10 Apr Midwife continuity of care models linked to positive experiences during pregnancy
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10 April 2024
Midwife continuity of care models linked to positive experiences during pregnancy
Researchers at ARC South London have found that women who experienced midwife continuity of care models are more likely to experience a spontaneous vaginal birth, less likely to experience a caesarean section or instrumental birth, and report more positive experiences during pregnancy.
Updated Cochrane Review — 10 April 2024
An updated Cochrane Review led by Professor Jane Sandall and colleagues, building on previous ARC South London research, compares how outcomes differed for women or their babies who received a midwife continuity of care model versus other models of care.
Midwife continuity of care models provide care from the same midwife or team of midwives during pregnancy, birth, and the early parenting period — in collaboration with obstetric and specialist teams when needed. These models have been a key approach to transforming maternity services in England since 2016, with the aim of making birth safer, more personalised, and equitable.
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studies involving 18,533 women in Australia, Canada, China, Ireland and the UK analysed
Key findings
The review found that women receiving midwife continuity of care models were:
to experience spontaneous vaginal birth
to experience a caesarean section
to experience an instrumental birth (forceps/vacuum)
to report positive experiences during pregnancy, labour and after birth
Additionally, midwife continuity of care provides benefits for health services through cost savings in the antenatal and intrapartum periods.
“The studies included models of care that offered intrapartum care in hospitals, midwife birth centres co-located in a maternity unit, and home birth. We found that midwife continuity of care models, as compared to other models of care, increase spontaneous vaginal birth, reduce caesarean sections and instrumental vaginal birth (forceps/vacuum), and may reduce episiotomy.”
ARC South London maternity and perinatal mental health research lead
Areas of uncertainty and no difference
Although the review found clear benefits, there was uncertainty about the effect of continuity of care models compared with other models of care on:
Fetal loss at or after 24 weeks gestation
Neonatal death
Third or fourth-degree tear
Maternal readmission within 28 days of birth
The researchers also found that midwife continuity models resulted in little to no difference in preterm birth, intact perineum, postpartum haemorrhage, and admission to special care nursery or neonatal intensive care unit.
Implications for future research
The review suggests that further evidence may change the results, and that future research should prioritise:
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The impact of midwife continuity of care models on women with social risk factors
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Women at higher risk of complications
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Evidence from low- and middle-income countries
“Maternity and perinatal mental health researchers at the ARC are carrying out work in this area, exploring the benefits of midwife continuity models for diverse groups of women, including women at risk of preterm birth, and women belonging to ethnic minorities or living in disadvantaged areas.”
ARC South London maternity and perinatal mental health research lead
Policy context
The findings provide further evidence supporting a call for midwife continuity of care models outlined in recent UK policies, all of which have tackling health inequalities as a key focus and priority:
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Better Births Review (2016)
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Core20PLUS5 — NHS England’s approach to reducing healthcare inequalities
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Read the full Cochrane Review
Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews (2024). doi:10.1002/14651858.CD004667.pub6
Further ARC South London research in this area
- →
Poppie trial (included in this Cochrane Review)
Findings published from first trial of continuity of midwife care for women at risk of preterm birth — women at higher risk of preterm birth in Lewisham - →
Project20 — women with social risk factors
How do women with social risk factors experience United Kingdom maternity care? A realist synthesis - →
LEAP cohort study — Lambeth
Clinical outcomes for women with social risk factors in a deprived area of Lambeth receiving a community-based midwifery continuity of care model — BMJ Open - →
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.
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