Cristina Fernandez Turienzo tells us about her PhD on continuity of care
"My PhD thesis was an evaluation of a continuity of midwifery care pathway throughout pregnancy, birth and postpartum for women at increased risk of PTB in South London. This involved exploring implementation, mechanisms of action and women's experiences of care by using mixed methods (e.g. pilot trial, qualitative interviews with women and staff, postnatal survey).
Being awarded the Iolanthe Midwifery Research Fellowship enabled me to buy some time away from my full-time job and focus on the last year of my PhD, giving me the opportunity to have dedicated and protected time for the next six months to write the different chapters of my thesis and submit by January 2020.
High rates of preterm births remain a public health problem in the UK and elsewhere. Preterm birth (PTB) is a major determinant of adverse infant and longer-term outcomes, including survival, quality of life, as well as having psychosocial effects on the family.
A wide range of risk factors have been associated with PTB: from obstetric and medical risk (e.g having a previous PTB, late miscarriage, surgery of the cervix, hypertension, mental illness) social stress and deprivation, smoking, substance misuse and pollution and being of black, Asian of from an ethnic minority. As there are many factors which can have an effect on the likelihood of being at risk from pre-term birth, no single intervention will have an effect on PTB rates.
A Cochrane review found that women who receive continuity of care by a named midwife or a small group of midwives throughout pregnancy, birth and postnatal periods are 24% less likely to experience a PTB and 16% less likely to lose their baby before 24 weeks. At the moment, the reasons for this remain unclear as there is insufficient evidence on the outcomes of continuity models for women with clinical risk factors and complications.
I would like to thank Iolanthe for the support the Midwifery Research Fellowship has given me. "
Please note: the Midwifery Research Fellowship is awarded periodically, subject to availability of funds and at the discretion of the Iolanthe Trustees.
Fernandez Turienzo C, Bick D, Briley AL, et al. Midwifery continuity of care versus standard maternity care for women at increased risk of preterm birth: A hybrid implementation-effectiveness, randomised controlled pilot trial in the UK. PLoS Med. 2020;17(10):e1003350. Published 6 Oct 2020. doi:10.1371/journal.pmed.1003350