Research in the general population has shown that women who receive care from the same midwife or small team of midwives during pregnancy, labour and in the first few weeks of parenting, are more likely to give birth naturally and less likely to experience preterm birth.
As a result, this type of continuity of midwife care model is recommended internationally and is at the heart of maternity policy in the UK. However, until now, no research evidence has existed on the impact of these models on women with risk factors for preterm birth.
Working with Lewisham Clinical Commissioning Group, the ARC (then CLAHRC) research team set up a new service with Lewisham Hospital in south London that was designed to better support women who have a higher risk of preterm birth and to address the gap in evidence. The service, known as POPPIE, launched in May 2017, with a team of midwives offering continuity of care, and a specialist preterm surveillance clinic at the hospital.
The research team, led by the ARC’s Professor Jane Sandall CBE, set up a hybrid pilot effectiveness-implementation randomised controlled trial to compare the new model of care with standard care.
Between May 2017 and October 2018, 334 women were recruited to the trial – 169 women under the care of the POPPIE team and 165 receiving standard care. The mean maternal age of the women was 31 years, with 32% from Black, Asian, and minority ethnic groups, and nearly 70% living in areas of social deprivation. More than a quarter of the women had at least one pre-existing medical condition and multiple risk factors for pre-term birth.
The results of the trial, published in PLOS Medicine, showed it was feasible to set up and deliver this new model of care. There was no significant difference between the two groups for receiving appropriate and timely interventions to prevent or manage preterm birth. There was also no difference in adverse outcomes for women or their babies. However, infants in the POPPIE team were more likely to have skin-to-skin contact after birth, to have it for a longer time, and to breastfeed immediately after birth. Outcomes relating to women's experience of care and psycho-social outcomes are still to be reported.
Commenting on the findings, Professor Sandall says: “Many women at higher risk of preterm birth have a particular physiological problem requiring timely and appropriate obstetric interventions, and these are already being picked up by standard care.”
“Previous research has shown than continuity of midwifery care has a positive impact in women who are low risk or mixed risk. These models act as a safety net, improving trust, engagement and coordination with maternity services, and reducing anxiety and stress. This type of service could be beneficial to a wider group of women living in disadvantaged communities, or with complex social factors. To inform policy and practice, we must fund larger trials to evaluate whether this is the case.”
The ARC’s maternity and perinatal mental health research team are evaluating different place-based models of maternity care for women in the most deprived groups in Lambeth.