Impact of Implementing the Midwifery Model of Care on Maternal and Neonatal Health Outcomes in Ethiopia

Summary

Background: The Continuity of Midwifery Care (CoMC) is a maternity care model used in some high-income countries. In this model, a dedicated group of midwives supports women throughout pregnancy, labor, and the early postnatal period. This model has been shown to improve maternal and neonatal outcomes and enhance maternal satisfaction. However, its effectiveness in low-and middle-income countries remains uncertain.

Purpose and Aim of the Study: This study aims to evaluate whether CoMC, supported by midwife-led birthing centers, improves maternal and neonatal health outcomes compared to the standard care model in Ethiopia.

Research Question: Does the CoMC model, integrated with midwife-led birthing centers, enhance maternal and neonatal outcomes compared to the standard maternal health care model? Additionally, does its implementation strengthen midwives' capacity to deliver quality care and increase the uptake of evidence-based practices in Ethiopia? Methods: A hybrid implementation-effectiveness, randomized, controlled, unblinded, parallel-group pilot trial will be conducted. The type 2 hybrid design will equally emphasize effectiveness and implementation outcomes. The study will take place in four randomly selected hospitals in the North Shoa Zone, Amhara regional state, Ethiopia, involving 1,654 pregnant women (\<20 weeks gestation at first ANC visit). Participants will be randomly assigned to CoMC (Group A) or standard care (Group B) using a computer-generated scheme. Midwives will be organized into teams following the CoMC model. Women will receive study information during ANC visits and, if interested, will discuss participation with the CoMC team leader. Upon consent, they will be randomly allocated using a secure computerized system.

In the CoMC arm, women will receive care from a single midwife or a backup midwife throughout pregnancy, labor, birth, and the immediate postnatal period. In the standard care arm, multiple staff members will provide care at different times.

Outcomes: The primary maternal outcome is the proportion of women achieving spontaneous vaginal birth. The primary neonatal outcome is the proportion of neonates experiencing preterm birth. These outcomes will be analyzed using bivariable and multivariable generalized linear models (GLMs) with 95% confidence intervals.

Conditions

• Midwifery Continuity of Care Model
• Maternal Health Outcomes
• Neonatal Health Outcomes
• Cost Effectiveness

Interventions

OTHER

Continuity of Midwifery care model

The intervention group will receive a continuity of midwifery care model organized by a team of qualified midwives. In this model, antenatal, intrapartum, and postnatal care will be provided by a named (or primary) midwife, who works within a small team (4-8) of CoMC midwives to their cohort of women and will refer or consult an obstetrician in case of complications that requires specialized care. Each named midwife will be backed up by a partner midwife and other team colleagues. The CoMC team comprises 8 whole-time equivalent midwives, including an experienced senior midwife, who leads the team. Following a training needs assessment by the team leader, midwives will receive specialist training, provided by a team of clinical experts and educators, on how to work in midwife continuity models. Pregnant women receive their entire antenatal, intrapartum, and postnatal care from one of the participating CoMC midwives.

OTHER

Standard care model

Pregnant women who receive antenatal, intrapartum, and postnatal care following standard practice in Ethiopia will be assigned to the control group. An established practice followed the shared model of care in which responsibility is shared among different staff members, including midwives, nurses, health officers, and medical doctors. Midwives and other health care providers worked conventional eight-hour shifts and handed over care to the next health care provider coming on duty during the next shift. In this model of care, each unit of care had its staff working independently. Besides, the health care provider assigned to the postnatal ward will be responsible for immediate postnatal care. After discharge, each woman in this group become the responsibility of a different group of healthcare providers (usually midwives or nurses) in the family planning and immunization room.

Sponsors & Collaborators

• Dalarna University

  collaborator OTHER

• Sophiahemmet University

  collaborator OTHER

• Bill and Melinda Gates Foundation

  collaborator OTHER

• Debre Berhan University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

49 Years

Sex

FEMALE

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-02-24

Primary Completion

2026-02-23

Completion

2026-02-23