A recent Cochrane review of 11 randomized trials with 12,276 pregnant women has recommended midwife-led care as a safe and effective option for childbirth (grade A recommendation [consistent high-quality evidence]).  Compared to other models, midwife-led care was associated with significantly lower rates of antenatal hospitalization, instrumental birth, episiotomy and regional analgesia or anesthesia use.  Rates of neonatal death and fetal loss before 24 weeks gestation were also lower in midwife care groups.  Women under midwife-led care were more likely to experience spontaneous vaginal birth, to have a high perception of control during labor and childbirth and to have a known care-provider attending the birth.  Midwife-led care was also associated with higher rates of anesthesia-free delivery and breastfeeding initiation and with shorter mean hospital stays for infants (Cochrane Database Syst Rev 2008 Oct 8;(4):CD004667).  For more information, see the Pregnancy topic in DynaMed.

Epidemiological data published this week shows that the incidence of pneumococcal meningitis in the United States has decreased significantly since the introduction of the 7-valent pneumococcal conjugate (Prevnar, PCV7) vaccine in 2000.  Annual incidence per 100,000 persons fell from 1.13 to 0.79 cases from 1998-1999 to 2004-2005 for all serotypes in all ages.  Over the same period, incidence fell among children younger than 2 years old from 10.16 to 3.66 cases, and among adults 65 years and older from 1.9 to 0.87 cases (N Engl J Med 2009 Jan 15;360(3):244).

In last week’s update, (DynaMed Weekly Update Volume 4, Issue 2), DynaMed Editors reported that vaccination with Pneumovax (23-valent pneumococcal polysaccharide vaccine) may be ineffective for preventing pneumonia, even in populations for whom it is recommended.  This may not be the case for all pneumococcal vaccines, however.  A recent MMWR analysis found a significant decrease in hospitalizations for pneumonia in children younger than 2 years old comparing time periods before and after the introduction of Prevnar (MMWR Morb Mortal Wkly Rep 2009 Jan 16;58(1):1 full-text).  For more information, see the Pneumococcal meningitis and Pneumococcal pneumonia topics in DynaMed.