Midwifery Care Models and Maternal Outcomes

Midwifery care models encompass a spectrum of organisational and clinical arrangements in which trained midwives lead or coordinate care for women during pregnancy, childbirth and the postpartum period. These models range from standard hospital-based services to midwife-led birth centres, community and home settings, and caseload midwifery offering continuity by a small team or individual practitioner. Evidence shows that midwife-led models can reduce rates of obstetric intervention, lower caesarean sections and perineal trauma, while enhancing women’s satisfaction and psychological well-being. In low- and middle-income countries, expanding midwife availability and strengthening the enabling environment for professional practice have been linked to reductions in maternal and neonatal mortality. Cost-effectiveness analyses demonstrate that midwife-led units can deliver high-quality outcomes at lower or comparable cost to conventional care. Optimal results are achieved when midwifery services are integrated within multidisciplinary teams, supported by adequate resources, clear governance and respect for midwifery competencies.

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Midwifery Care Models and Maternal Outcomes publication trend

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

Technical terms

Midwifery care model: An organised framework defining roles, settings and pathways for midwife-led maternity care.

Caseload midwifery: A model in which a midwife or small team provides continuous care throughout pregnancy, birth and postpartum.

Midwife-led birthing centre: A facility outside the main obstetric unit where midwives assume primary responsibility for low-risk births.

Continuity of care: A care pathway ensuring that a woman sees the same provider or small team throughout her maternity journey.

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

Incremental cost-effectiveness ratio (ICER): The additional cost per unit of health gain, often expressed as cost per DALY averted.

References

1. Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites. BMJ Global Health (2024).
2. 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).
3. 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).
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. Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy and Childbirth (2016).