Midwife-led continuity models versus other models of care for childbearing women
Open accessAbstract
Analysis 1.17.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 17 Perineal laceration requiring suturing. . . . . . . . . . . . . . . . . . . . . .Analysis 1.18.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 18 Mean labour length (hrs). . . . . . . . . . . . . . . . . . . . . . . . . .Analysis 1.19.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 19 Postpartum haemorrhage (as defined by trial authors). . . . . . . . . . . . . . . .Analysis 1.20.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 20 Breastfeeding initiation. . . . . . . . . . . . . . . . . . . . . . . . . . .Analysis 1.21.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 21 Duration of postnatal hospital stay (days). . . . . . . . . . . . . . . . . . . .Analysis 1.22.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 22 Low birthweight (< 2500 g). . . . . . . . . . . . . . . . . . . . . . . . .Analysis 1.23.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 23 5-minute Apgar score below or equal to 7. . . . . . . . . . . . . . . . . . . .Analysis 1.24.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 24 Neonatal convulsions (as defined by trial authors). . . . . . . . . . . . . . . . .Analysis 1.25.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 25 Admission to special care nursery/neonatal intensive care unit. . . . . . . . . . . . .Analysis 1.26.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 26 Mean length of neonatal hospital stay (days).. . . . . . . . . . . . . . . . . .Analysis 1.27.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 27 Fetal loss less than 24 weeks and neonatal death. . . . . . . . . . . . . . . . . .Analysis 1.28.Comparison 1 Midwife-led versus other models of care for childbearing women and their infants (all), Outcome 28 Fetal loss equal to/after 24 weeks and neonatal death. . . . . . . . . . . . . . . .Analysis 2.1.Comparison 2 Midwife-led versus other models of care: variation in midwifery models of care (caseload/oneto-one or team), Outcome 1 Regional analgesia (epidural/spinal). . . . . . . . . . . . . . . . .Analysis 2.2.Comparison 2 Midwife-led versus other models of care: variation in midwifery models of care (caseload/oneto-one or team), Outcome 2 Caesarean birth. . . . . . . . . . . . . . . . . . . . . . . .Analysis 2.3.Comparison 2 Midwife-led versus other models of care: variation in midwifery models of care (caseload/oneto-one or team), Outcome 3 Instrumental vaginal birth (forceps/vacuum). . . . . . . . . . . . . .Analysis 2.4.Comparison 2 Midwife-led versus other models of care: variation in midwifery models of care (caseload/oneto-one or team), Outcome 4 Spontaneous vaginal birth (as defined by trial authors). . . . . . . . . .Analysis 2.5.Comparison 2 Midwife-led versus other models of care: variation in midwifery models of care (caseload/oneto-one or team), Outcome 5 Intact perineum. . . . . . . . . . . . . . . . . . . . . . . .Analysis 2.6.Comparison 2 Midwife-led versus other models of care: variation in midwifery models of care (caseload/oneto-one or team), Outcome 6 Preterm birth (< 37 weeks). . . . . . . . . . . . . . . . . . . .Analysis 2.7.Comparison 2 Midwife-led versus other models of care: variation in midwifery models of care (caseload/oneto-one or team), Outcome 7 All fetal loss before and after 24 weeks plus neonatal death. . . . . . . . .Analysis 3.1.Comparison 3 Midwife-led versus other models of care: variation in risk status (low versus mixed), Outcome 1 Regional analgesia (epidural/spinal). . . . . . . . . . . . . . . . . . . . . . . . . .Analysis 3.2.Comparison 3 Midwife-led versus other models of care: variation in risk status (low versus mixed), Outcome 2 Caesarean birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Analysis 3.3.Comparison 3 Midwife-led versus other models of care: variation in risk status (low versus mixed), Outcome 3 Instrumental vaginal birth (forceps/vacuum). . . . . . . . . . . . . . . . . . . . . . .Analysis 3.4.Comparison 3 Midwife-led versus other models of care: variation in risk status (low versus mixed), Outcome 4 Spontaneous vaginal birth (as defined by trial authors). . . . . . . . . . . . . . . . . . . .Analysis 3.5.Comparison 3 Midwife-led versus other models of care: variation in risk status (low versus mixed), Outcome 5 Intact perineum. . . . . . . . . . . . . . . . . . . . . . . . . .
