child Hospital, Medical School of Biomedical and Clinical Sciences, University of Milan , Milan , Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrazzi
authors.forename: Elena
authors.initials: E
authors.lastname: Visconti
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Paganelli
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Campi
authors.forename: Cristina
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Federico
authors.initials: F
authors.lastname: Cirillo
authors.forename: Stefania
authors.initials: S
authors.lastname: Livio
authors.forename: Cinzia
authors.initials: C
authors.lastname: Piola
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D008880:Midwifery / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
keywords: Apgar score; cesarean section; labor and delivery; midwifery; women's health issues