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BACKGROUND The high caesarean section rate is a prominent public health problem in China. AIM This study aimed to determine the effects of midwife-led care during labour on birth outcomes for healthy primiparas. DESIGN Randomized controlled trial. SETTING The Obstetrics Department of Fujian Provincial Maternity and Child Health Hospital. METHODS A total of 666 primiparas in labour were randomly divided into an intervention and control group (333 in each group). The intervention group received a midwife-led model of care during labour. RESULTS Data from 648 cases (331 intervention group and 317 control group) were analysed. The intervention group was less likely to experience caesarean section, postpartum haemorrhage, opiate analgesia, vaginal examinations, neonatal asphyxia, and neonatal hospitalization and was more likely to experience shorter length of labour and vaginal birth than the control group (all, P < 0.05). No differences were found in the number of artificial rupture of membranes and oxytocin use (P > 0.05). CONCLUSIONS Midwife-led care can reduce the caesarean section rate, promote normal birth, improve birth outcomes, and promote maternal and child health.