title: Continuity of caregivers for care during pregnancy and childbirth.
abstract: BACKGROUND
  Care is often provided by multiple caregivers, many of whom work only in the antenatal clinic, labour ward or postnatal unit. However continuity of care is provided by the same caregiver or a small group from pregnancy through the postnatal period.
  
  
  OBJECTIVE
  The objective of this review was to assess continuity of care during pregnancy and childbirth and the puerperium with usual care by multiple caregivers.
  
  
  METHODS
  The Cochrane Pregnancy and Childbirth Group trials register was searched.
  
  
  METHODS
  Controlled trials comparing continuity of care with usual care during pregnancy, childbirth and the postnatal period.
  
  
  METHODS
  Trial quality was assessed. Study authors were contacted for additional information.
  
  
  RESULTS
  Two studies involving 1815 women were included. Both trials compared continuity of care by midwives with non-continuity of care by a combination of physicians and midwives. The trials were of good quality. Compared to usual care, women who had continuity of care from a team of midwives were less likely to be admitted to hospital antenatally (odds ratio 0.79, 95% confidence interval 0.64 to 0.97) and more likely to attend antenatal education programs (odds ratio 0.58, 95% confidence interval 0.41 to 0.81). They were also less likely to have drugs for pain relief during labour (odds ratio 0.53, 95% confidence interval 0.44 to 0.64) and their newborns were less likely to require resuscitation (odds ratio 0.66, 95% confidence interval 0.52 to 0.83). No differences were detected in Apgar scores, low birthweight and stillbirths or neonatal deaths. While they were less likely to have an episiotomy (odds ratio 0.75, 95% confidence interval 0.60 to 0.94), women receiving continuity of care were more likely to have either a vaginal or perineal tear (odds ratio 1.28, 95% confidence interval 1.05, 1.56). They were more likely to be pleased with their antenatal, intrapartum and postnatal care.
  
  
  CONCLUSIONS
  Studies of continuity of care show beneficial effects. It is not clear whether these are due to greater continuity of care, or to midwifery care.
authors.affiliation: Maternal, Infant and Reproductive Health Research Unit, 790 Bay Street, Sute 715, Toronto, Ontario, CANADA, M5G 1N8. ellen.hodnett@utoronto.ca
authors.forename: E D
authors.initials: ED
authors.lastname: Hodnett
mesh_terms: D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016389:Maternal-Child Nursing; D008880:Midwifery; D011181:Postnatal Care; D011247:Pregnancy; D011295:Prenatal Care