What makes the difference for women? Implementation of a continuity of care model for women at high risk of preterm birth

BACKGROUND Midwifery led-care continuity models have been associated not only with improved maternal outcomes but also with prevention of preterm births and stillbirths. The theoretical basis of how relational continuity models might work is not yet fully understood. OBJECTIVES The aim of this study was to explore the experiences of women at higher risk of preterm birth on the implementation of a new midwife-led continuity model. Two implementation outcomes evaluated were acceptability and fidelity of the model of care as perceived by women. METHODS The POPPIE programme consists of linked studies including a pilot trial assessing feasibility of whether a pathway combining continuity of midwifery care with a obstetric led pre-term birth clinic improves outcomes for pregnant women at high risk of preterm birth. Women identified to be at increased risk of preterm birth were randomised into two groups: those in the intervention group received antenatal, intra-partum and postnatal continuity from a primary midwife, while control group received standard care. Sixteen women cared for by the POPPIE team were interviewed in the postnatal period through purposive sampling (variation in social complexity, social economic group, ethnicity, parity & obstetric history). Data collection and thematic analysis were informed by CFIR framework and analysis was data driven. Ethical approval:IRAS ID 214196. RESULTS The findings identified the core components of the model: access, advocacy, building relationships, trust, time and reduction of stress and anxiety. Secondary objectives included exploration of the mechanism of effect of continuity of care on management of preterm labour and pregnancy loss. CONCLUSIONS Acceptability of the model to women is confirmed by this study. Fidelity to the intervention is essential as its lack dilutes the potential benefit of the model and causes disappointments for women when intra-partum continuity is disregarded. KEY MESSAGE Women value continuity of care,specialist pre-term birth clinics need to be integrated in the maternity pathway to avoid fragmentation.