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. 2024 Apr 10;4(4):CD004667.
doi: 10.1002/14651858.CD004667.pub6.

Midwife continuity of care models versus other models of care for childbearing women

Jane Sandall  1 , Cristina Fernandez Turienzo  1 , Declan Devane  2   3 , Hora Soltani  4 , Paddy Gillespie  5 , Simon Gates  6 , Leanne V Jones  7 , Andrew H Shennan  1 , Hannah Rayment-Jones  1
Affiliations

Midwife continuity of care models versus other models of care for childbearing women

Jane Sandall et al. Cochrane Database Syst Rev. .

Abstract

Background: Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016.

Objectives: To compare the effects of midwife continuity of care models with other models of care for childbearing women and their infants.

Search methods: We searched the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (17 August 2022), as well as the reference lists of retrieved studies.

Selection criteria: All published and unpublished trials in which pregnant women are randomly allocated to midwife continuity of care models or other models of care during pregnancy and birth.

Data collection and analysis: Two authors independently assessed studies for inclusion criteria, scientific integrity, and risk of bias, and carried out data extraction and entry. Primary outcomes were spontaneous vaginal birth, caesarean section, regional anaesthesia, intact perineum, fetal loss after 24 weeks gestation, preterm birth, and neonatal death. We used GRADE to rate the certainty of evidence.

Main results: We included 17 studies involving 18,533 randomised women. We assessed all studies as being at low risk of scientific integrity/trustworthiness concerns. Studies were conducted in Australia, Canada, China, Ireland, and the United Kingdom. The majority of the included studies did not include women at high risk of complications. There are three ongoing studies targeting disadvantaged women. Primary outcomes Based on control group risks observed in the studies, midwife continuity of care models, as compared to other models of care, likely increase spontaneous vaginal birth from 66% to 70% (risk ratio (RR) 1.05, 95% confidence interval (CI) 1.03 to 1.07; 15 studies, 17,864 participants; moderate-certainty evidence), likelyreduce caesarean sections from 16% to 15% (RR 0.91, 95% CI 0.84 to 0.99; 16 studies, 18,037 participants; moderate-certainty evidence), and likely result in little to no difference in intact perineum (29% in other care models and 31% in midwife continuity of care models, average RR 1.05, 95% CI 0.98 to 1.12; 12 studies, 14,268 participants; moderate-certainty evidence). There may belittle or no difference in preterm birth (< 37 weeks) (6% under both care models, average RR 0.95, 95% CI 0.78 to 1.16; 10 studies, 13,850 participants; low-certainty evidence). We arevery uncertain about the effect of midwife continuity of care models on regional analgesia (average RR 0.85, 95% CI 0.79 to 0.92; 15 studies, 17,754 participants, very low-certainty evidence), fetal loss at or after 24 weeks gestation (average RR 1.24, 95% CI 0.73 to 2.13; 12 studies, 16,122 participants; very low-certainty evidence), and neonatal death (average RR 0.85, 95% CI 0.43 to 1.71; 10 studies, 14,718 participants; very low-certainty evidence). Secondary outcomes When compared to other models of care, midwife continuity of care models likely reduce instrumental vaginal birth (forceps/vacuum) from 14% to 13% (average RR 0.89, 95% CI 0.83 to 0.96; 14 studies, 17,769 participants; moderate-certainty evidence), and may reduceepisiotomy 23% to 19% (average RR 0.83, 95% CI 0.77 to 0.91; 15 studies, 17,839 participants; low-certainty evidence). When compared to other models of care, midwife continuity of care models likelyresult in little to no difference inpostpartum haemorrhage (average RR 0.92, 95% CI 0.82 to 1.03; 11 studies, 14,407 participants; moderate-certainty evidence) and admission to special care nursery/neonatal intensive care unit (average RR 0.89, 95% CI 0.77 to 1.03; 13 studies, 16,260 participants; moderate-certainty evidence). There may be little or no difference in induction of labour (average RR 0.92, 95% CI 0.85 to 1.00; 14 studies, 17,666 participants; low-certainty evidence), breastfeeding initiation (average RR 1.06, 95% CI 1.00 to 1.12; 8 studies, 8575 participants; low-certainty evidence), and birth weight less than 2500 g (average RR 0.92, 95% CI 0.79 to 1.08; 9 studies, 12,420 participants; low-certainty evidence). We are very uncertain about the effect of midwife continuity of care models compared to other models of care onthird or fourth-degree tear (average RR 1.10, 95% CI 0.81 to 1.49; 7 studies, 9437 participants; very low-certainty evidence), maternal readmission within 28 days (average RR 1.52, 95% CI 0.78 to 2.96; 1 study, 1195 participants; very low-certainty evidence), attendance at birth by a known midwife (average RR 9.13, 95% CI 5.87 to 14.21; 11 studies, 9273 participants; very low-certainty evidence), Apgar score less than or equal to seven at five minutes (average RR 0.95, 95% CI 0.72 to 1.24; 13 studies, 12,806 participants; very low-certainty evidence) andfetal loss before 24 weeks gestation (average RR 0.82, 95% CI 0.67 to 1.01; 12 studies, 15,913 participants; very low-certainty evidence). No maternal deaths were reported across three studies. Although the observed risk of adverse events was similar between midwifery continuity of care models and other models, our confidence in the findings was limited. Our confidence in the findings was lowered by possible risks of bias, inconsistency, and imprecision of some estimates. There were no available data for the outcomes: maternal health status, neonatal readmission within 28 days, infant health status, and birth weight of 4000 g or more. Maternal experiences and cost implications are described narratively. Women receiving care from midwife continuity of care models, as opposed to other care models, generally reported more positive experiences during pregnancy, labour, and postpartum. Cost savings were noted in the antenatal and intrapartum periods in midwife continuity of care models.

