VIII. Midwifery & Global Models
The Scandinavian Model of Care (Sandall et al. Cochrane Review)
Midwife-led countries have near-zero maternal mortality
Countries where midwives lead normal maternity care (Norway, Sweden, Finland, Netherlands) have the lowest maternal and infant mortality globally. The Sandall Cochrane review of midwife-led continuity care (15 trials, 17,674 women) found less preterm birth, less episiotomy, less instrumental birth, and more spontaneous vaginal birth.
The Scandinavian countries (Norway, Sweden, Finland, Denmark) along with the Netherlands operate maternity systems where midwives provide normal antenatal, labor, and postnatal care, and obstetricians are consulted only when complications develop. These same countries occupy the top of the global rankings for maternal and infant mortality. Norway records near-zero maternal deaths in most years. Sweden runs at 5 per 100,000. By comparison, the US runs 22.3.
The countries also share other features (universal healthcare, paid maternity leave, postpartum follow-up), so the midwife-led model is not the only variable.
But the cluster of features that produces good outcomes is well-defined, and the midwifery model is consistently part of it. Health systems that have shifted toward this model see outcomes improve. The UK NHS has been moving in this direction since 2016.
~0
Norway maternal deaths most years
5
Sweden, per 100K
22.3
US, per 100K
Top
Scandinavian global outcomes ranking
Why it matters
The countries that have shifted to midwife-led normal care have the best maternal outcomes in the world. The cluster of features matters, but no version of the cluster has been built without midwives at the center.
This is one finding from the research library behind How to Birth a Mother. Everything here traces back to a study, a dataset, or a systematic review.