Midwife continuity of care: A systematic review and meta-analysis of case-control and cohort studies

Randomised controlled trials demonstrated the effectiveness of midwife continuity of care. Further assessment can be achieved by extending causal inference to non-randomised data and study designs for comparative research.

To evaluate the association of midwife continuity of care compared with other models of maternity care during the perinatal period (pregnancy, birth, postpartum) on labour/birth, maternal and neonatal outcomes, and the relationship between midwife continuity of care moderators and outcomes.

Systematic review and meta-analysis of non-randomised cohort studies with a comparison group and case-control studies.

Literature was searched across five databases, and additional hand-searching was conducted using institutional catalogues and Google Scholar. Study details and absolute numbers were extracted, and relative risks (RR) with 95 % confidence intervals (95 % CI) were calculated. Meta-analyses were conducted using a random-effects model when five or more studies reported the same outcome. Additional sensitivity and publication bias analyses, and moderator tests were performed.

Thirteen studies were included in 17 meta-analyses. Midwife continuity of care was associated with a higher likelihood of spontaneous vaginal birth (RR 1.16, 95 % CI 1.07 to 1.26) and a lower risk of caesarean birth (RR 0.72, 95 % CI 0.62 to 0.84), elective caesarean section (RR 0.54, 95 % CI 0.35 to 0.82), labour induction (RR 0.78, 95 % CI 0.64 to 0.96), regional analgesia (RR 0.71, 95 % CI 0.57 to 0.90), and episiotomy (RR 0.62, 95 % CI 0.52 to 0.75). Women who received midwife continuity of care were less likely to give birth before 37 weeks (RR 0.60, 95 % CI 0.49 to 0.74), and less likely to have neonates with an Apgar score below 7 at 5 min (RR 0.69, 95 % CI 0.53 to 0.90), a birthweight under 2500 g (RR 0.63, 95 % CI 0.50 to 0.79), or neonates being admitted (RR 0.51, 95 % CI 0.48 to 0.78). The overall risk of bias across studies was low. Influential studies and outliers were detected, affecting the outcomes of amniotomy, induction of labour, and elective caesarean section. Medical, obstetric, or psychosocial complexity, the continuity of care continuum, team size, and the midwife's workload moderate labour and birth outcomes.

Midwife continuity of care is associated with significant labour and birth, maternal, and neonatal outcomes. Addressing the moderators could further optimise the benefits of midwife continuity of care.

CRD42024495200.