BACKGROUND:
Ethnic minority women and those living in deprived areas face disproportionately poor perinatal outcomes, including stillbirth, preterm birth, and experiences of disrespectful care. The NHS CORE20PLUS5 strategy identifies continuity of care as a key intervention to address these disparities. However, limited evidence exists on how such models are experienced by the women they intend to benefit. Applying an intersectional lens can help reveal how overlapping social structures shape experiences and outcomes.

OBJECTIVES:
To explore whether a place-based model of midwifery continuity of care can improve experiences for women in a highly diverse, socially deprived area, and critically examine how power operates within maternity care using intersectional theory.

METHODS:
A longitudinal qualitative study was conducted with fifteen women who received care through a community-based midwifery continuity model. Participants were interviewed at three timepoints: during the third trimester of pregnancy, within three months postpartum, and again at 9–12 months after birth, resulting in 34 interviews. Data were analysed using narrative analysis and informed by an intersectional lens to examine how women’s social identities, structural disadvantage, and care relationships intersected across time and setting.

RESULTS:
Two core narrative themes were identified: (1) Organisational power, where participants described feeling disempowered within hospital-based systems but reported increased access, responsiveness, and coordination of care in the community setting; and (2) Interpersonal power, where continuity enabled trusting relationships with midwives that fostered personalisation, advocacy, and respectful communication. These narratives revealed how power relations were experienced and navigated by women.

CONCLUSIONS:
Community-based midwifery continuity models can help mitigate inequalities by addressing structural and relational dimensions of care. Intersectionality offers a valuable lens for understanding experiences and informing equitable policy and maternity care models.

KEY MESSAGE:
Midwives delivering continuity of care in community settings play a critical role in reducing inequalities by fostering trust, improving access, and enabling respectful, relational care for marginalised women. Continuity of care - outcomes 1