Continuity of Care During Pregnancy Linked to Lower Rates of Birth Trauma

Every pregnant woman hopes for a healthy baby and a positive birth experience. Increasingly, research highlights the importance of feeling listened to, respected and supported throughout labor and birth, both physically and emotionally. However, around 28% of Australian women describe their most recent birth as traumatic.

What is Birth Trauma?

Birth trauma can manifest in various ways, including fear for one’s own life or the baby’s life, a loss of control during labor, physical injuries like perineal or pelvic floor damage, or experiencing disrespectful or mistreating care from healthcare providers. Birth Trauma Australia provides resources and support for those affected.

The Impact of Different Models of Care

A recent research study examined birth outcomes and the physical and psychological experiences of women who received five different types of maternity care in Australia during the COVID-19 pandemic. The findings suggest that continuity of care – seeing the same midwife or team of midwives throughout pregnancy, labor, and postpartum – is associated with lower rates of intervention and birth trauma compared to standard care. For some women, private obstetric care also showed lower rates of birth trauma than standard public care.

Five Main Models of Maternity Care in Australia

Most Australian women receive either standard public care or GP shared care.

• Standard Public Care: Women see rotating hospital staff (midwives, obstetricians, and trainees) throughout pregnancy and often deliver with healthcare professionals they haven’t met before.
• GP Shared Care: Women primarily see their GP during pregnancy, with some antenatal appointments at the hospital. The GP typically doesn’t attend the birth, except in certain rural or remote areas.
• Continuity of Care Models: These models involve one or a small number of midwives and/or obstetricians providing the majority of care before, during, and after birth. This includes:
  • Continuity of midwifery care in the public system
  • Private obstetric care
  • Private midwifery care

Study Findings: Continuity of Care Makes a Difference

A study of 3,682 Australian women who gave birth in 2020 and 2021 revealed significant differences between those who received continuity of midwifery care and those who received standard care. Women with continuity of midwifery care were:

• Less likely to be induced or require oxytocin to speed up labor
• More likely to have a vaginal birth
• More likely to receive a postpartum home visit from their midwife
• Less likely to require a Cesarean section
• Less likely to have their baby admitted to special or neonatal intensive care
• Less likely to have their baby receive formula in hospital when they had chosen to breastfeed
• Half as likely to describe their birth as traumatic

These benefits were observed even after accounting for factors like age, medical risk, education, employment status, country of birth, income, and mental health.

A 2024 Cochrane review of 17 randomized controlled trials confirmed that midwifery continuity of care models can reduce birth interventions, including Cesarean section, forceps/vacuum births, and episiotomy.

The study also found that women receiving private obstetric care experienced lower rates of birth trauma compared to standard care, although they had higher rates of intervention. Baby outcomes, such as admission to special or neonatal intensive care, were not different between the groups. This suggests that aligning a woman’s preferences with her care provider’s approach can improve outcomes, even with increased intervention.

Limitations of the Study

The study relied on women self-reporting their labor and birth experiences, which may be subject to recall bias. The study population was also not fully representative of the Australian population, with a high proportion of participants born in Australia, speaking English at home, and identifying as Australian or English. The study did not examine stillbirth or neonatal deaths, focusing only on women who had live births.

Why Continuity of Care Matters

Continuity of care provides women with a consistent, familiar healthcare provider who understands their individual story, concerns, and advocates for their needs. It allows for personalized care, which women consistently express a desire for and which midwives strive to provide.

Access to Continuity of Care

While nearly half of all maternity care models (49%) involve a midwife as the designated carer, only 16% offer full midwifery continuity of care. These models are more common in urban areas and can be difficult to access in rural and remote regions. Demand for these programs is high, and booking early in pregnancy is often necessary. Private obstetric and midwifery care options come with out-of-pocket costs and limited availability.

The recent New South Wales Birth Trauma Inquiry recommended expanding continuity of care models to address the high rates of birth trauma in Australia. This study supports that recommendation.