.png)
The evidence is clear: being known by your midwife matters.
Continuity can make a real difference to your care and birth experience.
The Evidence for Continuity of Midwifery Care
Continuity is at the heart of the way I work.
Quite simply, it means being cared for by a midwife who knows you, your pregnancy, your history, your preferences and what matters to you, rather than having to start again with someone new at each appointment or when you go into labour.
And there is good evidence behind this way of providing maternity care.
A major Cochrane review published in 2024 looked at 17 studies involving more than 18,500 women. It found that women receiving midwifery continuity of care were more likely to have a spontaneous vaginal birth, less likely to have a caesarean or instrumental birth, and may be less likely to have an episiotomy.
But continuity is about much more than statistics. Women receiving this model of care also reported more positive experiences during pregnancy, labour and after their baby was born.
What does continuity of care actually mean?
Midwifery continuity of care means receiving care from the same midwife, throughout pregnancy and birth, and often into the postnatal period.
It doesn't mean that pregnancy or birth will always follow a particular path, or that complications won't arise.
If additional medical or obstetric care is needed, your midwife can continue to care for you alongside the wider maternity team.
The difference is that you have someone alongside you who already knows you.
There is less need to repeatedly explain your history, your previous experiences or what's important to you.
Conversations can develop over time. Questions don't have to be squeezed into a first meeting.
And the relationship between you and your midwife has the opportunity to grow throughout your pregnancy.
What does the evidence show?
A greater chance of spontaneous vaginal birth
In the 2024 Cochrane review, around 70% of women receiving continuity of midwifery care had a spontaneous vaginal birth, compared with around 66% receiving other models of maternity care.
That doesn't mean continuity can guarantee a particular kind of birth. It means that, across thousands of women studied, spontaneous vaginal birth was more likely when care was provided through a continuity model.
Fewer caesarean births
Caesarean birth was also slightly less common, reducing from around 16% with other models of care to 15% with midwifery continuity of care.
The difference may sound small when expressed as a percentage, but across a maternity population it is meaningful, and importantly, it comes without promising individual women an outcome that no midwife can guarantee.
Fewer instrumental births
Instrumental vaginal births using forceps or ventouse reduced from approximately 14% to 13% with continuity of midwifery care.
Fewer episiotomies
The review also found that women receiving continuity of care may be less likely to have an episiotomy, with rates of approximately 19% compared with 23% in other models of care.
Being known matters too
Some of the most important benefits of continuity aren't captured by what happens clinically during birth.
Women receiving continuity of midwifery care generally reported more positive experiences during pregnancy, labour and the postnatal period.
And that makes sense.
When we have spent time together throughout your pregnancy, I know more than what's written in your maternity notes.
I know the conversations we've had, the things you're looking forward to, the things you're worried about and the choices that matter to you.
You know me too.
That relationship doesn't remove uncertainty from birth, but it means you're not beginning one of the most important days of your life by introducing yourself to the person caring for you.
Why might continuity make a difference?
Research can tell us that outcomes differ between models of care more confidently than it can tell us exactly why every difference occurs.
But continuity changes something fundamental about the way care is provided: the relationship has already been established.
Your midwife has had time to understand you and your pregnancy. You have had time to ask questions, explore your options and make informed decisions.
Trust and communication have developed over weeks and months rather than needing to be established for the first time during labour.
Continuity also doesn't mean avoiding intervention when it is needed.
Good midwifery care is about recognising when something is outside the normal course of pregnancy or birth and involving obstetric or specialist colleagues appropriately.
The aim isn't no intervention.
It's individualised care, informed decision-making and appropriate intervention when it is genuinely needed.
What the evidence doesn't tell us
It's important to be just as clear about this.
The Cochrane review found that continuity may make little or no difference to preterm birth, and there may also be little or no difference in breastfeeding initiation.
For some other outcomes, there simply isn't enough good-quality evidence yet to be certain.
Most of the women included in the studies were also considered at lower risk of complications at the beginning of pregnancy, and more research is needed in women with medical complications and social risk factors.
Evidence should help you understand your choices, not be used to promise you a particular birth.
Continuity in my care
For me, continuity isn't an added extra. It's the foundation of the care I provide.
From our antenatal appointments through birth and into those early days and weeks with your baby, our relationship develops alongside your pregnancy.
It means that when you have a question, you're asking someone who knows the story behind it.
If your preferences change, we can talk them through. And when the time comes to give birth, you're being supported by somebody with whom you've already built a relationship.
The research tells us that continuity of midwifery care can influence outcomes and women's experiences.
But perhaps the simplest way of describing it is this:
You are known, your choices are known, and you don't have to keep repeating yourself.
If you'd like to find out what continuity of care could look like for you, get in touch for a relaxed, no-obligation conversation.
Source
Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews. 2024; Issue 4: CD004667.