The midwife who knows you

What continuity of midwife care actually means, and what the evidence says it changes.

There is a particular moment that many women describe in almost identical terms. You arrive at your antenatal appointment, and the midwife who sees you has never met you before. She reads through your notes while you sit across from her. She asks questions you have already answered twice. And somewhere in the room, the thing you actually needed to say, the thing that had been building for weeks, stays unsaid, because there isn't time, and because you don't quite know where to begin with a stranger.

This is not a failure of the individual midwife. It is a structural problem. And it has a name, a body of evidence, and a solution.

What continuity of midwife care actually means

Before the evidence, a definition. The world's most comprehensive systematic review of midwifery care models, published in the Cochrane Database of Systematic Reviews in April 2024, describes the model precisely:

"Midwife continuity of care models provide care from the same midwife or team of midwives during pregnancy, birth, and the early parenting period in collaboration with obstetric and specialist teams when required."

Sandall et al., Cochrane Database of Systematic Reviews, 2024

Three things in that sentence are worth pausing on. The same midwife or team: not whoever is on shift, not a rotating roster of strangers, but someone who knows you. Across pregnancy, birth, and the early parenting period: not just the antenatal appointments, but all of it, including the weeks after your baby arrives when the clinical and emotional demands are often at their most intense and the support most absent. And in collaboration with obstetric and specialist teams when required: because continuity of midwife care is not a rejection of specialist medicine. When complexity arises, your midwife does not step aside. She escalates, she coordinates and she stays by your side.

What 35 years of research shows

The evidence base for midwife continuity of care is one of the most robust in maternity research. The most recent and comprehensive assessment, the 2024 Cochrane systematic review by Sandall and colleagues, incorporated seventeen randomised controlled trials and nearly 19,000 women. It found that compared to standard models of care, women receiving midwife continuity of care were 9% less likely to have a caesarean section, 11% less likely to have an instrumental birth with forceps or ventouse, and 5% more likely to give birth spontaneously and vaginally. These are moderate-certainty findings, meaning the research community has substantial confidence in them.

The same review found a 17% reduction in episiotomy rates, a finding that carries slightly lower certainty and warrants further research to confirm, but which points consistently in the same direction.

The review also showed a trend toward reduced use of regional anaesthesia, though this finding requires further research to confirm.

These are not marginal differences. Across a population of many thousands of women, they represent a meaningful shift in how birth proceeds, and in the physical and psychological recovery that follows.

Beyond outcomes, the review found that women receiving midwife continuity of care consistently reported more positive experiences during pregnancy, labour, and the postnatal period than those in standard care. And notably, continuity models were associated with cost savings in the antenatal and intrapartum periods: not a premium for something that works, but an efficiency gain.

It is worth saying clearly what these figures represent: they are the outcomes of women cared for by midwives who knew them. Not who had read their notes. Knew them.

Why the World Health Organisation is paying attention

In June 2025, the World Health Organization published its implementation guidance on transitioning to midwifery models of care, a detailed framework developed in collaboration with UNICEF, UNFPA, and the International Confederation of Midwives. The guidance is unambiguous: midwifery models of care, in which a known midwife coordinates care from pregnancy through to the postnatal period, represent one of the most effective strategies for improving maternal and newborn health available to any health system. This follows a 2024 WHO global position paper calling for a worldwide transition to midwifery-led care.

In the UK, this maps directly onto existing policy commitments. The Better Births Review (2016), the NHS Three-Year Delivery Plan for Maternity and Neonatal Services (2023), and the Core20PLUS5 approach to reducing healthcare inequalities all identify midwife continuity of care as a priority. The research and the policy point in the same direction.

In April 2026, the government published its Renewed Women's Health Strategy for England, setting out priorities for the next ten years. It is a document with genuine ambition in several areas: Black maternal mortality, gynaecology waiting times, the culture of not being believed. It is also a document in which continuity of midwifery care does not appear, and in which postnatal support receives no meaningful commitment. The WHO has published its guidance. The Cochrane evidence has been in the public domain for years. Policy, it seems, is still catching up. You do not have to wait for it.

What continuity looks like in practice

The clinical benefits of continuity are real. But they are grounded in something that is harder to measure and easier to underestimate: what happens when a midwife knows you well enough to notice when something has changed.

A midwife who has seen you across multiple appointments does not need to be told that your anxiety has shifted, or that you seem quieter than last time, or that the question you asked about induction sounds like it comes from somewhere specific. She already knows the baseline. She can see the deviation from it. When you arrive at labour, she has already read your birth plan, not because she was handed it at the door, but because she helped you write it. And when you come home with your baby and everything feels simultaneously wonderful and completely overwhelming, she is there for that too.

This is also what distinguishes continuity from simply having access to a midwife. Access is a low bar. A named midwife who knows your pregnancy, your birth, and your recovery is something categorically different.

The question worth asking

The NHS provides excellent clinical expertise. Its consultants, obstetricians, and hospital teams deliver world-class acute care. What the system cannot consistently provide, because of how it is structured and resourced, is continuity of relationship across the full journey. The same face at every antenatal appointment. A midwife at birth who already knows you. Someone who visits you at home in the days and weeks after, who knows what your pregnancy was like, what your birth was like, and what kind of support you actually need now.

That gap is not a criticism of anyone working within the system. It is simply a structural reality. And it is one that can be addressed.

At The Motherhood Practice, continuity is the foundation, but it is not the only thing we offer. Our midwives bring deep expertise across both normal and complex pregnancies and births. Your appointments happen at home, last one to two hours, and are never rushed, which means you have the time and space to ask every question and to be heard fully. We provide continuous WhatsApp support, seven days a week. We stay with you through pregnancy, prepare a formal medical handover to your hospital team ahead of birth, and continue to visit you at home for six weeks postpartum, as your body recovers and your family finds its shape.

If the idea of a midwife who truly knows you, not just your notes but you, from the first appointment to first feed, is something you haven't been able to find, we would love to talk. We offer a free 20-minute conversation. We're here when you're ready.

References

Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2024, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub6

World Health Organization. Implementation guidance on transitioning to midwifery models of care. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO. Available at: https://www.who.int/publications/i/item/9789240110199

World Health Organization. Transitioning to midwifery models of care: global position paper. Geneva: World Health Organization; 2024.

NHS England. Three-Year Delivery Plan for Maternity and Neonatal Services. London: NHS England; 2023.

NHS England. Better Births: Improving outcomes of maternity services in England. National Maternity Review; 2016.

NHS England. Core20PLUS5: an approach to reducing healthcare inequalities. London: NHS England; 2021.

Department of Health and Social Care. The Renewed Women's Health Strategy for England. London: His Majesty's Stationery Office; April 2026. CP 1558. Available at: https://assets.publishing.service.gov.uk/media/69df5d7261d2e8e9b9e42d2e/renewed-womens-health-strategy-for-england-web-accessible.pdf