Authors' conclusions: Women receiving midwife continuity of care models were less likely to experience a caesarean section and instrumental birth, and may be less likely to experience episiotomy. They were more likely to experience spontaneous vaginal birth and report a positive experience. The certainty of some findings varies due to possible risks of bias, inconsistencies, and imprecision of some estimates. Future research should focus on the impact on women with social risk factors, and those at higher risk of complications, and implementation and scaling up of midwife continuity of care models, with emphasis on low- and middle-income countries.

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Conflict of interest statement

Jane Sandall: Jane Sandall was Head of Maternity and Midwifery Research NHS England 2/21‐8/23. She is also a member of the WHO Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child, adolescent health, and nutrition. JS was Chief Investigator on the study Fernandez Turienzo 2020, and had no involvement in the assessment of this trial for the review.

Cristina Fernandez Turienzo: CFT was lead author on Fernandez Turienzo 2020, and had no involvement in the assessment of this trial for the review.

Declan Devane: Declan Devane is Director of Evidence Synthesis Ireland, Scientific Director of Cochrane Ireland, but had no involvement in the editorial processing of this review. DD was an author on Begley 2011. He had no involvement in the assessment of this trial for the review.

Hora Soltani: no known conflict of interest.

Simon Gates: no known conflict of interest. Simon was the Statistical Editor for Cochrane Pregnancy and Childbirth but had no involvement in the editorial processing of this review.

Paddy Gillespie: no known conflict of interest.

Leanne Jones: Leanne Jones was the Acting Managing Editor of Cochrane Pregnancy and Childbirth but had no involvement in the editorial processing of this review. Leanne is currently a Managing Editor within the Evidence Production & Methods Directorate for the Cochrane Central Executive, but again had no involvement in the editorial or peer review processing of this review.

Andrew Shennan: Andrew Shennan is chair of the FIGO preterm birth committee and has advised WHO in this capacity. He leads a NIHR global health research group. AS was co‐investigator on Fernandez Turienzo 2020, and had no involvement in the assessment of this trial for the review.

Hannah Rayment‐Jones: no known conflict of interest.

