Models of Care and Place of Birth

Models of maternity care range from highly medicalised hospital services to midwife-led units, birth centres and home birth settings. Each model varies in its organisational structure, professional leadership and approach to intervention. In many high-income settings, standard obstetric care is centred on risk stratification and rapid access to surgical and pharmacological interventions, often accompanied by protocols that can limit personalised choice. By contrast, midwife-led continuity models—whether based in community clinics, standalone birth centres or private homes—emphasise a physiological view of childbirth. Such models promote minimal intervention for women assessed as low risk, continuity of carer by a known midwife or small team, and emotional as well as clinical support throughout pregnancy, labour and the postpartum period. Evidence indicates that midwife-led care can reduce rates of caesarean section, instrumental delivery and perineal trauma, while enhancing maternal satisfaction and psychological well-being. In low- and middle-income countries, investing in both the numbers of professional midwives and the enabling environment for their practice has been linked with significant reductions in maternal and neonatal mortality. Economic assessments show that midwife-led birth centres can deliver health gains at lower or comparable cost to conventional hospital care, though cost–effectiveness varies by staff salaries, facility expenses and local resource availability. Safety outcomes by planned place of birth in high-income settings demonstrate no increase in perinatal mortality outside hospitals for low-risk women, while offering lower intervention rates and faster maternal recovery. Optimal results are achieved when different models of care are harmonised within multidisciplinary networks, allowing timely referral and transfer between home, birth centre and obstetric services according to individual needs, and when environmental design supports maternal comfort and physiological labour progress.

Research from Nature Portfolio

Recent observational work has explored how the physical and sensory design of delivery rooms influences obstetric intervention rates. In a cohort study comparing women labouring in innovative ‘sensory delivery rooms’ equipped with programmable ambient lighting, large-scale artwork and gentle soundscapes against those in standard birthing rooms, first-time mothers in the sensory environment had substantially lower odds of caesarean delivery and a trend towards reduced use of labour-augmenting agents. These findings suggest that optimising the aesthetic and sensory aspects of birth spaces may support physiological labour and reduce reliance on invasive interventions, highlighting the importance of environmental design in maternity facilities.

Models of Care and Place of Birth publication trend

The graph below shows the total number of articles in models of care and place of birth across all publications each year (not limited to Nature Index journals).

Technical terms

Midwife-led continuity of care: A model in which a woman is supported throughout her maternity journey by a known midwife or small team, ensuring informational, managerial and relational continuity.

Disability-adjusted life-year (DALY): A composite measure of disease burden combining years of life lost and years lived with disability.

Lives Saved Tool (LiST): A mathematical model used to estimate the impact of health interventions on mortality and morbidity in maternal, neonatal and child health.

Sensory delivery room: A birth environment designed with adjustable lighting, soundscapes and visual stimuli to promote relaxation and support physiological labour.

References

1. Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites. BMJ Global Health (2024).
2. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study. The Lancet Global Health (2020).
3. Increasing the number of midwives is necessary but not sufficient: using global data to support the case for investment in both midwife availability and the enabling work environment in low- and middle-income countries. Human Resources for Health (2024).
4. Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis. Midwifery (2018).
5. The aesthetic nature of the birthing room environment may alter the need for obstetrical interventions – an observational retrospective cohort study. Scientific Reports (2019).