Abstract
Introduction: Midwifery continuity of care may improve maternal mental health. Integrating this model into midwifery education may facilitate broader adoption; however, no trials examined its effects on maternal health. We aimed to assess the effect of a midwifery student’s continuity of care program on fear of childbirth and postpartum depression (primary outcomes).
Methods: In this trial, low-risk women at 26–29 weeks of gestation were recruited from Tabriz health centers from November 2022 to February 2023 and assigned to intervention or control groups using stratified block randomization. Twenty-five final-year midwifery students provided continuity of care (each for one to two women) from pregnancy through postpartum for the intervention group; both groups received usual care. Childbirth fear and depression were assessed using the Wijma Delivery Expectancy/Experience Questionnaire and Edinburgh Postnatal Depression Scale at baseline, and 40–50 days postpartum. Analysis of covariance, adjusted for baseline values, parity, and intended hospital type, was used to compare the groups.
Results: All 93 recruited women were analyzed; 50% were primiparous. In the intervention group (n=45), 76% attended≥6 antenatal sessions, and 64% participated in≥3 postpartum sessions provided by the students. The intervention group showed lower mean total fear of childbirth (35.8 vs. 75.8, adjusted mean difference (AMD) -43.2; 95% CI: -52.7 to -33.7) and depression scores (5.3 vs. 11.2, AMD -5.9; 95% CI: -8.1 to -3.7) than controls.
Conclusion: The findings support further evaluation and implementation research. However, these findings should be interpreted cautiously considering the single-city design, lack of blinding, and reliance on self-reported outcomes.
Trial registration: Iranian Registry of Clinical Trials, IRCT20100414003706N41, registered prospectively on 30 April 2022, https://www.irct.ir/search/ result?query=IRCT20100414003706N41.