Midwifery continuity of care versus standard maternity care for women at increased risk of preterm birth: A hybrid implementation–effectiveness, randomised controlled pilot trial in the UK

Turienzo, Cristina Fernandez; Bick, Debra; Briley, Annette; Bollard, Mary; Coxon, Kirstie; Cross, Pauline; Silverio, Sergio A.; Singh, Claire; Seed, Paul; Tribe, Rachel M.; Shennan, Andrew; Sandall, Jane

doi:10.1371/journal.pmed.1003350

Cited by 31 publications

(48 citation statements)

References 15 publications

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“…Interview data came from a less diverse demographic sample compared to the survey data and this possibly limits richness and breath in the data, particularly for some sub-groups of women. The main pilot trial included a highrisk population with more than one quarter of women in both groups having one or more preexisting medical conditions and multiple obstetric and social risk factors for PTB [14]. Since people who are socially disadvantaged and have complex needs, and those from ethnic minority groups are less likely to engage in research follow up [47], further investigations should focus on community participatory research working in partnership with women with more complex needs who have multiple clinical and social risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…The results of the first pilot randomised controlled trial to evaluate a model of midwifery continuity of care linked with a specialist obstetric clinic for women at increased risk for PTB were recently published [14]. When assessing feasibility, fidelity and clinical outcomes, authors found that it was feasible to set up and maintain fidelity to the model indicating that a full scale RCT is possible, but the model did not improve the clinical composite outcome of appropriate and timely interventions for the prevention and/or management of preterm labour and birth, in this setting, for this very high-risk population group.…”

Section: Introductionmentioning

confidence: 99%

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Experiences of maternity care among women at increased risk of preterm birth receiving midwifery continuity of care compared to women receiving standard care: Results from the POPPIE pilot trial

et al. 2021

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Background Midwifery continuity of care models for women at low and mixed risk of complications have been shown to improve women’s experiences of care. However, there is limited research on care experiences among women at increased risk of preterm birth. We aimed to explore the experiences of care among women with risk factors for preterm birth participating in a pilot trial (POPPIE) of a midwifery continuity of care model which included a specialist obstetric clinic. Methods A total of 334 pregnant women identified at increased risk of preterm birth were randomly allocated to either midwifery continuity of care (POPPIE group) or standard maternity care. Women in both groups were followed up at six-to-eight weeks postpartum and were invited to complete a postnatal survey either online or by post. An equal status exploratory sequential mixed method design was chosen to collect and analyse the quantitative postnatal survey data and qualitative interviews data. The postnatal survey included measures of social support, trust, perceptions of safety, quality of care, control during childbirth, bonding and quality of life. Categorical data were analysed with chi-squared tests and continuous data were analysed with t-tests and/or Mann-Whitney U test to measure differences in measures scores among groups. The qualitative interview data were subjected to a thematic framework analysis. Data triangulation brought quantitative and qualitative data together at the interpretation stage. Findings A total of 166 women completed the survey and 30 women were interviewed (90 and 16 in POPPIE group; 76 and 14 in standard group). We found survey respondents in the POPPIE group, compared to respondents in the standard group, were significantly more likely to report greater trust in midwives (Mann-Whitney U, p<0.0001), greater perceptions of safety during the antenatal care (t-test, p = 0.0138), have a particular midwife to contact when they needed during their pregnancy (t-test, p<0.0001) and the postnatal period (chi-squared, p<0.0001). They reported increased involvement in decisions regarding antenatal, intrapartum and postnatal care (t-test, p = 0.002; p = 0.008; p = 0.006 respectively); and greater postnatal support and advice about: feeding the baby (chi-squared, p<0.0001), handling, settling and looking after the baby (chi-squared, p<0.0001), baby’s health and progress (chi-squared, p = 0.039), their own health and recovery (chi-squared, p = 0.006) and who to contact about any emotional changes (chi-squared, p = 0.005). There were no significant differences between groups in the reporting of perceptions of safety during birth and the postnatal period, concerns raised during labour and birth taken seriously, being left alone during childbirth at a time of worries, control during labour, bonding, social support, and physical and mental health related quality of life after birth. Results from qualitative interviews provided insight and depth into many of these findings, with women in the POPPIE group reporting more positive experiences of bonding towards their babies and more positive physical health postnatally. Conclusions Compared with standard maternity care, women at increased risk of PTB who received midwifery continuity of care were more likely to report increased perceptions of trust, safety and quality of care. Trial registration ISRCTN (Number: 37733900); UK CRN (ID: 31951).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experiences of maternity care among women at increased risk of preterm birth receiving midwifery continuity of care compared to women receiving standard care: Results from the POPPIE pilot trial

et al. 2021

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“…Skin-to-skin contact, sometimes referred to as 'kangaroo care', can be defined as 'placing a naked infant onto the bare chest of the mother' [100] the benefits of which include improved adaptation to extrauterine life, stimulation of the digestive system and hormone release leading to improved feeding, protection against infection, reduced cortisol levels, and parent-infant bonding [100][101][102][103]. A recently published trial of a specialist continuity model of care for women at risk of preterm birth found those women randomised to the intervention were significantly more likely to have skin-to-skin contact after birth and to have it for a longer time [104]. Although the underlying mechanisms for these outcomes remain unclear and warrant further research, the phenomenon could be explained using Lipsky's [105] street level bureaucracy theory in that when midwives know women and are invested in them and their outcomes, they are more likely to provide gold standard practice.…”

