The impact of maternity care models on perinatal outcomes for women who gave birth and their babies: a national survey

Background There are several maternity care models in Australia providing varying levels of continuity of care in the private and public maternity system. These were disrupted to varying degrees during the pandemic. Aim To examine the impact of the five main maternity care models in Australia on perinatal outcomes for women who gave birth during the COVID-19 pandemic and their babies. Design A national survey, was conducted from March to December 2020, and again from August 2021 to March 2022. Participants A weighted sample of 3682 postnatal women provided information on birthing outcomes. Analysis Survey tabulations of prevalence and weighted logistic regressions examined associations between five models of maternity care and perinatal outcomes. Results Compared with standard care, continuity of care in both public (MWCOC) and private midwife (PPM) models was associated with higher odds of: spontaneous labour (MWCOC AOR 1.66; CI 1.35–2.04; PPM AOR 11.01; CI 0.6.29–19.28), spontaneous vaginal birth (MWCOC AOR 1.84; CI 1.49–2.28; PPM AOR 3.14; CI 2.08–4.73), postnatal midwife visits at home, feeling supported postnatally, feeling the care provider showed commitment, and feeling known by the care provider; as well as lower odds: of induction, elective and emergency caesarean section, augmentation with oxytocin, perceived traumatic birth (MWCOC AOR 0.57; CI 0.45–0.73; PPM AOR 0.49; CI 0.31–0.77), fetal distress, and infant admission to special/neonatal intensive care. Compared to standard care, private obstetric care was associated with lower rates of postpartum haemorrhage, perceived traumatic birth (AOR 0.56; CI 0.45–0.69), spontaneous labour (AOR 0.45; CI 0.37–0.54), spontaneous vaginal birth (AOR 0.54; CI 0.45–0.65), postnatal home visits from a midwife, and higher rates of elective caesarean section (AOR 2.65; CI 2.12–3.30). Conclusions Continuity of midwifery care models are associated with lower intervention rates and birth trauma compared to standard care. However, for women who seek, or are not concerned about increased obstetric intervention, private obstetric care also leads to lower rates of birth trauma when compared to standard care. Continuity of care models should be prioritised in future disaster events.