Figures

1
1
Applying the Cochrane Pregnancy and Childbirth Trustworthiness Screening Tool
2
2
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 1: Spontaneous vaginal birth (as defined by trial authors)
1.2
1.2. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 2: Caesarean birth
1.3
1.3. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 3: Regional analgesia (epidural/spinal)
1.4
1.4. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 4: Intact perineum
1.5
1.5. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 5: Fetal loss at or after 24 weeks gestation
1.6
1.6. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 6: Preterm birth (< 37 weeks)
1.7
1.7. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 7: Neonatal death (baby born alive at any gestation and dies within 28 days)
1.8
1.8. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 8: Healthy mother
1.9
1.9. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 9: Maternal death
1.10
1.10. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 10: Induction of labour
1.11
1.11. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 11: Instrumental vaginal birth (forceps/vacuum)
1.12
1.12. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 12: Episiotomy
1.13
1.13. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 13: Third or fourth degree tear
1.14
1.14. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 14: Postpartum haemorrhage (as defined by trial authors)
1.15
1.15. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 15: Breastfeeding initiation
1.16
1.16. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 16: Maternal readmission within 28 days
1.17
1.17. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 17: Neonatal readmission within 28 days
1.18
1.18. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 18: Attendance at birth by known midwife
1.19
1.19. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 19: Healthy baby
1.20
1.20. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 20: Birth weight less than 2500 g
1.21
1.21. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 21: Birth weight equal to or more than 4000 g
1.22
1.22. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 22: Apgar score less than or equal to 7 at 5 minutes
1.23
1.23. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 23: Admission to special care nursery/neonatal intensive care unit
1.24
1.24. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 24: Fetal loss before 24 weeks gestation
1.25
1.25. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 25: Maternal experience
1.26
1.26. Analysis
Comparison 1: Midwife continuity models versus other models of care for childbearing women and their infants (all), Outcome 26: Cost
2.1
2.1. Analysis
Comparison 2: Midwife continuity models versus other models of care: variation in midwifery models of care (caseload or team), Outcome 1: Spontaneous vaginal birth (as defined by trial authors)
2.2
2.2. Analysis
Comparison 2: Midwife continuity models versus other models of care: variation in midwifery models of care (caseload or team), Outcome 2: Caesarean birth
2.3
2.3. Analysis
Comparison 2: Midwife continuity models versus other models of care: variation in midwifery models of care (caseload or team), Outcome 3: Regional analgesia (epidural/spinal)
2.4
2.4. Analysis
Comparison 2: Midwife continuity models versus other models of care: variation in midwifery models of care (caseload or team), Outcome 4: Intact perineum
2.5
2.5. Analysis
Comparison 2: Midwife continuity models versus other models of care: variation in midwifery models of care (caseload or team), Outcome 5: Fetal loss at or after 24 weeks gestation
2.6
2.6. Analysis
Comparison 2: Midwife continuity models versus other models of care: variation in midwifery models of care (caseload or team), Outcome 6: Preterm birth (< 37 weeks)
2.7
2.7. Analysis
Comparison 2: Midwife continuity models versus other models of care: variation in midwifery models of care (caseload or team), Outcome 7: Neonatal death (baby born alive at any gestation and dies within 28 days)
3.1
3.1. Analysis
Comparison 3: Midwife continuity models versus other models of care: variation in obstetric and medical risk factors (low versus mixed), Outcome 1: Spontaneous vaginal birth (as defined by trial authors)
3.2
3.2. Analysis
Comparison 3: Midwife continuity models versus other models of care: variation in obstetric and medical risk factors (low versus mixed), Outcome 2: Caesarean birth
3.3
3.3. Analysis
Comparison 3: Midwife continuity models versus other models of care: variation in obstetric and medical risk factors (low versus mixed), Outcome 3: Regional analgesia (epidural/spinal)
3.4
3.4. Analysis
Comparison 3: Midwife continuity models versus other models of care: variation in obstetric and medical risk factors (low versus mixed), Outcome 4: Intact perineum
3.5
3.5. Analysis
Comparison 3: Midwife continuity models versus other models of care: variation in obstetric and medical risk factors (low versus mixed), Outcome 5: Fetal loss at or after 24 weeks gestation
3.6
3.6. Analysis
Comparison 3: Midwife continuity models versus other models of care: variation in obstetric and medical risk factors (low versus mixed), Outcome 6: Preterm birth (< 37 weeks)
3.7
3.7. Analysis
Comparison 3: Midwife continuity models versus other models of care: variation in obstetric and medical risk factors (low versus mixed), Outcome 7: Neonatal death (baby born alive at any gestation and dies within 28 days)
5.1
5.1. Analysis
Comparison 5: Midwife continuity models versus other models of care: variation in country setting (very high Human Development Index (HDI) > 0.8 versus high, medium, and low HDI), Outcome 1: Spontaneous vaginal birth (as defined by trial authors)
5.2
5.2. Analysis
Comparison 5: Midwife continuity models versus other models of care: variation in country setting (very high Human Development Index (HDI) > 0.8 versus high, medium, and low HDI), Outcome 2: Caesarean birth
5.3
5.3. Analysis
Comparison 5: Midwife continuity models versus other models of care: variation in country setting (very high Human Development Index (HDI) > 0.8 versus high, medium, and low HDI), Outcome 3: Regional analgesia (epidural/spinal)
5.4
5.4. Analysis
Comparison 5: Midwife continuity models versus other models of care: variation in country setting (very high Human Development Index (HDI) > 0.8 versus high, medium, and low HDI), Outcome 4: Intact perineum
5.5
5.5. Analysis
Comparison 5: Midwife continuity models versus other models of care: variation in country setting (very high Human Development Index (HDI) > 0.8 versus high, medium, and low HDI), Outcome 5: Fetal loss at or after 24 weeks gestation
5.6
5.6. Analysis
Comparison 5: Midwife continuity models versus other models of care: variation in country setting (very high Human Development Index (HDI) > 0.8 versus high, medium, and low HDI), Outcome 6: Preterm birth (< 37 weeks)
5.7
5.7. Analysis
Comparison 5: Midwife continuity models versus other models of care: variation in country setting (very high Human Development Index (HDI) > 0.8 versus high, medium, and low HDI), Outcome 7: Neonatal death (baby born alive at any gestation and dies within 28 days)
See this image and copyright information in PMC

