Midwifery continuity of care: A scoping review of where, how, by whom and for whom?

Abstract

Systems of care that provide midwifery care and services through a continuity of care model have positive health outcomes for women and newborns. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? Using a scoping review framework, we searched electronic and grey literature databases for reports in any language between January 2012 and January 2022, which described current and recent trials, implementation or scaling-up of midwifery continuity of care studies or initiatives in high-, middle- and low-income countries. After screening, 175 reports were included, the majority (157, 90%) from high-income countries (HICs) and fewer (18, 10%) from low- to middle-income countries (LMICs). There were 163 unique studies including eight (4.9%) randomised or quasi-randomised trials, 58 (38.5%) qualitative, 53 (32.7%) quantitative (cohort, cross sectional, descriptive, observational), 31 (19.0%) survey studies, and three (1.9%) health economics analyses. There were 10 practice-based accounts that did not include research. Midwives led almost all continuity of care models. In HICs, the most dominant model was where small groups of midwives provided care for designated women, across the antenatal, childbirth and postnatal care continuum. This was mostly known as caseload midwifery or midwifery group practice. There was more diversity of models in low- to middle-income countries. Of the 175 initiatives described, 31 (18%) were implemented for women, newborns and families from priority or vulnerable communities. With the exception of New Zealand, no countries have managed to scale-up continuity of midwifery care at a national level. Further implementation studies are needed to support countries planning to transition to midwifery continuity of care models in all countries to determine optimal model types and strategies to achieve sustainable scale-up at a national level.

Author response to “Pitfalls of analyzing perinatal outcomes by health care provider”

“…Regarding the lack of biological plausibility, other research studies and reviews have found reduced perinatal mortality rates and preterm birth rates for midwife-led continuity of care (MLCC) models, compared with medical-led or shared-care models (see citations in our paper and also the scoping review by Bradford and colleagues 5 ). When the World Health Organization recommended MLCC in 2016, they wrote that they made this recommendation despite the fact that “the mechanism for the probable reduction in preterm birth and perinatal death is unclear.” 6 They explain, “MLCC models are complex interventions and it is unclear whether the pathway of influence producing these positive effects is the continuity of care, the midwifery philosophy of care or both.” 6…”

Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs

“…Several interventions have been implemented to improve continuity, for example, MCH booklets introduced in Angola 18. Previous reviews on MCH in high-income countries have also emphasised the importance of strengthening continuity, highlighting this as a priority area for research in LMICs 19…”

The effect of a midwifery continuity of care program on clinical competence of midwifery students and delivery outcomes: a mixed-methods protocol

“…Continuity of midwifery care has become a global effort to enable women to have access to high-quality maternity care and delivery services [ 3 ]. As a result, many service providers today are transitioning to a continuous care model [ 4 ], and they have considered continuous care to be necessary for realizing women's rights [ 5 ]. Also, continuous midwifery care is known as the gold standard in maternity care to achieve excellent results for women [ 5 , 6 ].…”

“…Providing high quality care requires enhancing the clinical competence of the professionals [ 4 ]. There is a close relationship between the concept of patient care quality and clinical competence.…”