This retrospective cohort study published in BMJ Open in November 2021, examined whether birth outcome inequality can be reduced using targeted caseload midwifery – where women receive care from a named midwife and team throughout their pregnancy, birth, and the postnatal period.
The aims of the research were to:
- Report maternal and newborn outcomes of pregnant women in areas of social deprivation in inner-city London
- Compare the effect of caseload midwifery with standard care on maternal and newborn outcomes in this cohort of women.
The research was carried out in an area of Lambeth where more than 90% of residents are in the two most deprived quintiles of the English Index of Multiple Deprivation (IMD) (2019) and the population is ethnically diverse.
Participants were all women booked for antenatal care from Guy’s and St Thomas’ NHS Foundation Trust after 11 July 2018 (when the Lambeth Early Action Partnership (LEAP) award winning caseload midwifery team currently led by Isabelle Bourton was set up) until data collection on 18 June 2020. There were 523 pregnant women in the area covered by LEAP, of whom 293 who received traditional midwifery care and 230 received caseload midwifery from a team.
Analysis of this data showed that there was a significant reduction in the preterm birth rate in women allocated to caseload midwifery, when compared with those who received traditional midwifery care (5.1% vs 11.2%). Caesarean section births were also significantly reduced in women allocated to caseload midwifery care, when compared with traditional midwifery care (24.3% vs 38.0%), including emergency caesarean deliveries (15.2% vs 22.5%) without an increase in neonatal unit admission or stillbirth.
A recent study published in the Lancet that looked at one million births in the NHS between 2015 and 2017, found large inequalities in pregnancy outcomes between ethnic and socioeconomic groups in England.
Professor Jane Sandall, ARC co-lead for maternity and perinatal mental health research at King’s College London, and Head of Midwifery and Maternity research at NHS England and Improvement, says: “This real-world study shows that a model of caseload midwifery care implemented in an inner-city area of deprivation and ethnic diversity improves outcomes by significantly reducing preterm birth and birth by caesarean section when compared with traditional care. These findings, as well as our previous NIHR funded research, such as the PoPPIE study, and Project 2020 are informing the rollout and implementation of targeted midwife continuity of care for these groups in the NHS Long Term Plan.
We know very little about the longer term impact, and our ARC research (CONNECT), is following up the women and their babies into the first year of life. This study is an excellent example of research driven by local need and priorities that has both national and international relevance. Further research is needed to determine whether the improvements seen will translate to other inner-city populations with similar demographics. We are working with researchers in Sweden and Australia to develop a large prospective trial, and with the WHO on the relevance of this model of care internationally.”