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Mothers who receive care based on midwife-led continuity models were more satisfied and were less likely to experience intervention and adverse outcomes for themselves or their infants during the postnatal period than women who received other models of care.
“Mothers who receive care based on these continuity models were more satisfied and were less likely to experience intervention and adverse outcomes for themselves or their infants during the postnatal period than women who received other models of care [5]”
From Support during the postnatal period: Evaluating new mothers' and midwives' experiences of a new, coordinated postnatal care model in a midwifery clinic in Sweden (2023) · cites this paper as [5]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredContinuity models of midwifery care have clear benefits for the health of the mother and baby, as well as increased satisfaction and lower costs.
“A Cochrane review of 17,674 women in 15 scientific studies showed clear benefits for the health of the mother and baby, as well as increased satisfaction and lower costs [3].”
From Fulfilment of expectations on birth and the postpartum period – A Swedish cohort study (2022) · cites this paper as [3]
The Main results (page not provided) confirm that the review included 15 trials involving 17,674 women and found benefits including fewer preterm births and fewer fetal losses or neonatal deaths. They also report higher maternal satisfaction in most studies. However, the Main results describe only a trend toward cost savings, with inconsistent cost assessment, so the claim of lower costs as a clear benefit overstates the evidence. (LLM, conf=0.89)
Experimental — accuracy not yet measuredContinuity models result in better maternal and foetal outcomes and greater satisfaction compared to standard care.
“Continuity models not only result in better maternal and foetal outcomes but also a greater satisfaction compared to standard care [3].”
From Fulfilment of expectations on birth and the postpartum period – A Swedish cohort study (2022) · cites this paper as [3]
The Authors’ conclusions report fewer interventions and greater satisfaction with midwife-led continuity care, while describing adverse outcomes for women and infants as at least comparable. The Main results report reductions in some fetal outcomes but no difference in several others. Thus, the unqualified claim of better maternal and foetal outcomes overstates the review’s findings; the comparison was with other models of care, not solely standard care. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe countries that have more than others implemented the midwifery-led care model are Canada, Australia, United Kingdom and Sweden, Netherlands and Norway, and Denmark.
“The countries that have more than others implemented the midwifery-led care model are Canada (10), Australia (11), United Kingdom and Sweden (12), Netherlands and Norway (13), and Denmark (14).”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
The Background says that midwife-led continuity care is available in the United Kingdom. However, the review does not establish that the United Kingdom and Sweden have implemented it more than other countries; its Included studies section lists trials in four countries and does not include Sweden. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMidwife-led continuity models are associated with a lower frequency of preterm delivery (RR 0.76; RC 96%: 0.64; 8 trials, n=13238).
“preterm delivery: 8 trials, n= 13238; RR: 0.76; RC 96%: 0.64”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
The Summary of Findings reports fewer preterm births with midwife-led continuity care: RR 0.76 across 8 RCTs and 13,238 participants. It gives a 95% confidence interval of 0.64 to 0.91, not the quoted 96% interval, and the citing sentence omits the upper bound. (LLM, conf=0.88)
Experimental — accuracy not yet measured
In the midwife-centered model, the average duration of labour is longer (mean difference 0.50 hours; 95% CI 0.27-0.54; 3 trials, n=3328).
“major average duration of labour (3 trials, n= 3328; average difference in hours: 0.50; RC 95%: 0.27, 0.54)”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
Analysis 1.18 (p. 80) reports longer mean labour in the midwife-led group, with a mean difference of 0.50 hours across three trials and 3,328 participants. The cited 95% CI is 0.27–0.74, not 0.27–0.54; the upper bound in the claim is incorrect. (LLM, conf=0.95)
Experimental — accuracy not yet measuredIn the midwife-centered model, there is less recourse of analgesia/anesthesia during labour (RR 1.21; 95% CI 1.06-1.37; 7 trials, n=10499).