Update of

References

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MacVicar 1993 {published data only}
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Turnbull 1996 {published data only}
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Waldenstrom 2001 {published data only}
    1. Waldenstrom U, Brown S, McLachlan H, Forster D, Brennecke S. Does team midwife care increase satisfaction with antenatal, intrapartum, and postpartum care? A randomized controlled trial. Birth 2000;27(3):156-67. - PubMed
    1. Waldenstrom U, McLachlan H, Forster D, Brennecke S, Brown S. Team midwife care: maternal and infant outcomes. Australian and New Zealand Journal of Obstetrics and Gynaecology 2001;41(3):257-64. - PubMed

References to studies excluded from this review

Allen 2013 {published data only}
    1. Allen J, Stapleton H, Tracy S, Kildea S. Is a randomised controlled trial of a maternity care intervention for pregnant adolescents possible? An Australian feasibility study. BMC Medical Research Methodology 2013;13:138. - PMC - PubMed
Bagheri 2021 {published data only}
    1. Bagheri A, Simbar M, Samimi M, Nahidi F, Alavimajd H, Sadat Z. Comparing the Implications of midwifery-led care and standard model on maternal and neonatal outcomes during pregnancy, childbirth and postpartum. Journal of Midwifery & Reproductive Health 2021;9(3):1-10. [CENTRAL: CN-02309182]
    1. IRCT201408318801N9. Development and evaluating a model of continuous midwifery care during pregnancy, labor and postpartum, an action research study [Evaluation the effect of continuous midwifery care model during pregnancy, labor and postpartum on maternal and neonatal]. http://www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT201408318801N9 (first received 2016). [CENTRAL: CN-01850113]
Bergland 1998 {published data only}
    1. Berglund A, Lindmark G. Midwife managed care - impact on use of health services: and area-based randomised controlled trial. In: XVI FIGO World Congress of Obstetrics & Gynecology . Vol. Book 4. Washington DC USA, 2000:116.
    1. Berglund A, Lindmark GC. Health services effects of a reduced routine programme for antenatal care. European Journal of Obstetrics & Gynecology and Reproductive Biology 1998;77(2):193-9. - PubMed
Bergland 2007 {published data only}
    1. Berglund A, Lindberg M, Nystrom L, Lindmark G. Combining the perspectives of midwives and doctors improves risk assessment in early pregnancy. Acta Obstetricia et Gynecologica Scandinavica 2007;86(2):177-84. - PubMed
Bernitz 2011 {published data only}
    1. Bernitz S, Aas E, Oian P. Economic evaluation of birth care in low-risk women. A comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Norway. A randomised controlled trial. Midwifery 2012;28(5):591-9. - PubMed
    1. Bernitz S, Rolland R, Blix E, Jacobsen M, Sjoborg K, Oian P. Is the operative delivery rate in low-risk women dependent on the level of birth care? A randomised controlled trial. BJOG: International journal of obstetrics and gynaecology 2011;118(11):1357-64. - PMC - PubMed
    1. Bernitz S, Rolland R, Blix E, Jacobsen M, Sjoborg K, Oian PL. Is the operative delivery rate in low-risk women dependent on birth care level? A randomised controlled trial. Acta Obstetricia et Gynecologica Scandinavica 2012;91(159):45-6.
Brugha 2016 {published data only}ISRCTN72346869
    1. Brugha TS, Smith J, Austin J, Bankart J, Patterson M, Lovett C, et al. Can community midwives prevent antenatal depression? An external pilot study to test the feasibility of a cluster randomized controlled universal prevention trial. Psychological Medicine 2016;46(2):345-56. [CENTRAL: CN-01200735] [PMID: ] - PMC - PubMed
Byrne 2000 {published data only}
    1. Byrne JP, Crowther CA, Moss JR. A randomised controlled trial comparing birthing centre care with delivery suite care in Adelaide, Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology 2000;40(3):268-74. [DOI: 10.1111/j.1479-828x.2000.tb03333.x] - DOI - PubMed
Chambliss 1991 {published data only}
    1. Chambliss L, Daly C, Medearis AL, Ames M, Turnquist R, Kayne M, et al. Significant differences in cesarean birth rates for resident physician and nurse midwife services are the result of selection criteria. American Journal of Obstetrics and Gynecology 1991;164:313.
    1. Chambliss LR, Daly C, Medearis AL, Ames M, Kayne M, Paul R. The role of selection bias in comparing cesarean birth rates between physician and midwifery management. Obstetrics & Gynecology 1992;80(2):161-5. - PubMed
Chapman 1986 {published data only}
    1. Chapman MG, Jones M, Spring JE, De Swiet M, Chamberlain GVP. The use of a birthroom: a randomized controlled trial comparing delivery with that in the labour ward. British Journal of Obstetrics and Gynaecology 1986;93:182-7. - PubMed
