Cochrane · systematic review · CD004667

Midwife continuity of care models versus other models of care for childbearing women

Sandall, J, Fernandez Turienzo, C, Devane, D, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library

Pregnancy and Childbirth3 versionsAMSTAR 2: not assessed

SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.

Questions

current version

GRADE rated

No studies

Included studies

No studies 0 · 0%Ungraded 7 · 26.9%Very low 8 · 30.8%Low 5 · 19.2%Moderate 6 · 23.1%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Questions and results

Current version only

Summary of findings table ‐ Midwife continuity of care models compared to other models of care for childbearing women and their infants (all) (critical outcomes)

Population: childbearing women and their infants (all) (critical outcomes)

CD004667.PUB6 (current) · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Spontaneous vaginal birth (as defined by trial authors) Summary of findings table ‐ Midwife continuity of care models vs other models of care	RR 1.05 [1.03, 1.07]	15 studies · 17864 participants	Moderate Downgraded: risk of bias
Caesarean birth Summary of findings table ‐ Midwife continuity of care models vs other models of care	RR 0.91 [0.84, 0.99]	16 studies · 18037 participants	Moderate Downgraded: risk of bias
Regional analgesia (epidural/spinal) Summary of findings table ‐ Midwife continuity of care models vs other models of care	RR 0.85 [0.79, 0.92]	15 studies · 17754 participants	Very low Downgraded: risk of bias, inconsistency, publication bias
Intact perineum Summary of findings table ‐ Midwife continuity of care models vs other models of care	RR 1.05 [0.98, 1.12]	12 studies · 14268 participants	Moderate Downgraded: risk of bias
Fetal loss at or after 24 weeks gestation Summary of findings table ‐ Midwife continuity of care models vs other models of care	RR 1.24 [0.73, 2.13]	12 studies · 16122 participants	Very low Downgraded: risk of bias, imprecision
Preterm birth (< 37 weeks) Summary of findings table ‐ Midwife continuity of care models vs other models of care	RR 0.95 [0.78, 1.16]	10 studies · 13850 participants	Low Downgraded: risk of bias, inconsistency
Neonatal death (baby born alive at any gestation and dies within 28 days) Summary of findings table ‐ Midwife continuity of care models vs other models of care	RR 0.85 [0.43, 1.71]	10 studies · 14718 participants	Very low Downgraded: risk of bias, imprecision

Summary of findings table ‐ Midwife continuity models compared to other models of care for childbearing women and their infants (all) (important/secondary outcomes)

Population: childbearing women and their infants (all) (important/secondary outcomes)

