At the 34th ICM Triennial Congress, I will be presenting one of the workstreams from my PhD research which explores one of the ongoing questions in contemporary maternity care: how are Midwifery Continuity of Carer (MCoC) models implemented in practice, and what is needed to sustain them across maternity services in the United Kingdom (UK) and internationally? This discussion is particularly relevant at the 34th ICM Triennial Congress, where midwives, educators, researchers, leaders and policymakers from across the world will come together to share knowledge and address the challenges facing maternity care.
MCoC is a relationship-based model in which women and birthing people receive care from a known midwife, supported by a small team, throughout pregnancy, birth and the postnatal period. The model continues to receive strong professional and policy support. In the UK, the Royal College of Midwives (RCM) supports MCoC across the maternity journey as the central model of care. Internationally the World Health Organisation (WHO) identifies MCoC models as an important approach to strengthening person-centred maternity care and improving maternal and newborn outcomes; and call for global expansion of midwifery models of care.
The evidence underpinning MCoC is one reason this topic remains so relevant. Cochrane’s 2024 review found that women receiving midwife continuity models were more likely to report positive experiences of pregnancy, labour and postpartum care, and were less likely to experience caesarean section or instrumental birth.. However, translating policy ambition into sustainable everyday practice has proved more difficult, particularly within maternity systems experiencing workforce shortages, increasing demand and wider organisational pressures.
My presentation shares findings from a scoping literature review of studies from countries including Australia, Canada, New Zealand and the UK. Rather than focusing only on whether MCoC is beneficial, the review explores how MCoC is defined, organised, implemented and sustained within real maternity settings. Using the COM-B framework, the review examines implementation through three interconnected factors: Capability, Opportunity and Motivation. This includes whether midwives feel prepared for MCoC roles, whether organisations create the right conditions for the model to succeed, and whether professional identity, morale and workplace culture support sustainability over time.
What becomes clear from the literature is that successful implementation depends on more than policy direction alone. Training, leadership, manageable caseloads, supportive teams and protected implementation time all play an important role. Wider organisational factors, including staffing, rostering, funding and multidisciplinary collaboration, are equally influential.
I hope attendees leave the session with a clearer understanding that successful implementation of MCoC relies on collaborative organisational support, workforce engagement and sustained commitment. Above all, I hope the discussion highlights how implementation science frameworks, such as COM-B, can help maternity services design and sustain evidence-informed MCoC models that are safe, realistic and professionally rewarding for midwives, while continuing to improve care experiences for women, birthing people and families.
iCM Speaker session: Wednesday 17 June, 16:00 – 17:30, Room 1.06