de Wolff 2021 {published data only}
    1. De Wolff M, Midtgaard J, Johansen M, Rom L, Tabor A, Hegaard H. A midwife-coordinated maternity care intervention (ChroPreg) vs. standard care for pregnant women with chronic medical conditions: results from a randomized controlled trial. European Journal of Obstetrics and Gynecology and Reproductive Biology 2022;270:e84. [CENTRAL: CN-02421972] [EMBASE: 2017204835]
    1. De Wolff MG, Johansen M, Ersboll AS, Rosthoj S, Brunsgaard A, Midtgaard J, et al. Efficacy of a midwife-coordinated, individualized, and specialized maternity care intervention (ChroPreg) in addition to standard care in pregnant women with chronic disease: protocol for a parallel randomized controlled trial. Trials 2019;20(1):291. [CENTRAL: CN-01956269] [EMBASE: 627902223] [PMID: ] - PMC - PubMed
    1. Hegaard HK. Pregnancy and chronic disease: the effect of a midwife-coordinated maternity care Intervention [Efficacy of a midwife-coordinated, individualized, and specialized maternity care intervention (ChroPreg) in addition to standard care in pregnant women with chronic disease: a parallel randomized controlled trial]. https://clinicaltrials.gov/show/NCT03511508 2018. [CENTRAL: CN-02047550] - PMC - PubMed
    1. Wolff MG, Midtgaard J, Johansen M, Rom AL, Rosthoj S, Tabor A, et al. Effects of a midwife-coordinated maternity care intervention (Chropreg) vs. standard care in pregnant women with chronic medical conditions: results from a randomized controlled trial. International Journal of Environmental Research and Public Health 2021;18(15):7875. [CENTRAL: CN-02291979] [EMBASE: 2007881315] [PMID: ] - PMC - PubMed
Famuyide 2014 {published data only}
    1. Famuyide A. OB Nest; redefining continuity of care for expectant mothers. http://clinicaltrials.gov/ 2014.
Forster 2022 {published data only}
    1. Forster. Exploring the impact of midwife-led group antenatal care on caesarean section rates and infant health: a multi-site randomised controlled trial. ACTRN12622000607774. https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12622000607774 2022. [CENTRAL: CN-02424850]
Giles 1992 {published data only}
    1. Giles W, Collins J, Ong F, MacDonald R. Antenatal care of low risk obstetric patients by midwives. Medical Journal of Australia 1992;157:158-61. - PubMed
Hailemeskel 2021 {published data only}
    1. Hailemeskel S, Alemu K, Christensson K, Tesfahun E, Lindgren H. Health care providers’ perceptions and experiences related to midwife-led continuity of care–a qualitative study. PLOS One 2021;16(10):e0258248. - PMC - PubMed
    1. Hailemeskel S, Alemu K, Christensson K, Tesfahun E, Lindgren H. Midwife-led continuity of care improved maternal and neonatal health outcomes in North Shoazone, Amhararegional state, Ethiopia: a quasi-experimental study. Women and Birth 2021;3:340-8. [DOI: 10.1016/j.wombi.2022.01.005] - DOI - PubMed
    1. Hailemeskel S, Alemu K, Christensson K, Tesfahun E, Lindgren H. Midwife-led continuity of care increases women’s satisfaction with antenatal, intrapartum, and postpartum care: North Shoa, Amhara regional state, Ethiopia: a quasi-experimental study. Women and Birth 2022;20(35):553-62. - PubMed
Hans 2018 {published data only}
    1. Hans SL, Edwards RC, Zhang Y. Randomized controlled trial of doula-home-visiting services: impact on maternal and infant health. Maternal and Child Health Journal 2018;22(Suppl 1):105-13. [CENTRAL: CN-01650829] [EMBASE: 624237872] [PMID: ] - PMC - PubMed
Heins 1990 {published data only}
    1. Heins HC, Nance NW, McCarthy BJ, Efird CM. A randomized trial of nurse-midwifery prenatal care to reduce low birth weight. Obstetrics & Gynecology 1990;75:341-5. - PubMed
Hildingsson 2003 {published data only}
    1. Hildingsson I, Waldenstrom U, Radestad I. Swedish women's interest in home birth and in-hospital birth center care. Birth 2003;30(1):11-22. - PubMed
Hundley 1994 {published data only}
    1. Hundley VA, Cruickshank FM, Lang GD, Glazener CMA, Milne JM, Turner M, et al. Midwife managed delivery unit: a randomised controlled comparison with consultant led care. BMJ 1994;309:1400-4. - PMC - PubMed
    1. Hundley VA, Cruickshank FM, Milne JM, Glazener CMA, Lang GD, Turner M, et al. Satisfaction and continuity of care: staff views of care in a midwife‐managed delivery unit. Midwifery 1995;11:163-73. - PubMed
    1. Hundley VA, Donaldson C, Lang GD, Cruickshank FM, Glazener CMA, Milne JM, et al. Costs of intrapartum care in a midwife managed delivery unit and a consultant led labour ward. Midwifery 1995;11:103-9. - PubMed
