Midwifery continuity of carer in an area of high socio-economic disadvantage in London: A retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997-2009)

- The Albany Midwifery Practice was established within King's College Hospital NHS Trust in South East London and provided care to 2568 women from 1997 until 2009.
- The caseload included high proportions (57%) of women from Black, Asian and Minority Ethnic communities from an area of high social disadvantage.
- Midwifery continuity of carer was high with almost all women (95.5%) being attended in labour by their primary or secondary midwife.
- Spontaneous birth rates were high (79.8%) with a low caesarean section rate (16%). Overall, 43.5% of women gave birth at home.
- Neonatal outcomes were positive with 95% of babies having Apgar scores of >8 at 5 minutes. There were 15 perinatal deaths and no intrapartum intrauterine deaths.

Objectivein 1997, The Albany Midwifery Practice was established within King's College Hospital NHS Trust in a South East London area of high social disadvantage. The Albany midwives provided continuity of care to around 216 women per year, including those with obstetric, medical or social risk factors. In 2009, the Albany Midwifery Practice was closed in response to concerns about safety, amidst much publicity and controversy. The aim of this evaluation was to examine trends and outcomes for all mothers and babies who received care from the practice from 1997-2009.Designa retrospective, descriptive analysis of data routinely collected over the 12.5 year period was undertaken including changes over time and outcomes by demographic features.Setting and participantsall women booked with the Albany Midwifery Practice were included.Findingsof the 2568 women included over the 12.5 year period, more than half (57%) were from Black, Asian and Minority Ethnic (BAME) communities; one third were single and 11.4% reported being single and unsupported. Almost all women (95.5%) were cared for in labour by either their primary or secondary midwife. There were high rates of spontaneous onset of labour (80.5%), spontaneous vaginal birth (79.8%), homebirth (43.5%), initiation of breastfeeding (91.5%) and breastfeeding at 28 days (74.3% exclusively and 14.8% mixed feeding). Of the 79% of women who had a physiological third stage, 5.9% had a postpartum haemorrhage. The overall rate of caesarean section was 16%. The preterm birth rate was low (5%). Ninety-five per cent of babies had an Apgar score of 8 or greater at 5 minutes and 6% were admitted to a neonatal unit for more than two days. There were 15 perinatal deaths (perinatal mortality rate of 5.78 per 1000 births); two were associated with significant congenital abnormalities. There were no intrapartum intrauterine deaths.Key conclusionsthis analysis has shown that the Albany Midwifery Practice demonstrated positive outcomes for women and babies in socially disadvantaged and BAME groups, including those with complex pregnancies and perceived risk factors.Implications for practiceconsideration should be given to making similar models of care available to all women.