Abstract
Background
In a low-resource setting, information on the effect of midwife-led continuity of
care (MLCC) is limited. Therefore, this study aimed to determine the effect of MLCC
on maternal and neonatal health outcomes in the Ethiopian context.
Method
A study with a quasi-experimental design was conducted from August 2019 to September
2020 in four primary hospitals of the north Shoa zone, Amhara regional state, Ethiopia.
A total of 1178 low risk women were allocated to one of two groups; the midwife-led
continuity of care (MLCC or intervention group) (received all antenatal, labour, birth,
and immediate postnatal care from a single midwife or backup midwife) (n = 589) and
the Shared model of care (SMC or comparison group) (received care from different staff
members at different times) (n = 589). The two outcomes studied were Spontaneous vaginal
birth and preterm birth. Outcome variables were compared using multivariate generalized
linear models (GLMs) and reported using adjusted risk ratios (aRR) with 95% confidence
intervals.
Findings
Women in MLCC were, in comparison with women in the SMC group more likely to have
spontaneous vaginal birth (aRR of 1.198 (95% CI 1.101–1.303)). Neonates of women in
MLCC were in comparison with those in SMC less likely to be preterm (aRR of 0.394;
95% CI (0.227–0.683)).
Conclusion
In this study, use of the MLCC model improved maternal and neonatal health outcomes.
To scale up and further investigate the effect and feasibility of this model in a
low resource setting could be of considerable importance in Ethiopia and other Sub-Saharan
Africa countries.
Keywords
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References
- Midwife-led continuity models versus other models of care for childbearing women.Cochrane Database Syst. Rev. 2016; 4: Cd004667
- WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience.World Health Organization, 2016
- The Contribution of Continuity of Midwifery Care to High Quality Maternity Care.The Royal College of Midwives, London2014
- Midwife-led versus other models of care for childbearing women.Cochrane Database Syst. Rev. 2008; 4
- The state of the world’s midwifery report—a universal pathway.A Woman’s Right to Health. United Nations Population Fund, New York2014
- Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study.Lancet Glob. Health. 2021; 9: e24-e32
- Ethiopia Demographic and Health Survey Addis Ababa, Ethiopia, and Rockville, Maryland, USA 2017.CSA and ICF, 2016
- Ethiopia Mini Demographic and Health Survey 2019: Key Indicators.EPHI and ICF, Rockville, Maryland, USA2019
- Health Sector Transformation Plan.(Addis Ababa, Ethiopia October)2015
- Quality of care for pregnant women and newborns—the WHO vision.BJOG: Int. J. Obstet. Gynaecol. 2015; 122: 1045
- Midwife led units: transforming maternity care globally.Ann. Glob. Health. 2020; 86
- Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care.BMC Pregnancy Childbirth. 2016; 16: 1-15
- What prevents quality midwifery care? A systematic mapping of barriers in low and middle income countries from the provider perspective.PLoS One. 2016; 11 (e0153391)
- Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview.BMJ Open. 2014; 4
- Standards for Improving Quality of Maternal and Newborn Care in Health Facilities.2016
- Population Projection of Ethiopia for All Regions at Wereda Level from 2014–2017.(August)2013
- North Shoa Zonal Heath Department Report.2018
- A comparison of partnership caseload midwifery care with conventional team midwifery care: labour and birth outcomes.Midwifery. 2001; 17: 234-240
- Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes.BMC Pregnancy Childbirth. 2014; 14: 46
- Getting the first birth right: a retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital.Women Birth. 2015; 28: 279-284
- A comparison of frequency of medical interventions and birth outcomes between the midwife led unit and the obstetric unit in low-risk primiparous women.Obzornik zdravstvene nege. 2014; 48
- An investigation of the relationship between the caseload model of midwifery for socially disadvantaged women and childbirth outcomes using routine data—a retrospective, observational study.Midwifery. 2015; 31: 409-417
- Linking obstetric and midwifery practice with optimal outcomes.J. Obstet. Gynecol. Neonatal. Nurs. 2006; 35: 779-785
- Comparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomised trial.BMC Pregnancy Childbirth. 2011; 11: 85
- Comparison of midwife-led care and obstetrician-led care on maternal and neonatal outcomes in Singapore: a retrospective cohort study.Midwifery. 2017; 53: 71-79
- Does team midwife care increase satisfaction with antenatal, intrapartum, and postpartum care? A randomized controlled trial.Birth. 2000; 27: 156-167
- Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study.BMJ Open. 2018; 8e019509
- A summary of a Cochrane review: midwife-led care for childbearing women.Eur. J. Integr. Med. 2016; 8: 19
- Mothers’ views of caseload midwifery and the value of continuity of care at an Australian regional hospital.Midwifery. 2010; 26: 615-621
- Team midwifery care in a tertiary level obstetric service: a randomized controlled trial.Birth. 2000; 27: 168-173
- Midwife-led continuity models versus other models of care for childbearing women.Pract. Midwife. 2013; 16: 39-40
- Episiotomy for vaginal birth.Cochrane Database Syst. Rev. 1999; 3: CD000081
- Obstetric anal sphincter injury: incidence, risk factors, and management.Ann. Surg. 2008; 247: 224-237
- Views of Chinese women and health professionals about midwife-led care in China.Midwifery. 2011; 27: 842-847
- Essential competencies for midwifery practice 2019 update.ICN: 2019. 2019;
- A comparison between early maternal and neonatal complications of restrictive episiotomy and routine episiotomy in primiparous vaginal delivery.J. Res. Med. Sci. 2011; 16: 1583
- Improving maternal and neonatal health by a midwife-led continuity model of care—an observational study in one governmental hospital in Palestine.EClinicalMedicine. 2019; 10: 84-91
- Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.Lancet. 2016; 388: 2176-2192
- Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta-analysis.BMJ Open. 2016; 6
- A comparison of midwife-led and medical-led models of care and their relationship to adverse fetal and neonatal outcomes: a retrospective cohort study in New Zealand.PLoS Med. 2016; 13e1002134
- Improving quality and safety in maternity care: the contribution of midwife-led care.J. Midwifery Womens Health. 2010; 55: 255-261
- Factors associated with early initiation and exclusive breastfeeding practices among mothers of infant’s age less than 6 months.J. Pediatr. Neonatal Care. 2017; 7: 00292
- Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials.Lancet Glob. Health. 2016; 4: e266-e275
- The provision of midwife-led care in low-and middle-income countries: an integrative review.Midwifery. 2020; 84102659
- Midwifery 2030: a woman’s pathway to health. What does this mean?.Midwifery. 2016; 32: 1-6
Article info
Publication history
Published online: September 03, 2021
Accepted:
August 24,
2021
Received in revised form:
August 24,
2021
Received:
June 24,
2021
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
