Midwifery Continuity of Care During Pregnancy, Birth, and the Postpartum Period: A Matched Cohort Study.

OBJECTIVE

To compare pregnancy outcomes in a midwifery continuity of care (MCoC) model to standard midwifery care in Sweden.

DESIGN

Matched cohort study.

SETTING

Public healthcare during pregnancy and childbirth, Stockholm, Sweden.

POPULATION: Women giving birth at Karolinska University Hospital site Huddinge in Stockholm between January 1, 2019, and August 31, 2021.

METHODS

Data on all births including MCoC and standard care, during the time period, were retrieved from the national Swedish Pregnancy Register. Propensity score matching was applied to obtain a matched set from the standard care group for every woman in the MCoC model. Based on the matched cohort, we estimated risk ratios (RR) for binary outcomes with 95% confidence intervals (CI).

MAIN OUTCOME MEASURES: Interventions during labor, mode of birth, and preterm birth (< 37 gestational weeks).

RESULTS

Compared with standard care, women in the MCoC model were more likely to give birth spontaneously (RR 1.06 95% CI 1.02-1.10) and less likely to have an elective cesarean on maternal request (RR 0.24 95% CI 0.11-0.51). The risk of preterm birth was also reduced in the MCoC group (RR 0.51 95% CI 0.32-0.82).

CONCLUSION

The MCoC model was associated with fewer medical interventions and improved pregnancy outcomes.