“less recourse of analgesia/anesthesia during labour (7 trials, n= 10499; RR: 1.21; RC 95%: 1.06, 1.37)”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
Midwife-led continuity models are associated with a lower frequency of regional analgesia (epidural/spinal) compared with standard models (RR 0.85; 95% CI 0.78-0.92; 14 trials, n=17674).
“Within the primary outcomes we can observe a minor frequency of regional analgesia (epidural/ spinal analgesia): 14 trials, n=17674; related risk (RR): 0.85; usually defined as 95% confidence interval (RC 95%): 0.78, 0.92”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
In the midwife-centered model, fetal loss/neonatal deaths before 24+0 weeks are less frequent (RR 0.81; 95% CI 0.67-0.98; 11 trials, n=15645).
“fetal loss/neonatal deaths before 24+0 weeks (11 trials, n= 15645; RR: 0.81; RC 95%: 0.67, 0.98)”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
In the midwife-centered model, episiotomy is less frequent (RR 0.84; 95% CI 0.77-0.92; 14 trials, n=17674).
“episiotomy (14 trials, n= 17674; RR: 0.84; RC 95%: 0.77, 0.92)”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
Women assisted by a midwife are more likely to have a spontaneous birth (RR 1.05; 95% CI 1.03-1.07; 12 trials, n=16687).
“Women assisted by a midwife are also more likely to have a spontaneous birth: 12 trials, n = 16687; RR: 1.05; IC 95%: 1.03, 1.07.”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
The starting point of the time limits of the research was set to 2016 because it dates back to that year a Cochrane review of Sandall and Coll. titled "Midwife-led continuity models versus other models of care for childbearing women".
“It was decided to set the starting point of the time limits of the research to 2016 as it dates back to that year a Cochrane review of Sandall and Coll. titled “Midwife-led continuity models versus other models of care for childbearing women” (11).”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
In the midwife-centered model, amniorexi is less frequent (RR 0.80; 95% CI 0.66-0.98; 4 trials, n=3253).
“less frequently amniorexi (4 trials, n =3253; RR: 0.80; RC 95%: 0.66, 0.98)”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
Midwife-led continuity models are associated with a lower frequency of fetal loss/neonatal deaths (RR 0.84; 95% CI 0.71-0.99; 13 trials, n=17561).
“fetal loss/ neonatal deaths: 13 trials, n= 17561; RR: 0.84; RC 95%: 0.71, 0.99”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
Midwife-led continuity models are associated with a lower frequency of operative vaginal delivery (forceps/vacuum) (RR 0.90; 95% CI 0.83-0.97; 13 trials, n=17501).
“operative vaginal delivery (forceps/ vacuum): 13 trials, n= 17501; RR: 0.90; RC 95%: 0.83, 0.97”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
The systematic review by Sandall et al. consists of 15 randomized controlled trials (n=17674 women) carried out in Australia, Canada, Ireland, and the United Kingdom, within publicly funded health systems.
“The revision consists of 15 randomized controlled trials (n= 17674 women), carried out in Australia, Canada, Ireland, United Kingdom, so within systems of health assistance financed by public money.”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
In the midwife-centered model, there is a higher probability of being assisted during delivery by known professionals (RR 7.04; 95% CI 4.48-11.08; 7 trials, n=6917).
“major probability of being assisted during delivery by a known professionals’ (7 trials, n= 6917; RR: 7.04; RC 95%: 4.48, 11.08)”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
No differences were seen between midwife-led and standard models in the percentage of C-sections, complete perineum, prenatal recoveries, pre-delivery hemorrhages, inductions, use of oxytocin during delivery, analgesia with opioids, beginning of breastfeeding, low weight at birth, Apgar score after 5 minutes ≤7, neonatal convulsions, recovery in NICU, and average duration of recovery.
