Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia

Allison Cummins; Kathleen Baird; Sarah J Melov; Lena Melhem; Carolyn Hilsabeck; Monica Hook; James Elhindi; Dharmintra Pasupathy

doi:10.1016/j.wombi.2022.08.002

Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia

Women Birth. 2023 Mar;36(2):e270-e275. doi: 10.1016/j.wombi.2022.08.002. Epub 2022 Aug 6.

Authors

Allison Cummins¹, Kathleen Baird², Sarah J Melov³, Lena Melhem⁴, Carolyn Hilsabeck⁴, Monica Hook⁴, James Elhindi⁵, Dharmintra Pasupathy³

Affiliations

¹ School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia. Electronic address: Allison.cummins@Newcastle.edu.au.
² Centre for Midwifery, Child and Family Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia.
³ Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, NSW, Australia.
⁴ Women's and Newborn's Health, Westmead Hospital, Western Sydney Local Health Districts, Australia.
⁵ Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Australia.

PMID: 35941058
DOI: 10.1016/j.wombi.2022.08.002

Abstract

Background: Perinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions.

Aim: To compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth.

Methods: A retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 - 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care.

Results: The cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24-0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93-3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10-4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57-1.09).

Conclusions: This evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.

Keywords: Midwifery continuity of care, pre-term birth; Perinatal mental health.

MeSH terms

Cohort Studies
Continuity of Patient Care
Female
Humans
Infant, Newborn
Maternal Health Services*
Mental Health
Midwifery*
Pregnancy
Premature Birth*
Retrospective Studies