MIDWIFERY CONTINUITY OF CARE IN PORTUGAL: MATERNAL AND NEONATAL OUTCOMES (2009-2024)

Abstract

Objective To examine maternal, neonatal, and breastfeeding outcomes among women receiving care under a midwifery continuity of care model in a private healthcare unit in northern Portugal between 2009 and 2024. Design Retrospective, descriptive, quantitative analysis of routinely collected clinical data over a 15-year period, following the RECORD reporting guidelines. Setting and Participants All women (N=320) who received antenatal, intrapartum, and/or postnatal care from a dedicated midwifery team in a private health unit in northern Portugal. Care was provided either at home, in private hospitals, or in public hospitals where possible, according to women's preferences and clinical indications. Findings The overall caesarean section rate was 14.3%, with 92.1% vaginal birth after caesarean success among eligible women in active labour. Of all vaginal births, 68.6% resulted in an intact perineum or first-degree laceration, and episiotomy prevalence was 13.9%. Most women (76.6%) used only non-pharmacological pain relief methods; water immersion was used in 57.5% of labours, including 102 water births. Neonatal outcomes were positive: 99.7% had a 5-minute Apgar ≥ 7, 92.9% were term births, and there were no perinatal deaths. Exclusive breastfeeding rates were 89.8% at one hour, three months, and six months, with 57.7% still breastfeeding at two years. Outcomes were significantly more favourable when births occurred in settings where midwives maintained full continuity and clinical autonomy. Key Conclusions Midwifery-led continuity of care in this private Portuguese setting was associated with low caesarean rates, high vaginal birth after cesarean (VBAC) success, favourable perineal outcomes, minimal intervention use, very good neonatal health indicators, and sustained breastfeeding rates. The model appears to offer a safe and effective alternative to the prevailing medicalised approaches in Portugal. Implications for Practice Findings support the expansion of midwifery-led continuity care models in Portugal, particularly for low-risk pregnancies, as a strategy to reduce unnecessary interventions, improve birth experiences, and promote optimal maternal and neonatal health. Policy and service planning should consider piloting and scaling such models in both private and public sectors.