This care model also significantly reduced risks of preterm births in women who are at greatest social risk of adverse outcomes. The research carried out by ARC South London’s maternity and perinatal mental health theme at King’s College London was published today in BJOG: An International Journal of Obstetrics & Gynaecology. The study looked at data from 6,600 pregnancies in south London, an area with high ethnic diversity and social disadvantage.
Community-based midwife continuity of care (CMBCOC) vs. standard care
The researchers analysed data from 2018-2020, where a quarter of the women received community-based care from midwives and the others received standard care.
In community-based midwife continuity of care (CMBCOC), the same team of midwives provides care to a woman throughout her pregnancy, birth, and the postnatal care. These midwives provided midwifery care across community and hospital settings, working in partnership with women and multidisciplinary teams. When complications arose, women were referred for obstetric care under standard guidelines while continuing to receive midwifery care from the team.
In standard care models, midwives, GPs, and obstetricians share the responsibility for the organisation and delivery of care throughout the initial booking to the postnatal period provided in both hospital and/or community settings.
Community-based midwife continuity of care (CMBCOC), benefits all women, including women in higher social risk groups
The risk of preterm birth among women from Black, Asian, and other ethnic minority backgrounds was significantly reduced from 9.5% to 6.4%. Similarly, the risk is reduced for women in the most socially deprived areas (8.2% to 5.1%).
Researchers also found that in the CBMCOC group, women had an increased rate of spontaneous vaginal delivery, were less likely to miss their antenatal appointments and more likely to receive necessary referrals to mental health support.
Our study demonstrates the potential of locality-based interventions integrating community-based care and midwife continuity. This approach significantly reduces risk of preterm birth compared to standard care and may help reduce health inequities for high social risk groups
Community-based midwife continuity of care and population health
In September 2022, NHS England announced that their plan to deliver midwife continuity of carer nationally was on hold due to insufficient staffing levels. Women are currently not able to choose which care pathways they are placed in, and the CMBCOC model is currently only available in some NHS Trusts.
Our findings provide a potential solution to mitigating inequities in maternity care. Women get to know the small team of midwives, receive care close to home, and know that their midwives will coordinate with the wider health team when needed. One of the priorities in the NHS 10 Year Health Plan for England is shifting care from hospital to community, and our findings are supportive of this plan.
This study used data from the eLIXIR Partnership, linking healthcare information from various providers in south London, where CBMCOC is offered. The strength of this study is the availability of robust and continuous maternity, neonatal and mental health data and the diversity of the south London population, representing worldwide demographics.
Future trials will be crucial, but need to be done carefully to include the women who are at a greater social risk, who have also been historically underrepresented, in such trials.
Read the paper 'The Impact of Community-Based Midwife Continuity of Care Models for Women Living in Areas of Social Disadvantage and Ethnic Diversity in the United Kingdom: A Prospective Cohort Study' BJOG: An International Journal of Obstetrics & Gynaecology (Jan 3036)