Abstract
BackgroundResearch shows that continuity of midwifery carer in pregnancy improves maternal and neonatal outcomes. This study examines whether midwifery group practice (MGP) care during pregnancy affects infant neurodevelopment at 6-months of age compared to women receiving standard hospital maternity care (SC) in the context of a natural disaster.MethodsThis prospective cohort study included 115 women who were affected by a sudden-onset flood during pregnancy. They received one of two models of maternity care: MGP or SC. The women’s flood-related objective stress, subjective reactions, and cognitive appraisal of the disaster were assessed at recruitment into the study. At 6-months postpartum they completed the Ages and Stages Questionnaire (ASQ-3) on their infants’ communication, fine and gross motor, problem solving, and personal-social skills.ResultsGreater maternal objective and subjective stress predicted worse infant outcomes. Even when controlling for maternal stress from the flood, infants of mothers who were in the MGP model of maternity care performed better than infants of mothers in SC on two of the five ASQ-3 domains (fine motor and problem solving) at 6-months of age. Furthermore, infants in the SC model were more likely to be identified as at risk for delayed development on these domains than infants in the MGP model of care.ConclusionsContinuity of midwifery care has positive effects on infant neurodevelopment when mothers experience disaster-related stress in pregnancy, with significantly better outcomes on two developmental domains at 6 months compared to infants whose mothers received standard hospital care.
Highlights
Research shows that continuity of midwifery carer in pregnancy improves maternal and neonatal outcomes
As flood-related prenatal maternal stress (PNMS) has negative effects on infant neurodevelopment at 6-months, we examined whether the model of maternity care (MGP vs standard hospital maternity care (SC)) that the women received would buffer their infants’ development from the effects of flood-related PNMS
M@NGO women were randomly allocated to midwifery group practice (MGP) or SC whereas Queensland Flood Study (QF2011) women self-selected their model of care or received SC when all MGP places were filled. 56 women were recruited from M@NGO and 59 women were recruited into QF2011
Summary
Research shows that continuity of midwifery carer in pregnancy improves maternal and neonatal outcomes. This study examines whether midwifery group practice (MGP) care during pregnancy affects infant neurodevelopment at 6-months of age compared to women receiving standard hospital maternity care (SC) in the context of a natural disaster. Women experiencing continuity of midwifery carer during the maternity episode, in comparison to those in standard care, have better maternal, childbirth, and neonatal outcomes including reduced interventions (e.g., induction, analgesia, episiotomy) and operative birth (e.g., instrumental, caesarean) [1]. Prior research shows that stress in pregnancy has an enduring influence on neonatal outcomes [5, 6] and infant neurodevelopment, including adversely affecting early cognitive [7], linguistic [8], motor [9], and behavioral [10] development. Simcock et al BMC Pregnancy and Childbirth (2018) 18:309 were receiving standard hospital care (SC) and half were receiving midwifery group practice (MGP) maternity care. In MGP care, women have a primary midwife, with two to three back-up midwives working in a small group
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