16 Feb 2022

Models of midwifery continuity of care are recommended in international guidance and are at the heart of maternity policy in the UK. These models, in which the same midwife or small team of midwives provide care during pregnancy, birth, and the early parenting period, have been found to improve outcomes and experiences of care among women at low- and mixed-risk of complications.

The event was chaired by Professor Jane Sandall, CBE, the ARC’s maternity and perinatal mental health theme lead, and professor of women’s health & social sciences, King’s College London, who led an influential international review into the evidence on midwifery continuity of carer.

The event was designed as an opportunity to share experiences of midwifery continuity of care from many perspectives, exploring what researchers already know and where they need to find out more. There were three presentations of research findings on implementation of continuity models of care.

Findings from the POPPIE trial

The first presentation explored findings from a new model of care in Lewisham in which women who are likely to give birth prematurely receive care from a specialist team of midwives (pictured) before, during and after their pregnancy (known as the POPPIE trial).

Jessica George a service user who was part of the POPPIE trial, explained how she went into labour at 23 weeks. “It was a very scary experience. But when I got to the hospital it was a friendly face who I’d seen many times who met me and that puts your mind at ease.”

If everyone had the POPPIE experience, even with another lockdown, the care of a woman would be so much better managed because it’s the same person who would know everything about that woman. […] You really build up that relationship; your husband, your partner, even my mum, knew my midwife, and that’s such an underrated blessing

Jessica George, a service user who was part of the POPPIE trial

Maternity care for women with social risk factors

The second presentation was led by Dr Hannah Rayment-Jones, research fellow, King’s College London, outlining findings from her PhD, which examined and compared models of maternity care that could improve clinical outcomes and experiences for women and infants living socially complex lives (‘Project 20: maternity care for women with social risk factors’).

Dr Rayment-Jones highlighted some of the social risk factors that are associated with poor birth outcomes (pictured below).

Explaining the context to her research, Dr Rayment-Jones said:

We don’t know the underlying causes of health inequalities for women; we don’t know what models of care improve women’s outcomes and how; who benefits the most; whether these models of care are safe and acceptable; and if they are stigmatising. Overall, there has been a lack of evaluation of these models

Dr Hannah Rayment-Jones, research fellow, King’s College London

Findings from a community-based continuity of care model in Lambeth

The final presentation was from the Lambeth Early Action Partnership (LEAP) caseload team, a community-based continuity of care model for women living in areas of social disadvantage and ethnic diversity in Lambeth (the LEAP team's work is pictured below).

Issy Bourton, the LEAP midwifery practice leader, outlined findings from the LEAP trial published in the BMJ. These findings show that the model of care significantly reduced preterm birth and birth by caesarean section when compared with traditional care:

  • Preterm birth rate in women allocated to caseload midwifery, compared with those who received traditional midwifery care (5.1% vs 11.2%)
  • Caesarean section births significantly reduced in women allocated to caseload midwifery care, when compared with traditional midwifery care (24.3% vs 38.0%)
  • This includes emergency caesarean deliveries (15.2% vs 22.5%).

There was then a panel discussion with all the presenters chaired by Zenab Barry, Chair of Council, National Maternity Voices and Co-Chair Chelsea and Westminster Maternity Voices Partnership.

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