Transforming Maternity Care: Insights from India’s First Decade Long Midwifery-Led Birth Cohort (2013–2023)

Midwife‑led care is increasingly promoted to improve maternal and neonatal outcomes and reduce unnecessary interventions, particularly for low‑risk pregnancies in high‑volume settings in India. To describe trends, characteristics, and outcomes of midwife‑led births at the Fernandez Foundation from 2013 to 2023 and compare with doctor‑led births. A retrospective analysis was conducted of 36,204 vaginal births at a tertiary maternity centre between 1 January 2013 and 31 December 2023. Births were categorized by provider (doctor or midwife). Maternal and neonatal variables were compared between the providers using descriptive statistics. Of 36,204 vaginal births, 44.6% were attended by midwives and 55.4% by doctors. The proportion of midwife‑led births increased from about one‑third in 2013 to nearly half in 2023. Midwives predominantly managed lower‑risk women, including those in Robson groups 3 and 4 and with spontaneous labour, while doctors attended a higher proportion of women with previous caesarean sections and those requiring induction. Midwife-led births showed lower episiotomy (13.5% vs 42.4%), reduced atonic PPH (4.7% vs 7.7%), and higher intact perineum rates (14.4% vs 6.5%). Maternal anthropometric characteristics and overall gestational age and birthweight were similar between provider groups. Appropriate for gestational age neonates were slightly more frequent in midwife-attended births, and serious adverse outcomes were uncommon in both groups. Over an 11‑year, midwife‑led care at this high‑volume Indian maternity centre expanded substantially and safely, with outcomes comparable to doctor‑led care for appropriately selected low‑risk women. These findings support further integration and scaling of professional midwifery within India’s maternity services.