Models of maternity care: evidence for midwifery continuity of care

Abstract

There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects. Non-randomised studies have shown benefits of midwifery continuity of care for specific groups, such as Aboriginal and Torres Strait Islander women. There are also benefits for midwives, including high levels of job satisfaction and less occupational burnout. Implementing midwifery continuity of care in public and private settings in Australia has been challenging, despite the evidence in its favour and government policy documents that support it. A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.

Women’s experiences and satisfaction with having a cesarean birth: An integrative review

“…56,59 In addition, models of midwifery continuity of care may be valuable in supporting effective communication and play an important role in supporting women to feel less out of control and more satisfied with their cesarean birth experience. 60,61 This review provides an overview of the field, systematically analyzed by two reviewers for both content and quality. Furthermore, the integrative nature of this review synthesizes information from both quantitative and qualitative methodologies to provide insight into women's experiences of having a cesarean birth.…”

Obstetric and neonatal outcomes for women intending to use immersion in water for labour and birth in Western Australia (2015–2016): A retrospective audit of clinical outcomes

“…The study was conducted between July 2015 and June 2016 at the sole tertiary public maternity hospital in WA which annually has approximately 5200 births. At the time of the study, women wanting to labour or birth in water were cared for by midwives working within a low-risk midwifery continuity of care caseload model, 19 based in a birth centre, a building adjacent to the tertiary obstetric centre. Ethics approval was granted (2016127QK).…”

Risk and the politics of boundary work: preserving autonomous midwifery in the Netherlands

“…As such, a richer understanding the SGKL's work will be a useful guide for the current efforts to understand and, where necessary, reform Dutch MNC. The insights gained from our study can also inform policies elsewhere, especially given the current call for the implementation of midwifeled models of care (Homer, 2016;Renfrew et al, 2014;Sandall et al, 2016); an approach that is recommended by the World Health Organization (2018) and is gaining traction around the world, including in England, Scotland and Australia (Homer, 2016; The Royal College of Midwives, 2016; The Scottisch Government, 2017).…”