Impact of midwife continuity of carer on stillbirth rate and first feed in England

Background In 2017 NHS England started rolling out a model where women have continuity of carer with the same midwifery team throughout the perinatal period. This study uses national data to test whether women of different groups receiving midwife continuity of carer had lower stillbirth rates and higher rates of a first feed of breast milk than women receiving standard care.

Methods We compared the two outcomes for women placed on the midwife continuity of carer pathway by 24 weeks and women receiving standard care in England, with logistic regression standardising between groups. We used the Maternity Services Dataset covering 922,149 women conceiving between 2020 and 2022.

Results Combining all demographic groups, women on a midwife continuity of carer pathway have a higher first feed of breast milk rate (p < 0.001), but do not show a difference in stillbirth rate, compared to women receiving standard care. However, Black women on this pathway have lower stillbirth rates (p = 0.047) compared to Black women receiving standard care, the only demographic group showing a difference.

Women with no antenatal appointment at all by 24 weeks have much higher stillbirth rates than those with an appointment (p < 0.001).

Conclusions The findings that midwifery continuity of carer increases the first feed of breast milk uptake, which has health benefits. It may decrease stillbirth rates for Black women. Both findings inform future policy development and research. Further investigation and outreach around women not coming forward for timely antenatal care may also be beneficial.