A known care provider
A woman is supported by a known and trusted midwife, or by a small group of known midwives, across the maternity continuum.
Pregnancy • Labour • Birth • Postnatal
Continuity of Maternity Care
A WHO-aligned guide to midwife-led continuity of care, where a known midwife or small group of known midwives supports a woman across the antenatal, intrapartum and postnatal continuum.
WHO-aligned
Known care provider
Person-centred
Multidisciplinary
Referral-ready
What continuity means
Care that follows the woman, not just the appointment
WHO describes midwife-led continuity of care as a model in which a known and trusted midwife, or a small group of known midwives, supports the woman throughout pregnancy, labour, birth and the postnatal period.
Continuity across stages
The model connects antenatal, intrapartum and postnatal care rather than treating each stage as a separate episode.
Relationship-based care
Time, communication, privacy, respect and individualized education help build a therapeutic relationship with the woman and family.
Coordinated referral
Midwives continue to coordinate and support care when obstetric, medical or other specialist assessment is needed.
Safe within a system
Continuity is not isolation: effective models require clear scope, consultation, referral pathways, emergency access and multidisciplinary teamwork.
Healthy transition to parenting
Care extends beyond birth to postnatal recovery, newborn care, feeding, self-care and healthy parenting practices.
The maternity continuum
How continuity can connect care from pregnancy to postnatal life
The precise service configuration varies by health system, setting and clinical need, but the principle is continuity across the maternity journey.
Before / early pregnancy
Build the relationship
Establish the care relationship, understand the woman’s priorities, identify health and social needs, and create an individualized care plan.
Antenatal period
Assess, educate and prepare
Provide routine antenatal assessment within scope, health education, screening coordination, birth preparedness and complication-readiness, and continuity of communication.
Labour & birth
Stay with the woman
When appropriate and within the model, a known midwife or small team supports labour and birth while monitoring maternal and fetal well-being and coordinating escalation when required.
Immediate postnatal period
Continue the transition
Support maternal recovery, newborn adaptation, feeding, bonding, danger-sign recognition and discharge planning.
Postnatal period
Follow through
Continue postnatal assessment, counselling, feeding support, family planning and referral/follow-up according to needs and local protocols.
Caseload & team models
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Caseload model One primary midwife is responsible for a defined caseload, with appropriate backup arrangements for leave, rest and emergencies.
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Team model A small group of midwives shares responsibility so the woman becomes familiar with the team and can usually see a known provider.
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Named backup Every continuity model should make it clear who provides backup when the primary or team midwife is unavailable.
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Multidisciplinary network The midwife works with obstetricians, physicians, nurses, neonatal teams and other services when consultation or referral is needed.
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Women-held information Paper or electronic records carried or accessible to the woman can support continuity when she moves between providers or facilities.
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Clear boundaries Continuity does not mean providing care outside competence; the model must define escalation, referral, emergency response and documentation.
Continuity within a multidisciplinary system
WHO's model is not isolated midwifery care. The midwife remains responsible for appropriate assessment and coordination within scope while working with obstetric, medical, neonatal and other professionals when additional care is required.
Safety principle: continuity should strengthen coordination and relationships without delaying consultation, referral, emergency treatment or access to higher-level care.
Woman-centred care
The relationship is part of the care model
WHO's maternity guidance places respectful, person-centred communication and informed choice alongside clinical safety.
Informed choice
Explain options, benefits, risks and alternatives in understandable language and support the woman to participate in decisions.
Respect & dignity
Protect privacy, confidentiality and dignity and provide care free from discrimination, coercion and mistreatment.
Communication
Use effective, culturally acceptable communication and invite questions throughout the maternity journey.
Companionship
Support the woman’s chosen companion where feasible and consistent with the care setting and privacy of others.
Mobility & comfort
Discuss comfort measures, mobility and birth-position choices according to clinical circumstances and local guidance.
Individual goals
Document preferences and priorities while keeping the care plan responsive to changing clinical needs.
Practical workflow
What a continuity-of-care pathway should make possible
| Care function | Continuity approach | Safety / coordination requirement |
|---|---|---|
| Assessment | Known provider understands the woman's history, priorities and ongoing care plan. | Use appropriate clinical assessment, screening and documentation within scope. |
| Education & counselling | Information can be individualized and reinforced over multiple contacts. | Use clear communication, informed choice and teach-back where useful. |
| Labour & birth | A known midwife or small team can provide continuous supportive care when the model and clinical circumstances permit. | Maintain maternal/fetal monitoring, emergency readiness and access to obstetric/neonatal services. |
| Referral | The midwife helps coordinate the transition to additional or specialist care. | Referral should be timely, documented and communicated clearly. |
| