Are the birth outcomes from a midwifery antenatal and postnatal service (MAPS) comparable to midwifery group caseload practice: A retrospective cohort study

Midwifery continuity of care has demonstrated improved outcomes for mothers and babies including higher rates of spontaneous vaginal birth and more positive birth experiences, with health services cost savings, than non- continuity of care. However, midwives report challenges with continuity of care, such as on-call for labour/ birth. Health services have responded with a new model, Midwifery Antenatal and Postnatal Service (MAPS), with care from a known midwife only during pregnancy and the early postnatal period. Women in the MAPS model have intrapartum care by rostered birth suite midwives (potentially unknown to the woman) whereas Midwifery Group Practice have a known midwife. Aim: To determine if MAPS is associated with similar perinatal outcomes for women and babies as the Midwifery Group Practice (MGP) model. Methods: A retrospective study was undertaken using de-identified routinely collected maternity data. All women who booked in and gave birth with MGP or MAPS at one hospital in New South Wales, Australia between April 2022- April 2023. Descriptive and inferential statistics were used to describe the data. Results: A total of 1303 births were analysed (MGP=349, MAPS =954). The MGP cohort were more likely to experience spontaneous labour (< 0.001) with local anaesthesia or no analgesia, vaginal births without instruments (<0.001), and exclusive breastfeeding at discharge (0.004) compared to MAPS births. Conclusion: Continuity of care with a known midwife (antenatal, labour/birth, and postnatal) was associated with less intervention and improved breastfeeding rates as supported by international literature. Future research is needed comparing MAPS to standard fragmented midwifery care.