Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care ? An Observational Study in One Governmental Hospital in Palestine

Background:From 2013 a midwife-led continuity model of care was implemented in the Nablus region in occu-pied Palestine, involving a governmental hospital and ten rural villages. This study analysed the relation betweenthe midwife-led model and maternal and neonatal health outcomes.Method:A register-based, retrospective cohort design was used, involving 2201 singleton births betweenJanuary 2016 and June 2017 at Nablus governmental hospital. Data from rural women, with singleton preg-nancies and mixed risk status, who either lived in villages that offered the midwife-led continuity modeland had registered at the governmental clinic, or who lived in villages without the midwife-led modeland received regular care, were compared. Primary outcome was unplanned caesarean section. Secondaryoutcomes were other modes of birth, postpartum anaemia, preterm birth, birthweight, and admission toneonatal intensive care unit.Findings:Statistically significant less women receiving the midwife-led model had unplanned caesareansections, 12·8% vs 15·9%, adjusted risk ratio (aRR) 0·80 (95% CI 0·64–0·99) and postpartum anaemia,19·8%vs 28·6%, aRR 0·72 (0·60–0·85). There was also a statistically significant lower rate of preterm births withinthe exposed group, 13·1% vs 16·8, aRR 0·79 (0·63–0·98), admission to neonatal intensive care unit, 7·0% vs9·9%, aRR 0·71 (0·52–0·98) and newborn with birth weight 1500 g and less, 0·1% vs 1·1%, aRR 0·13(0·02–0·97).Interpretation:Receiving the midwife-led continuity model of care in Palestine was associated with severalimproved maternal and neonatal health outcomes. Thefindings support further implementation of the model.Implementation research, including randomised studies, would be useful to further investigate the effect andfeasibility of the model in a low resource setting.Funding:This study was partly funded by the Research Council of Norway through the Global Health andVaccination Program (GLOBVAC), project number 243706. The implementation received public funding throughNorwegian Aid Committee (NORWAC)