James 1988 {published data only}
    1. James DK. A comparison of a schematic approach to antenatal care and conventional shared care. Personal communication 1988.
Kelly 1986 {published data only}
    1. Kelly J. Comparison of two different methods of delivering antenatal care, one with components provided by an obstetrician, the other by a midwife. Personal communication 1986.
Kildea 2017 {published data only}
    1. Kildea S, Simcock G, Liu A, Elgbeili G, Laplante DP, Kahler A, et al. Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study. Archives of Women's Mental Health 2018;21(2):203-14. [CENTRAL: CN-01656702] [EMBASE: 618503182] - PubMed
Kildea 2021 {published data only}
    1. Kildea S, Gao Y, Hickey S, Nelson C, KruskeS, Carson A, et al. Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial. Lancet Global Health 2021;1(9):e651-9. - PubMed
Klein 1984 {published data only}
    1. Klein M, Papageorgiou AN, Westreich R, Spector-Dunsky L, Elkins V, Kramer MS, et al. Care in a birth room vs a conventional setting: a controlled trial. Canadian Medical Association Journal 1984;131:1461-6. - PMC - PubMed
Law 1999 {published data only}
    1. Law YY, Lam KY. A randomized controlled trial comparing midwife-managed care and obstetrician-managed care for women assessed to be at low risk in the initial intrapartum period. Journal of Obstetrics & Gynaecology Research 1999;25:107-12. - PubMed
Li 2015 {published data only}
    1. Li YP, Yeh CH, Lin SY, Chen TC, Yang YL, Lee CN, et al. A proposed mother-friendly childbirth model for taiwanese women, the implementation and satisfaction survey. Taiwanese Journal of Obstetrics & Gynecology 2015;54(6):731-6. [CENTRAL: CN-01200475] [PMID: ] - PubMed
Lin 2020 {published data only}
    1. Lin X, Yang T, Zhang X, Wei W. Lifestyle intervention to prevent gestational diabetes mellitus and adverse maternal outcomes among pregnant women at high risk for gestational diabetes mellitus. Journal of International Medical Research 2020;48(12):300060520979130. [CENTRAL: CN-02268776] [PMID: ] - PMC - PubMed
Loy 2021 {published data only}
    1. Loy SL, Thilagamangai, Teo J, Chan SW, Razak NKA, Chay OM, et al. A Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) for first-time families: study protocol of a three-arm randomised controlled trial. Trials 2021;22(1):1-10. [CENTRAL: CN-02265376] [EMBASE: 2010705084] [PMID: ] - PMC - PubMed
    1. NCT04275765. Community enabled readiness for first 1000 days learning ecosystem. https://clinicaltrials.gov/show/NCT04275765 (first received 19 February 2020). [CENTRAL: CN-02088295]
Michel‐Schuldt 2021 {published data only}
    1. Michel-Schuldt M. Midwife-Led Care in Low-and Middle-Income Countries with a Focus on Implementation in Bangladesh. Doctoral dissertation 2021.
Mohammad‐Alizadeh‐Charandabi 2019 {published data only}
    1. Mohammad-Alizadeh-Charandabi S. Effect of continuous care model from pregnancy to postpartum by midwifery students [The effect of implementing the continuous care model by midwifery students during pregnancy, childbirth, and postpartum on childbirth experience, fear of childbirth, and postpartum depression]. https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20100414003706N41 2019. [CENTRAL: CN-02410556]
Morrison 2002 {published data only}
    1. Morrison J, Neale L, Taylor R, McCowan L. Caring for pregnant women with diabetes. British Journal of Midwifery 2002;10(7):434-9. [DOI: 10.12968/bjom.2002.10.7.10587] - DOI
Mortensen 2018 {published data only}
    1. Mortensen B, Diep LM, Lukasse M, Lieng M, Dwekat I, Elias D, et al. Women’s satisfaction with midwife-led continuity of care: an observational study in Palestine. BMJ Open 2019;9(11):e030324. - PMC - PubMed
    1. Mortensen B, Lieng M, Diep LM, Lukasse M, AtiehK, Fosse E. Improving maternal and neonatal health by a midwife-led continuity model of care–an observational study in one governmental hospital in Palestine. EClinicalMedicine 2019;1(10):84-91. - PMC - PubMed
    1. Mortensen B, Lukasse M, Diep LM, Lieng M, Abu-Awad A, Suleiman M, et al. Can a midwife-led continuity model improve maternal services in a low-resource setting? A non-randomised cluster intervention study in Palestine. BMJ Open 2018;3(8):e019568. - PMC - PubMed
    1. Mortensen B. Making midwifery matter -the introduction of a midwife-led continuity model of care in occupied Palestine. Doctoral thesis 2020.
Nagle 2011 {published data only}
    1. Nagle C, Skouteris H, Hotchin A, Bruce L, Patterson D, Teale G. Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial. BMC Public Health 2011;11:174. - PMC - PubMed
