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CONFERENCE PROCEEDING
Midwifery continuity of care in a crisis: How New Zealand’s model of maternity care safely supported a surge in home births during the Covid-19 lockdown
1
New Zealand College of Midwives, Research, Christchurch, New Zealand
2
University of Otago, Population Health, Christchurch, New Zealand
Eur J Midwifery 2026;10(Supplement 1):A69
ABSTRACT
BACKGROUND:
During the COVID-19 pandemic, many high-income countries restricted home birth services due to system pressures. In contrast, Aotearoa New Zealand’s midwifery-led continuity of care (MLCC) model – where publicly funded, caseloading, community midwives provide care across home, midwifery-led units and hospitals – enabled women to retain choice in birthplace.
OBJECTIVES:
To examine the impact of New Zealand’s 2020 lockdown on maternity care and clinical safety, with a focus on how the MLCC model supported adaptation.
METHODS:
A population-based interrupted time-series analysis of 172,511 singleton, live births (2018–2020) compared pre-lockdown, lockdown (7 weeks), and post-lockdown periods for maternity and neonatal indicators. Analyses were stratified by ethnicity (Māori/NZ European).
RESULTS:
During lockdown, the home birth rate rose to 7.41% nationally (+3.94 percentage points from the predicted rate, 95% CI 3.30–4.57, p<0.001), with the largest increase among Māori women (+5.46%, p<0.001). Midwifery-led unit use declined overall and among NZ European women but remained stable for Māori women; hospital births decreased. There were no significant changes in maternal morbidity (composite of postpartum haemorrhage, obstetric anal sphincter injury, ICU admission) or neonatal morbidity (Apgar score <7 at 5 minutes, respiratory support >4 hours, neonatal unit admission).
CONCLUSIONS:
New Zealand’s MLCC model provided critical flexibility and maternity service stability during a global pandemic which significantly disrupted health service delivery. Continuity of care, midwifery autonomy, and a contractual relationship with the woman rather than the institution, enabled midwives to adapt rapidly to women’s changing birth preferences while maintaining safe clinical outcomes for indigenous and non-indigenous women. Women's and babies' safety was further supported by the integrated maternity service model, whereby caseloading midwives collaborate with hospital midwives and obstetric services when needed.
KEY MESSAGE:
Midwifery continuity of care, supported by adequate funding, professional autonomy and collaborative care, is a workforce retention and crisis preparedness strategy, aligning with the global “One Million More Midwives” goal. Continuity of care - outcomes 1
During the COVID-19 pandemic, many high-income countries restricted home birth services due to system pressures. In contrast, Aotearoa New Zealand’s midwifery-led continuity of care (MLCC) model – where publicly funded, caseloading, community midwives provide care across home, midwifery-led units and hospitals – enabled women to retain choice in birthplace.
OBJECTIVES:
To examine the impact of New Zealand’s 2020 lockdown on maternity care and clinical safety, with a focus on how the MLCC model supported adaptation.
METHODS:
A population-based interrupted time-series analysis of 172,511 singleton, live births (2018–2020) compared pre-lockdown, lockdown (7 weeks), and post-lockdown periods for maternity and neonatal indicators. Analyses were stratified by ethnicity (Māori/NZ European).
RESULTS:
During lockdown, the home birth rate rose to 7.41% nationally (+3.94 percentage points from the predicted rate, 95% CI 3.30–4.57, p<0.001), with the largest increase among Māori women (+5.46%, p<0.001). Midwifery-led unit use declined overall and among NZ European women but remained stable for Māori women; hospital births decreased. There were no significant changes in maternal morbidity (composite of postpartum haemorrhage, obstetric anal sphincter injury, ICU admission) or neonatal morbidity (Apgar score <7 at 5 minutes, respiratory support >4 hours, neonatal unit admission).
CONCLUSIONS:
New Zealand’s MLCC model provided critical flexibility and maternity service stability during a global pandemic which significantly disrupted health service delivery. Continuity of care, midwifery autonomy, and a contractual relationship with the woman rather than the institution, enabled midwives to adapt rapidly to women’s changing birth preferences while maintaining safe clinical outcomes for indigenous and non-indigenous women. Women's and babies' safety was further supported by the integrated maternity service model, whereby caseloading midwives collaborate with hospital midwives and obstetric services when needed.
KEY MESSAGE:
Midwifery continuity of care, supported by adequate funding, professional autonomy and collaborative care, is a workforce retention and crisis preparedness strategy, aligning with the global “One Million More Midwives” goal. Continuity of care - outcomes 1
| eISSN: | 2585-2906 |
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