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

Abstract

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.