    1. Nagle C. The impact of continuity of care on weight gain in obese pregnant women. ACTRN12610001078044 8 December 2010.
Qiu 2020 {published data only}
    1. Qiu J, Liu Y, Zhu W, Zhang C. Comparison of effectiveness of routine antenatal care with a midwife-managed clinic service in prevention of gestational diabetes mellitus in early pregnancy at a hospital in China. Medical Science Monitor 2020;26:e925991. [CENTRAL: CN-02277357] [PMID: ] - PMC - PubMed
Ridgeway 2015 {published data only}
    1. Baron AM, Ridgeway JL, Stirn SL, Morris MA, Branda ME, Inselman JW, et al. Increasing the connectivity and autonomy of RNs with low-risk obstetric patients. American Journal of Nursing 2018;1(118):48-55. - PubMed
    1. Ridgeway JL, LeBlanc A, Branda M, Harms RW, Morris MA, Nesbitt K, et al. Implementation of a new prenatal care model to reduce office visits and increase connectivity and continuity of care: protocol for a mixed-methods study. BMC Pregnancy and Childbirth 2015;15:1. - PMC - PubMed
    1. Tobah YS, LeBlanc A, Branda ME, Inselman JW, Morris MA, Ridgeway JL, et al. Randomized comparison of a reduced-visitprenatal care model enhanced with remote monitoring. American Journal of Obstetrics and Gynecology 2019;1(221):638. - PubMed
    1. Mooij MJ, Hodny RL, O'Neil DA, Gardner MR, Beaver M, Brown AT, et al. OB Nest: reimagining low-risk prenatal care. Mayo Clinic Proceedings 2018;93(4):458-66. - PubMed
Runnerstrom 1969 {published data only}
    1. Runnerstrom L. The effectiveness of nurse-midwifery in a supervised hospital environment. Bulletin of the American College of Midwives 1969;14:40-52. - PubMed
Slome 1976 {published data only}
    1. Slome C, Wetherbee H, Daly M, Christensen K, Meglen M, Thiede H. Effectiveness of certified nurse-midwives. A prospective evaluation study. American Journal of Obstetrics and Gynecology 1976;124:177-82. - PubMed
Stevens 1988 {published data only}
    1. Stevens A. A randomised trial of community antenatal care in Birmingham. Oxford Database of Perinatal Trials Registration 1988.
Tucker 1996 {published data only}
    1. Ratcliffe J, Ryan M, Tucker J. The costs of alternative types of routine antenatal care for low-risk women: shared care vs care by general practitioners and community midwives. Journal of Health Services & Research Policy 1996;1:135-40. - PubMed
    1. Tucker JS, Hall MH, Howie PW, Reid ME, Barbour RS, Florey CD, et al. Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians. BMJ 1996;312:554-9. - PMC - PubMed
Waldenstrom 1997 {published data only}
    1. Gottvall K, Waldenstrom U. Does birth center care during a woman's first pregnancy have any impact on her future reproduction? Birth 2002;29(3):177-81. - PubMed
    1. Waldenstrom U, Nilsson CA, Winbladh B. The Stockholm birth centre trial: maternal and infant outcome. British Journal of Obstetrics and Gynaecology 1997;104:410-8. - PubMed
    1. Waldenstrom U, Nilsson CA. A randomized controlled study of birth center care versus standard maternity care: effects on women's health. Birth 1997;24:17-26. - PubMed
    1. Waldenstrom U, Nilsson CA. Experience of childbirth in birth center care: a randomized controlled study. Acta Obstetricia et Gynecologica Scandinavica 1994;73:547-54. - PubMed
    1. Waldenstrom U, Nilsson CA. No effect of birth centre care on either duration or experience of breast feeding, but more complications: findings from a randomised controlled trial. Midwifery 1994;10:8-17. - PubMed
Walker 2012 {published data only}
    1. Walker D, Demaria L, Gonzalez-Hernandez D, Padron-Salas A, Romero-Alvarez M, Suarez L. Are all skilled birth attendants created equal? A cluster randomised controlled study of non-physician based obstetric care in primary health care clinics in Mexico. Midwifery 2013;29(10):1199-205. - PubMed
    1. Walker DM, DeMaria L, Suarez L, Gonzales D, Romero M, Padron A. Are all skilled birth attendants created equal? Evidence from Mexico? International Journal of Gynecology and Obstetrics 2012;119(3):S516-7.
Wiggins 2020 {published data only}
    1. Wiggins M, Sawtell M, Wiseman O, McCourt C, Eldridge S, Hunter R, et al. Group antenatal care (Pregnancy Circles) for diverse and disadvantaged women: study protocol for a randomised controlled trial with integral process and economic evaluations. BMC Health Services Research 2020;20(1):919. [CENTRAL: CN-02191692] [EMBASE: 633136011] [PMID: ] - PMC - PubMed
Zelani 2011 {published data only}
    1. Zelani BD. Effectiveness of a midwife led continuity of antenatal care caseload model on preterm birth and maternal satisfaction among women in Malawi. http://www.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12621000008820 2021. [CENTRAL: CN-02238621]

