24 Nov Caseload midwifery significantly reduces rates of preterm birth and caesarean
Home › News & insights › Latest news
24 November 2021
Caseload midwifery significantly reduces rates of preterm birth and caesarean
A new study by a team at Guy’s and St Thomas’ NHS Foundation Trust and the ARC’s maternity researchers shows that a model of caseload midwifery care implemented in disadvantaged areas of Lambeth significantly reduced preterm birth and birth by caesarean section when compared with traditional care.
About the study
A retrospective cohort study published in BMJ Open, November 2021. Carried out in Lambeth, where more than 90% of residents are in the two most deprived quintiles of the English Index of Multiple Deprivation (IMD) (2019) and the population is ethnically diverse.
This retrospective cohort study examined whether birth outcome inequality can be reduced using targeted caseload midwifery — where women receive care from a named midwife and team throughout their pregnancy, birth, and the postnatal period.
523
pregnant women in the LEAP area — 293 traditional care and 230 caseload midwifery
Research aims
✓
Report maternal and newborn outcomes of pregnant women in areas of social deprivation in inner-city London
✓
Compare the effect of caseload midwifery vs standard care on maternal and newborn outcomes in this cohort
Key findings
Preterm birth rate
Caseload midwifery
vs
Traditional care
Emergency caesarean
Caseload midwifery
vs
Traditional care
All caesarean sections
Caseload midwifery
vs
Traditional care
No increase in adverse outcomes
Reductions achieved without an increase in neonatal unit admission or stillbirth
About the LEAP caseload midwifery team
Participants were women booked for antenatal care from Guy’s and St Thomas’ NHS Foundation Trust from 11 July 2018 — when the award-winning Lambeth Early Action Partnership (LEAP) caseload midwifery team, currently led by Isabelle Bourton, was set up — until data collection on 18 June 2020.
“This real-world study shows that a model of caseload midwifery care implemented in an inner-city area of deprivation and ethnic diversity improves outcomes by significantly reducing preterm birth and birth by caesarean section when compared with traditional care. These findings, as well as our previous NIHR funded research, such as the PoPPIE study and Project 2020, are informing the rollout and implementation of targeted midwife continuity of care for these groups in the NHS Long Term Plan.
“We know very little about the longer term impact, and our ARC research (CONNECT) is following up the women and their babies into the first year of life. This study is an excellent example of research driven by local need and priorities that has both national and international relevance. Further research is needed to determine whether the improvements seen will translate to other inner-city populations with similar demographics. We are working with researchers in Sweden and Australia to develop a large prospective trial, and with the WHO on the relevance of this model of care internationally.”
ARC co-lead for maternity and perinatal mental health research, King’s College London; Head of Midwifery and Maternity Research, NHS England and Improvement
📄
Read the full paper
Birth outcome inequality in an inner city London area: a retrospective cohort study comparing a model of caseload midwifery and standard care
Related content
- →
Models of maternity care for women living in areas of ethnic diversity and social disadvantage (LEAP/CONNECT) - →
Continuous care from community-based midwives reduces risk of preterm birth by 45% — January 2026 follow-up research - →
Midwife continuity of care models linked to positive experiences during pregnancy — updated Cochrane Review - →
Maternity and perinatal mental health research at ARC South London
Original source: arc-sl.nihr.ac.uk — NIHR ARC South London legacy content archived May 2026.