“No differences were seen in terms of percentage of C-sections, complete perineum, prenatal recoveries, pre-delivery hemorrhages, inductions, use of oxytocin during delivery, analgesia with opioids, beginning of breastfeeding, low weight at birth, Apgar score after 5 minutes ≤7, neonatal convulsions, recovery in NICU, average duration of recovery.”
From The midwifery-led care model: a continuity of care model in the birth path (2019) · cites this paper as [11]
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The Effectiveness of Nurse‐Midwifery in A Supervised Hospital Environment *
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Changing Childbirth: a pilot project
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A new style of midwife-managed antenatal care: costs and satisfaction
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Can midwife-managed units improve continuity of care?
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A consumer-driven quality assurance model for midwifery
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Combining the perspectives of midwives and doctors improves risk assessment in early pregnancy
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The M@NGO Trial: Does caseload midwifery reduce caesarean section operation rates?
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O728 ARE ALL SKILLED BIRTH ATTENDANTS CREATED EQUAL? EVIDENCE FROM MEXICO
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Intrapartum care for women: A sub-study of the M@NGO RCT
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What matters to women during childbirth: A systematic qualitative review
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Worldwide prevalence of tocophobia in pregnant women: systematic review and meta‐analysis
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Self-citationWomen’s psychological experiences of physiological childbirth: a meta-synthesis
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Models of maternity care: evidence for midwifery continuity of care
Homer, C. S. (2016) · Medical Journal of Australia · doi:10.5694/mja16.00844 · Cited by 212 · see citing works
Midwife continuity of care models versus other models of care for childbearing women
Sandall, J., Fernandez Turienzo, C., Devane, D., Soltani, H., Gillespie, P., Gates, S., Jones, L. V., Shennan, A. H., & Rayment-Jones, H. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004667.pub6 · Cited by 192 · see citing works
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Sustaining quality midwifery care in a pandemic and beyond'
Renfrew, M. J., Cheyne, H., Craig, J., Duff, E., Dykes, F., Hunter, B., Lavender, T., Page, L., Ross-Davie, M., Spiby, H., et al. (2020) · Midwifery · doi:10.1016/j.midw.2020.102759 · Cited by 127 · see citing works
Midwifery continuity of care: a scoping review of where, how, by whom and for whom?
Bradford, B. F., Wilson, A. N., Portela, A., McConville, F., Fernandez Turienzo, C., & Homer, C. S. E. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000935 · Cited by 117 · see citing works
Continuity of GP care for patients with dementia: Impact on prescribing and the health of patients
Delgado, J., Evans, P. H., Gray, D. P., Sidaway-Lee, K., Allan, L., Clare, L., Ballard, C., Masoli, J., Valderas, J. M., & Melzer, D. (2022) · British Journal of General Practice · doi:10.3399/bjgp.2021.0413 · Cited by 70 · see citing works
Fernandez Turienzo, C., Bick, D., Briley, A. L., Bollard, M., Coxon, K., Cross, P., Silverio, S. A., Singh, C., Seed, P. T., Tribe, R. M., et al. (2020) · PLOS Medicine · doi:10.1371/journal.pmed.1003350 · Cited by 51 · see citing works
Self-citationKhosravi, S., Babaey, F., Abedi, P., Kalahroodi, Z. M., & Hajimirzaie, S. S. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04379-7 · Cited by 45 · see citing works
Comprehensive maternity support and shared care in Switzerland: Comparison of levels of satisfaction