References to studies awaiting assessment

Zhang 2016 {published data only}
    1. Zhang T, Liu C. Comparison between continuing midwifery care and standard maternity care in vaginal birth after cesarean. Pakistan Journal of Medical Sciences 2016;32(3):711-4. [DOI: 10.12669/pjms.323.9546] - DOI - PMC - PubMed

References to ongoing studies

Cullinane 2021 {published data only}
    1. Cullinane D. Exploring the impact of caseload midwifery on preterm birth among vulnerable and disadvantaged women: a multi-centre randomised controlled trial. http://www.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12621001211853 2021. [CENTRAL: CN-02327273]
Dickerson 2022 {published data only}
    1. Dickerson. Does the midwife-led continuity of carer model improve birth outcomes and maternal mental health in vulnerable women? [Effectiveness of a midwife-led continuity of carer model on birth outcomes and maternal mental health in vulnerable women: study protocol for a randomised controlled trial with an internal pilot and process and economic evaluations]. https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN31836167 2022. [CENTRAL: CN-02429872] - PMC - PubMed
Xiaojiao 2020 {published data only}
    1. Xiaojiao. Development and implementation of midwife-based care model for urban women with uncomplicated pregnancies: a randomized controlled trial. http://www.who.int/trialsearch/Trial2.aspx?TrialID=ChiCTR2000033459 2020. [CENTRAL: CN-02166314]

Additional references

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