Women with perinatal mental health concerns have improved outcomes with Midwifery Continuity of Care but a change in practice is required to support the midwives

Perinatal mental health (PMH) conditions are common with immediate and long-term effects on women, their infants, and their families. Women with PMH conditions are more likely to give birth pre-term and this is the leading cause of neonatal death and long-term childhood disability. Policy directives recommend midwifery continuity of care for women with PMH conditions. Midwifery continuity of care (MCoC) has demonstrated benefits including a reduction in preterm birth and is beneficial in reducing anxiety, worry and depression in pregnant women. Provide results of an observational cohort study conducted in regional New South Wales and an exploration of midwives’ experiences of caring for these women. A retrospective observational cohort study using routinely collected data of women with PMH between 1st January 2018 – 31st January 2021 was undertaken in a large regional referral centre. Propensity scores (the probability of MCoC) were estimated using logistic regression. MCoC was regressed against mental health history, maternal age, ethnicity, socio-economic quintiles, BMI category, nulliparity, substance use, pregnancy complications, and a prior unviable pregnancy/preterm birth history. Births with MCoC were then matched 1-to-1 with standard care (SC) births. Following analysis, a qualitative descriptive study of midwives’ experiences of caring for women with PMH was undertaken. Midwifery continuity of care was associated with a reduction in preterm birth (OR, 0.43, 95%CI 0.27, 0.77) in a regional setting. Maternal anxiety was the most common condition (5431 of the 7487 births, 73%). Midwives caring for women with PMH stated they would benefit from professional development and extra support and raised concerns about their scope of practice. Conclusions: Women with PMH conditions are often excluded from MCoC. Evidence demonstrates that midwifery continuity of care can improve outcomes for women with PMH. Midwives require professional development and support to provide care to these women.