Section: Plos Onementioning

confidence: 99%

Project20: Does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study

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Background Social factors associated with poor childbirth outcomes and experiences of maternity care include minority ethnicity, poverty, young motherhood, homelessness, difficulty speaking or understanding English, migrant or refugee status, domestic violence, mental illness and substance abuse. It is not known what specific aspects of maternity care work to improve the maternal and neonatal outcomes for these under-served, complex populations. Methods This study aimed to compare maternal and neonatal clinical birth outcomes for women with social risk factors accessing different models of maternity care. Quantitative data on pregnancy and birth outcome measures for 1000 women accessing standard care, group practice and specialist models of care at two large, inner-city maternity services were prospectively collected and analysed using multinominal regression. The level of continuity of care and place of antenatal care were used as independent variables to explore these potentially influential aspects of care. Outcomes adjusted for women’s social and medical risk factors and the service attended. Results Women who received standard maternity care were significantly less likely to use water for pain relief in labour (RR 0.11, CI 0.02–0.62) and have skin to skin contact with their baby shortly after birth (RR 0.34, CI 0.14–0.80) compared to the specialist model of care. Antenatal care based in the hospital setting was associated with a significant increase in preterm birth (RR 2.38, CI 1.32–4.27) and low birth weight (RR 2.31, CI 1.24–4.32), and a decrease in induction of labour (RR 0.65, CI 0.45–0.95) compared to community-based antenatal care, this was despite women’s medical risk factors. A subgroup analysis found that preterm birth was increased further for women with the highest level of social risk accessing hospital-based antenatal care (RR 3.11, CI1.49–6.50), demonstrating the protective nature of community-based antenatal care. Conclusions This research highlights how community-based antenatal care, with a focus on continuity of carer reduced health inequalities and improved maternal and neonatal clinical outcomes for women with social risk factors. The findings support the current policy drive to increase continuity of midwife-led care, whilst adding that community-based care may further improve outcomes for women at increased risk of health inequalities. The relationship between community-based models of care and neonatal outcomes require further testing in future research. The identification of specific mechanisms such as help-seeking and reduced anxiety, to explain these findings are explored in a wider evaluation.

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“…This is in line with our findings from the pregnancy domain of the PCQ Personal treatment, which contains items related to the relationship with the midwife and perceived involvement in the decision-making process, rated higher in the intervention group. In the previous studies [18,19,49,50], satisfaction was measured in midwifery continuity of care models, where known midwives provide continuity of care throughout the childbearing experience from antenatal intrapartum and postpartum care [18,19,55] for women at both high and low risk. The ChroPreg intervention included only continuity of care provided by a known specialized midwife throughout all antenatal and postnatal consultations but not intrapartum, which may explain why we found no difference in satisfaction with care during birth.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial

Wolff

Midtgaard

Johansen

et al. 2021

IJERPH

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The proportion of childbearing women with pre-existing chronic medical conditions (CMC) is rising. In a randomized controlled trial, we aimed to evaluate the effects of a midwife-coordinated maternity care intervention (ChroPreg) in pregnant women with CMC. The intervention consisted of three main components: (1) Midwife-coordinated and individualized care, (2) Additional ante-and postpartum consultations, and (3) Specialized known midwives. The primary outcome was the total length of hospital stay (LOS). Secondary outcomes were patient-reported outcomes measuring psychological well-being and satisfaction with maternity care, health utilization, and maternal and infant outcomes. A total of 362 women were randomized to the ChroPreg intervention (n = 131) or Standard Care (n = 131). No differences in LOS were found between groups (median 3.0 days, ChroPreg group 0.1% lower LOS, 95% CI −7.8 to 7%, p = 0.97). Women in the ChroPreg group reported being more satisfied with maternity care measured by the Pregnancy and Childbirth Questionnaire (PCQ) compared with the Standard Care group (mean PCQ 104.5 vs. 98.2, mean difference 6.3, 95% CI 3.0–10.0, p < 0.0001). In conclusion, the ChroPreg intervention did not reduce LOS. However, women in the ChroPreg group were more satisfied with maternity care.

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Midwifery continuity of care versus standard maternity care for women at increased risk of preterm birth: A hybrid implementation–effectiveness, randomised controlled pilot trial in the UK

Cited by 31 publications

References 15 publications

Experiences of maternity care among women at increased risk of preterm birth receiving midwifery continuity of care compared to women receiving standard care: Results from the POPPIE pilot trial

Experiences of maternity care among women at increased risk of preterm birth receiving midwifery continuity of care compared to women receiving standard care: Results from the POPPIE pilot trial

Project20: Does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study

Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial

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