Floris, L., Irion, O., Bonnet, J., Politis Mercier, M.-P., & de Labrusse, C. (2018) · Women and Birth · doi:10.1016/j.wombi.2017.06.021 · Cited by 43 · see citing works
Wernham, E., Gurney, J., Stanley, J., Ellison-Loschmann, L., & Sarfati, D. (2016) · PLOS Medicine · doi:10.1371/journal.pmed.1002134 · Cited by 37 · see citing works
Hainsworth, N., Dowse, E., Ebert, L., & Foureur, M. (2021) · Women and Birth · doi:10.1016/j.wombi.2020.12.003 · Cited by 30 · see citing works
The midwifery-led care model: a continuity of care model in the birth path
Ricchi, A., Rossi, F., Borgognoni, P., Bassi, M. C., Artioli, G., Foà, C., & Neri, I. (2019) · Acta bio-medica dell'Ateneo parmense/Acta biomedica · doi:10.23750/abm.v90i6-s.8621 · Cited by 24 · see citing works
International insights into peer support in a neonatal context: A mixed-methods study
Thomson, G., & Balaam, M.-C. (2019) · PLOS ONE · doi:10.1371/journal.pone.0219743 · Cited by 25 · see citing works
Goldkuhl, L., Gyllensten, H., Begley, C., Nilsson, C., Wijk, H., Lindahl, G., Uvnäs-Moberg, K., & Berg, M. (2023) · HERD: Health Environments Research & Design Journal · doi:10.1177/19375867221124232 · Cited by 18 · see citing works
Abdolalipour, S., Abbasalizadeh, S., Mohammad-Alizadeh-Charandabi, S., Abbasalizadeh, F., Jahanfar, S., Raphi, F., & Mirghafourvand, M. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-06449-4 · Cited by 19 · see citing works
Tickle, N., Gamble, J., & Creedy, D. K. (2021) · Women and Birth · doi:10.1016/j.wombi.2020.11.004 · Cited by 19 · see citing works
Mixed‐method study of women’s assessment and experience of childbirth care
Donate‐Manzanares, M., Rodríguez‐Cano, T., Rodríguez‐Almagro, J., Hernández‐Martínez, A., Santos‐Hernández, G., & Beato‐Fernández, L. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.14984 · Cited by 16 · see citing works
Blomgren, J., Gabrielsson, S., Erlandsson, K., Wagoro, M. C. A., Namutebi, M., Chimala, E., & Lindgren, H. (2023) · Midwifery · doi:10.1016/j.midw.2023.103734 · Cited by 13 · see citing works
Postnatal <scp>ER</scp> visits within 30 days—Pattern, risk factors and implications for care
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Fulfilment of expectations on birth and the postpartum period – A Swedish cohort study
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Moridi, A., Abedi, P., Iravani, M., Khosravi, S., Alianmoghaddam, N., Maraghi, E., & Saadati, N. (2023) · PLOS ONE · doi:10.1371/journal.pone.0283022 · Cited by 2 · see citing works
- Authors
- Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D.
- Affiliations
- St Thomas' Hospital (GB)
- Sheffield Hallam University (GB)
- University of Warwick (GB)
- Ollscoil na Gaillimhe – University of Galway (IE)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2016-04-28
- Volume
- 2016
- Issue
- 4
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- OpenAlex
- W4296980855
- Cited by
- 906
- References
- 99
- Citations by year
- 2026: 74 · 2025: 79 · 2024: 109 · 2023: 116 · 2022: 110 · 2021: 94 · 2020: 107 · 2019: 77 · 2018: 61 · 2017: 49 · 2016: 20 · 2015: 8 · 2014: 2
- FWCI
- 12.19
- Type
- journal article
- Language
- en
- Update notices
- new_version (2024-04-10)
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
- Funders
- World Health Organization
- UNICEF
- Sheffield Hallam University
- King's College Hospital NHS Foundation Trust
- National Institute for Health and Care Research (NF-SI-0514-10145)
- King's College London
- Evidence Synthesis Programme
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
- Keywords
- models of care, childbirth, perineal tears, postpartum hemorrhage, breastfeeding initiation, low birth weight, Apgar score, neonatal seizures, neonatal intensive care admission, maternal outcomes, infant outcomes, obstetric surgery, cesarean section, episiotomy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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