Making Midwifery Matter -The introduction of a Midwife-led Continuity Model of care in occupied Palestine

Abstract

Action is urgently needed to achieve equity in maternal health care, especially since 99% of the annually estimated 300 000 maternal deaths occur in low- and middle-income countries. A woman’s health and wellbeing depend on good quality maternal care through pregnancy, labour and postnatally. Midwives are key to building sustainable quality maternal health care systems and solidarity is an important factor to reduce inequity in health. There is research evidence of several positive outcomes from implementing midwife-led continuity of care in high income countries, little research has been done in low- and middle-income settings. A midwife-led continuity model of care was adapted to local context and implemented in the Palestinian governmental health system in the West Bank to address challenges faced by rural women living under Israeli occupation. Midwives based at six governmental hospitals provided outreaching antenatal care and postnatal home visits to women in 37 villages. Three quantitative studies were conducted, each using different observational designs and datasets at both cluster and individual level, involving 30 508 women and newborns. The studies found that the implementation had positive impact on women’s utilization of services, detection of complications during pregnancy, and postnatal follow up. Receiving the midwife-led care was associated with reduced risk of unplanned caesarean section, and improved important maternal and neonatal health outcomes. Women who received the continuity model had significant higher satisfaction with care through the continuum and a longer period of exclusive breastfeeding. The research complies to the existing evidence from midwife-led continuity models of care and provides new knowledge about its impact in a low-middle-income setting. The implementation of continuity of care in Palestine, the findings and lessons learned, are relevant to any country or institution that strives to enhance woman-centred care by making midwifery matter.