Back
Science

Community Midwife Care Linked to Reduced Preterm Birth and Improved Maternal Outcomes

Generated on: Last updated: 2 sources
View source

Midwife Continuity of Care Linked to Reduced Preterm Birth, Improved Maternal and Infant Outcomes

A recent study published in BJOG: An International Journal of Obstetrics & Gynaecology indicates that continuous, community-based care from midwives may significantly reduce the risk of preterm birth and enhance various maternal and infant outcomes. Conducted by King's College London and funded by the National Institute for Health Research (NIHR), the research focused on women in South London, an area marked by high ethnic diversity and social disadvantage.

The study suggests that continuous, community-based care from midwives may significantly reduce the risk of preterm birth and enhance various maternal and infant outcomes.

Study Overview: Embracing Community-Based Midwife Continuity of Care

The study evaluated the effects of Community-Based Midwife Continuity of Care (CBMCOC) models in comparison to standard care, analyzing data collected from 2018 to 2020. Dr. Cristina Fernandez Turienzo, lead author from King's College London, underscored the research's focus on locality-based interventions that integrate both community-based care and midwife continuity.

In the CBMCOC model, a dedicated team of midwives provides comprehensive care throughout a woman's pregnancy, birth, and postnatal period, spanning both community and hospital settings. Midwives work closely with women and multidisciplinary teams, with referrals for obstetric care made according to standard guidelines when complications arise. In contrast, standard care models involve midwives, General Practitioners (GPs), and obstetricians sharing responsibility for organizing and delivering care from initial booking through the postnatal period, in either hospital, community, or both settings.

Methodology: A Rigorous Comparison

The analysis initially included 12,386 women who received standard care and 1,338 women who received CBMCOC. To ensure comparable populations, a propensity-matched analysis was performed, further comparing 5,352 women from the standard care group with the 1,338 women from the CBMCOC group. The study utilized the eLIXIR Partnership, which links healthcare data from various providers across South London, enabling a robust examination of care models.

Key Findings Unveiled

The study identified several positive outcomes strongly associated with the CBMCOC model:

  • Reduced Preterm Birth Risk:

    • Women receiving CBMCOC showed a lower risk of preterm birth. In the matched analysis, the risk was 4.6% for CBMCOC recipients compared to 8.4% for those in standard care.
    • This reduction was also significant among specific groups:
      • For women from Black, Asian, and other ethnic minority backgrounds, the risk decreased from 9.5% to 6.4%.
      • For women residing in the most socially deprived areas, the risk was reduced from 8.2% to 5.1%.

  • Improved Labor and Birth Outcomes: Women in the CBMCOC group were notably more likely to experience:

    • A spontaneous onset of labor (59% vs 47% in standard care).
    • A spontaneous vaginal birth (63% vs 49% in standard care).
    • Skin-to-skin contact after birth (85% vs 79% in standard care).

  • Reduced Interventions: Recipients of CBMCOC were less likely to undergo certain medical interventions:

    • Use of intrapartum analgesia/anaesthesia (9% vs 14%).
    • Induction of labor (24% vs 27%).
    • Caesarean birth (25% vs 36%).
    • Instrumental birth (11% vs 14%).

  • Infant Health: While no differences were observed in stillbirth or neonatal death rates, infants born to women in CBMCOC were less likely to be low birthweight or small for gestational age.

  • Antenatal Engagement and Support: Women in the CBMCOC group were less likely to miss antenatal appointments and more likely to receive necessary referrals for mental health support.

Policy Context and Future Considerations

Professor Jane Sandall, senior author and Professor of Social Science and Women's Health at King's College London, suggested that these findings offer a potential pathway to addressing inequities in maternity care. She highlighted that the model fosters stronger relationships between women and a small team of midwives, enabling care closer to home. Professor Sandall also noted the alignment of these findings with the NHS 10 Year Health Plan for England's objective of shifting care from hospital to community settings.

Despite these promising results, NHS England paused its national plan to implement Midwife Continuity of Carer in September 2022, citing staffing levels. Consequently, the CBMCOC model is currently available only in some NHS Trusts, meaning women do not universally have a choice in their care pathways.

Dr. Fernandez Turienzo emphasized the critical need for future trials to include women at greater social risk, a demographic that has historically been underrepresented in such studies, to further solidify the evidence base for these beneficial care models.