CD004667.PUB6 (current) · 19 questions

Outcome	Effect	Evidence	Status / GRADE
Healthy mother Summary of findings table ‐ Midwife continuity models vs other models of care	no estimate extracted	0 studies · 0 participants	Ungraded
Maternal death Summary of findings table ‐ Midwife continuity models vs other models of care	no estimate extracted	3 studies · 4282 participants	Ungraded
Induction of labour Summary of findings table ‐ Midwife continuity models vs other models of care	RR 0.92 [0.85, 1]	14 studies · 17666 participants	Low Downgraded: risk of bias, inconsistency
Instrumental vaginal birth (forceps/vacuum) Summary of findings table ‐ Midwife continuity models vs other models of care	RR 0.89 [0.83, 0.96]	14 studies · 17769 participants	Moderate Downgraded: risk of bias
Episiotomy Summary of findings table ‐ Midwife continuity models vs other models of care	RR 0.83 [0.77, 0.91]	15 studies · 17839 participants	Low Downgraded: risk of bias, inconsistency
Third or fourth degree tear Summary of findings table ‐ Midwife continuity models vs other models of care	RR 1.1 [0.81, 1.49]	7 studies · 9437 participants	Very low Downgraded: risk of bias, imprecision
Postpartum haemorrhage (as defined by trial authors) Summary of findings table ‐ Midwife continuity models vs other models of care	RR 0.92 [0.82, 1.03]	11 studies · 14407 participants	Moderate Downgraded: risk of bias
Breastfeeding initiation Summary of findings table ‐ Midwife continuity models vs other models of care	RR 1.06 [1, 1.12]	8 studies · 8575 participants	Low Downgraded: risk of bias, inconsistency
Maternal readmission within 28 days Summary of findings table ‐ Midwife continuity models vs other models of care	RR 1.52 [0.78, 2.96]	1 study · 1195 participants	Very low Downgraded: risk of bias, imprecision
Neonatal readmission within 28 days Summary of findings table ‐ Midwife continuity models vs other models of care	no estimate extracted	0 studies · 0 participants	Ungraded
Attendance at birth by known midwife Summary of findings table ‐ Midwife continuity models vs other models of care	RR 9.13 [5.87, 14.21]	11 studies · 9273 participants	Very low Downgraded: risk of bias, inconsistency, publication bias
Healthy baby Summary of findings table ‐ Midwife continuity models vs other models of care	no estimate extracted	0 studies · 0 participants	Ungraded
Birth weight less than 2500 g Summary of findings table ‐ Midwife continuity models vs other models of care	RR 0.92 [0.79, 1.08]	8 studies · 12420 participants	Low Downgraded: risk of bias, imprecision
Birth weight equal to or more than 4000 g Summary of findings table ‐ Midwife continuity models vs other models of care	no estimate extracted	0 studies · 0 participants	Ungraded
Apgar score less than or equal to 7 at 5 minutes Summary of findings table ‐ Midwife continuity models vs other models of care	RR 0.95 [0.72, 1.24]	13 studies · 12806 participants	Very low Downgraded: risk of bias, imprecision
Admission to special care nursery/neonatal intensive care unit Summary of findings table ‐ Midwife continuity models vs other models of care	RR 0.89 [0.77, 1.03]	13 studies · 16260 participants	Moderate Downgraded: risk of bias
Fetal loss before 24 weeks gestation Summary of findings table ‐ Midwife continuity models vs other models of care	RR 0.82 [0.67, 1.01]	12 studies · 15913 participants	Very low Downgraded: risk of bias, imprecision
Maternal experience Summary of findings table ‐ Midwife continuity models vs other models of care	no estimate extracted	16 studies · 16 participants	Ungraded
Cost Summary of findings table ‐ Midwife continuity models vs other models of care	no estimate extracted	7 studies · 7 participants	Ungraded

Midwife‐led compared with other models of care for childbearing women and their infants (all) for childbearing women

Population: Pregnant women

CD004667.PUB5 · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Preterm birth (less than 37 weeks) Midwife‐led vs other models of care	RR 0.76 [0.64, 0.91]	8 studies · 13238 participants	High
All fetal loss before and after 24 weeks plus neonatal death Midwife‐led vs other models of care	RR 0.84 [0.71, 0.99]	13 studies · 17561 participants	High
Spontaneous vaginal birth (as defined by trial authors) Midwife‐led vs other models of care	RR 1.05 [1.03, 1.07]	12 studies · 16687 participants	High
Caesarean birth Midwife‐led vs other models of care	RR 0.92 [0.84, 1]	14 studies · 17674 participants	High
Instrumental vaginal birth (forceps/vacuum) Midwife‐led vs other models of care	RR 0.9 [0.83, 0.97]	13 studies · 17501 participants	High
Intact perineum Midwife‐led vs other models of care	RR 1.04 [0.95, 1.13]	10 studies · 13186 participants	High
Regional analgesia (epidural/spinal) Midwife‐led vs other models of care	RR 0.85 [0.78, 0.92]	14 studies · 17674 participants	High

Midwife‐led compared with other models of care for childbearing women and their infants (all) for childbearing women

Population: Pregnant women

CD004667.PUB4 · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Preterm birth (less than 37 weeks) Midwife‐led vs other models of care	RR 0.76 [0.64, 0.91]	8 studies · 13238 participants	High
Overall fetal loss and neonatal death Midwife‐led vs other models of care	RR 0.84 [0.71, 0.99]	13 studies · 17561 participants	High
Spontaneous vaginal birth (as defined by trial authors) Midwife‐led vs other models of care	RR 1.05 [1.03, 1.07]	12 studies · 16687 participants	High
Caesarean birth Midwife‐led vs other models of care	RR 0.92 [0.84, 1]	14 studies · 17674 participants	High
Instrumental vaginal birth (forceps/vacuum) Midwife‐led vs other models of care	RR 0.9 [0.83, 0.97]	13 studies · 17501 participants	High
Intact perineum Midwife‐led vs other models of care	RR 1.04 [0.95, 1.13]	10 studies · 13186 participants	High
Regional analgesia (epidural/spinal) Midwife‐led vs other models of care	RR 0.85 [0.78, 0.92]	14 studies · 17674 participants	High