The Australian Preterm Birth Prevention Alliance recommends midwifery continuity of care as a key strategy to prevent preterm birth in Australia.
There is a considerable body of evidence that demonstrates a reduction in preterm birth when women experience continuity of care from a known midwife during pregnancy.
Midwifery continuity of care is defined as care provided by a known midwife or a small group of known midwives to women during pregnancy, birth and the postnatal period. This care is provided in collaboration with other relevant healthcare providers when appropriate, including obstetricians and general practitioners, together with specialised staff such as social support workers.
High quality evidence from the Cochrane Database of Systematic Reviews demonstrates clearly that women in midwifery continuity models of care have about a 24% lower risk of preterm birth before 37 weeks gestation when compared with other models of care. There is also good evidence of efficacy in preventing preterm birth in specific populations of pregnant women, such as those from vulnerable or disadvantaged groups.
Disparities in preterm birth rates are well known, and in Australia manifest as persistently higher rates of preterm birth among women who are Aboriginal and/or Torres Strait Islander, of migrant or refugee background, living in rural and remote areas, aged younger than 25 years, or experiencing social and economic disadvantage.
However, midwifery continuity of care is often not accessible to these vulnerable groups of women as these models of care often focus on women deemed ‘low risk’. Evidence suggests that increasing access to midwifery continuity of care offers great promise in reducing current disparities in preterm birth rates, especially when tailored to the needs and context of members of the individual groups of women.
Ensuring that the needs of vulnerable groups of women are met will require flexibility in design of the model of care to provide appropriate partnerships with multidisciplinary care providers (such as in the case of Aboriginal women when models need to support Aboriginal leadership).
The Alliance supports women's choice of care providers and this principle should be respected at all times.
We acknowledge that it may not always be possible to provide all women with full continuity of care throughout pregnancy and the perinatal period. Many creative models of service will be required to increase the extent of continuity provided by midwives throughout our diverse health care system, including within private obstetric models of care.
The Australian Preterm Birth Prevention Alliance calls on jurisdictional health departments and healthcare providers to increase women's access to midwifery continuity of care models, particularly in vulnerable groups, as a major public health strategy to safely reduce the rising rate of preterm birth in Australia.
Media contact: Richie Hodgson, 0408 128 099, [email protected]
The Australian Preterm Birth Prevention Alliance is a national Alliance of clinical leaders, researchers, health departments, and communities working together to safely lower the rate of preterm birth in Australia.