The effectiveness of a midwife-led continuity of care model on birth outcomes and maternal mental health in women from vulnerable populations.

In 2017, the UK National Health Service produced the ‘Better Births’ plan to improve maternity led care in England. Within this plan, the Maternity Transformation Programme aimed to implement the MCC model to support safer, more streamlined maternity care, while fostering positive relationships between women and their midwives, and resulting in better outcomes for women and their babies.
MCC is a model of maternity care wherein it is intended that women receive seamless care from the same midwife, or a small team of midwives, throughout the antenatal, intrapartum, and postnatal stages. The model promotes out of hours cover for labour and birth, safety, and sustainability for midwives, and provides a reduced caseload for midwives, longer appointment times and flexibility in how care is provided.
A Cochrane review of the MCC model provided evidence of effectiveness for the model in improving a range of birth-related outcomes. However, there is limited evidence as to whether this model reduces inequalities in birth outcomes for women from ethnic minority backgrounds and those living in deprived areas, and what impact the model has beyond discharge from the service. An in-depth qualitative evaluation of a pilot of a MCC model delivered in deprived and ethnically diverse inner-city areas of Bradford, UK, found MCC was well received by women from ethnic minority and deprived backgrounds, who valued the experience and reported that MCC helped to build trust with their midwife, leading to increased confidence with birth choices and disclosure of mental health concerns. MCC midwives reported less stress and burnout than their colleagues delivering standard care. However, the model evaluated in this study did not include intrapartum care.
On 1st April 2021, Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) began implementation of the full MCC model for women living in deprived inner-city areas of Bradford where most pregnancies are to women of ethnic minorities. The study comprises two phases: (1) a randomised internal pilot; and (2) a randomised controlled trial (RCT) with embedded process, and economic evaluation.