The Cochrane Making a Difference series focuses on stories of how Cochrane evidence has made an impact on real-world health decision making and outcomes. This story focuses on the improved outcomes that women and infants experience in pregnancy and delivery when they are cared for by a midwife that they know.
A Cochrane Review on continuity of midwife care was first published in 2004, and most recently updated in 2016. As more trials have been added to the Cochrane Review, uncertainties in the original findings have been reduced. The current evidence demonstrates that women who have received continuity of care from a midwife they know, rather than receiving medical-led or shared care, are:
- 24% less likely to experience preterm birth,
- 19% less likely to lose their baby before 24 weeks' gestation, and
- 16% less likely to lose their baby at any gestation.
These women are also more likely to have a vaginal birth, fewer interventions during birth (instrumental birth, amniotomy, epidural and episiotomy), and are likely to have a more positive experience of labour and birth. These findings apply to both low- and mixed-risk populations of women, and there are no significant differences in outcomes between caseload and team care models.
Both the World Health Organization and the UK’s Department of Health have identified this Cochrane Review as a priority topic for updating. Its findings have had a significant influence on recent policy developments in relation to maternity care in the UK and beyond:
- Evidence from the review has also been cited in Better births - Improving outcomes of maternity services in England, the National Maternity Review for England published in February 2016.
- Evidence from this review has also informed the Joint Royal College of Obstetricians and Gynaecologists/Royal College of Midwives statement on multi-disciplinary working and continuity of carer published in April 2016.
- The results were cited as a key piece of evidence to inform models of care in Creating a Better Future Together - National Maternity Strategy 2016-2026, the first national maternity strategy for Ireland, which was published in January 2016.
- Internationally, the Cochrane Review has been cited in the Lancet Midwifery Series, which aims to inform workforce and health system development plans under the United Nations' Post-2015 Development Agenda.
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