Increasing midwifery continuity of care has been identified as a key priority for maternity services in the UK. An updated Cochrane Review (published 10 April) led by Professor Jane Sandall and colleagues, which builds on previous ARC South London research, compares how outcomes differed for women or their babies who received a midwife continuity of care model to other models of care.
Midwife continuity of care models provide care from the same midwife or team of midwives during pregnancy, birth, and the early parenting period – in collaboration with obstetric and specialist teams when needed. Midwife continuity of care models have been a key approach to transforming Maternity Services in England since 2016, with the aim of making birth safer, more personalised, and equitable.
The researchers analysed data from 17 studies involving 18,533 women in Australia, Canada, China, Ireland and the UK that compared midwife continuity of care models throughout the antenatal (care during pregnancy), intrapartum (care during labour and birth) and postnatal period (where offered), with other models of care. The results of the trials were compared and summarised and rated in the evidence based on factors such as study methods and size.
The review found that women receiving midwife continuity of care models were less likely to experience a caesarean section or instrumental birth and were more likely to experience spontaneous vaginal birth and report a positive experiences during pregnancy, labour and following childbirth.
Additionally, midwife continuity of care provides benefits for health services through cost savings in the antenatal and intrapartum periods.
The studies included models of care that offered intrapartum care in hospitals, midwife birth centres co-located in a maternity unit, and home birth. We found that midwife continuity of care models, as compared to other models of care, increase spontaneous vaginal birth, reduce caesarean sections and instrumental vaginal birth (forceps/vacuum), and may reduce episiotomy
Although women who received midwife continuity models of care were less likely to experience certain interventions and more likely to have a positive experience throughout their care, there was uncertainty about the effect as compared to other models of care, on fetal loss at or after 24 weeks gestation, neonatal death, third or fourth-degree tear or maternal readmission within 28 days of birth.
The researchers also found that midwife continuity models resulted in little to no difference in preterm birth, intact perineum, postpartum haemorrhage, and admission to special care nursery/neonatal intensive care unit.
The review has implications for future research, suggesting that further evidence may change the results and focus should be given to the impact of midwife continuity of care models on women with social risk factors, those at higher risk of complications and on low- and middle-income countries.
Maternity and perinatal mental health researchers at the ARC are carrying out work in this area, exploring the benefits of midwife continuity models for diverse groups of women, including women at risk of preterm birth, and women belonging to ethnic minorities or living in disadvantaged areas.
