PLANS to reshape midwifery care in Scotland to create a model where expectant mothers are guided through pregnancy, childbirth and the postnatal period by a single midwife were hailed as a "seismic shift" when they were unveiled in January.
That may seem like hyperbole, but the mountain of evidence in favour of this "continuity of care" approach cannot be over-stated. With the Scottish Government confirming last week that it has appointed Jane Grant - who authored the 'Best Start' review proposing the shift - as the chair of the implementation group there is reason to hope that the recommendations will be rolled out.
In short, studies strongly indicate that the model - versions of which have already earned acclaim in New Zealand and the Netherlands - reduces premature births, miscarriages and stillbirths, caesarean deliveries, and even the average length of labour. It was also associated with increased breastfeeding rates and a reduction in overall costs to the health service.
The figures are not slight, either. A 2015 study based on more than 17,600 pregnancies from 1989 to 2013 in the UK, Ireland, Canada and Australia found that a woman who receives care from a known midwife is 24 per cent less likely to give birth prematurely (before 37 weeks) and 19 per cent less likely to suffer a foetal loss (miscarriage or stillbirth) before 24 weeks. There was also an overall reduction in foetal and neonatal deaths of 16 per cent.
Childbirth itself was on average half an hour shorter, 10 per cent less likely to require an intervention such as forceps delivery and the mothers were 15 per cent less likely to use epidural pain relief.
The fact that the model is also associated with a shift towards more natural births and fewer caesarean deliveries is also particularly significant for Scotland, where the percentage of babies delivered by C-section has tripled since the mid-1970s and reached an all-time high in 2016. While some C-sections may be necessary and safer, they are also associated with a heightened risk of stillbirth in subsequent pregnancies and - coupled with a decline in breastfeeding - have been cited as a potential factor behind the rise in obesity and allergies because, unlike traditional births, the infants' guts miss out of the chance to be exposed to their mother's protective bacteria.
There is no definitive explanation for why the model works. One theory is that mothers dealing consistently with the same midwife throughout their pregnancy experience less anxiety and therefore release less cortisol, the stress hormone.
It is also thought that it helps to shift the perception of the midwife from an "authority figure" to a "friend figure", which is particularly important in deprived demographics with higher rates of teenage pregnancy, smoker, poor diets or higher alcohol consumption as the mothers will be more open to advice on altering their behaviour.
England announced its own intentions to pursue the model around a year before Scotland, but the NHS in England is hamstrung by a shortage of midwives - putting Scotland in a position to be the UK's pioneer.
There is no doubt that the potential shift to a continuity-of-care model in Scotland has wide-ranging implications not only for the individual health of mothers and babies, but for public health as a whole and an under-pressure NHS.
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