Birth Confidence: Embracing Continuous Midwifery Care

The birth of a child marks one of the most significant moments in the life of a woman and her family. During pregnancy, childbirth, and the postpartum period, women undergo a variety of physical and emotional changes that affect both themselves and their newborns. In light of these changes, the process of becoming a family requires holistic, individualized care. This article explains a care model that implements this approach.

The Benefits of Continuous Midwife Care

In recent years, the importance of continuous midwife care during pregnancy, childbirth, and the postpartum period has gained increasing recognition. Scientific studies and reports show that this care can have a positive impact on the physical and mental health of both mother and child (Cibralic et al., 2023). Benefits include a higher chance of a vaginal, intervention-free birth and significantly better outcomes for mothers and babies, as well as improved birth satisfaction (Sandall et al., 2016; Hildingsson et al., 2021), as shown in Table 1. Moreover, several studies have found that childbirth preparation and care by a known midwife can reduce any existing childbirth anxiety in the expectant mother (Hildingsson et al., 2019). Overall, this type of care positively affects women’s mental health, including prevention against fears and depression (Cibralic et al., 2023).

Continuous midwife care allows pregnant women to build a strong, trusting relationship with their midwife (NSW Ministry of Health, 2023). This enables them to make informed decisions while receiving individualized care tailored to their needs. The care approach is holistic, addressing the emotional, mental, physical, social, and cultural needs and expectations of women and families (Homer et al., 2019). Overall, continuous midwife care is considered one of the safest, most cost-effective forms of maternity support, with the highest possible quality (Homer et al., 2019). Table 1: Key outcomes from the Cochrane Systematic Review on continuous midwife care by Sandall et al. (2016). Graphics adapted from Homer et al. (2019), captions translated by the author.

Women who have experienced a model of continuous midwife care

⫸ 7x more likely to be cared for by a known midwife at birth

⫸ 16% less likely to lose the baby

⫸ 19% less likely to lose the baby before the 24th week of pregnancy

⫸ 15% less likely to require regional anesthesia (e.g., epidural)

⫸ 24% less likely to experience a premature birth

⫸ 16% less likely to have an episiotomy

Midwife Care in Switzerland

The Swiss Midwives Association actively advocates for the expansion of midwife-led maternity care across Switzerland (Swiss Midwives Association, 2021). Many women in Switzerland are unaware that, in addition to care from their gynecologist, they have the option of midwife care during a normal pregnancy. This includes seven check-ups by the midwife and two ultrasound examinations by a doctor (BAG, 2023).

There are various forms of continuous midwife care. For example, pregnancy check-ups can be performed from the beginning by the same midwife, working independently, in a midwifery practice, or even in a gynecological practice. There are also models where a team of midwives shares the care—the check-ups occur in the same practice but not necessarily always by the same midwife (NSW Ministry of Health, 2023). It is also possible to switch to a midwife later in the pregnancy.

For childbirth, there are also various options. If childbirth is to take place in a hospital, depending on the hospital, there is the option of care by an attending midwife. This midwife, who has already accompanied the pregnancy and will continue to do so during the postpartum period, works closely with the medical team (Swiss Midwives Association, 2024). In a hospital birth without an attending midwife, the birth is usually accompanied by a midwife unknown to the couple, also in collaboration with the medical team. Beyond this, within continuous midwife care, options for childbirth include a birthing house and home birth.

Conclusion and Notes from the Author

In summary, continuous care by a midwife or a small team of midwives individually captures and holistically addresses the diverse physical, emotional, cultural, and social needs of expectant families. The sensitive process of becoming a family is thus safely accompanied, as repeatedly proven by scientific studies (Sandall et al., 2016; Homer et al., 2019; Cibralic et al., 2023; NSW Ministry of Health, 2023).

As a passionate midwife, it is very important to me to be able to accompany and care for expectant families individually. The longer this support can last, the more trust-based and holistic it becomes. Therefore, I highly value the significance of continuous midwife care.

Not all women have the opportunity to receive such care—whether due to timing issues or because they cannot find a midwife nearby due to a shortage of midwives. Online consultation through Holistiq enables continuous consultation by the midwife, which is further enhanced holistically and needs-oriented by additional relevant disciplines such as nutritional counseling. This complements the planned gynecological or midwife check-ups as a sensible addition during pregnancy and in preparation for childbirth and the postpartum period.

Sources

1. BAG, B. für G. (2023, Juli 6). Krankenversicherung: Leistungen bei Mutterschaft. https://www.bag.admin.ch/bag/de/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Leistungen-bei-Mutterschaft.html
2. Cibralic, S., Pickup, W., Diaz, A. M., Kohlhoff, J., Karlov, L., Stylianakis, A., Schmied, V., Barnett, B., & Eapen, V. (2023). The impact of midwifery continuity of care on maternal mental health: A narrative systematic review. Midwifery, 116, 103546. https://doi.org/10.1016/j.midw.2022.103546
3. Hildingsson, I., Karlström, A., & Larsson, B. (2021). Childbirth experience in women participating in a continuity of midwifery care project. Women and Birth, 34(3), e255–e261. https://doi.org/10.1016/j.wombi.2020.04.010
4. Hildingsson, I., Rubertsson, C., Karlström, A., & Haines, H. (2019). A known midwife can make a difference for women with fear of childbirth- birth outcome and women’s experiences of intrapartum care. Sexual & Reproductive Healthcare, 21, 33–38. https://doi.org/10.1016/j.srhc.2019.06.004
5. Homer, C., Brodie, P., Sandall, J., & Leap, N. (2019). Midwifery Continuity of Care: A Practical Guide. Elsevier Health Sciences.
6. NSW Ministry of Health. (2023). Continuity of Care Models—A Midwifery Toolkit.
7. Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 4. https://doi.org/10.1002/14651858.CD004667.pub5
8. Schweizerischer Hebammenverband. (2021). Anerkennungsverfahren Hebammengeleitete Geburtshilfe SHV. https://www.hebamme.ch/qualitaet/hebammengeleitete-geburtshilfe/
9. Schweizerischer Hebammenverband. (2024). Beleghebamme. Die Hebammensuche des Schweizerischen Hebammenverbandes. https://www.hebammensuche.ch/hebammenleistung/beleghebamme/
10. Schweizerischer Hebammenverband. (2024a). Hebammengeleitete Geburtshilfe. Die Hebammensuche des Schweizerischen Hebammenverbandes. https://www.hebammensuche.ch/hebammenleistung/hebammengeleitete-geburtshilfe/
11. Schweizerischer Hebammenverband. (2024b). Wochenbett (Zeit nach der Geburt). Die Hebammensuche des Schweizerischen Hebammenverbandes. https://www.hebammensuche.ch/hebammenleistung/wochenbett-zeit-nach-der-geburt/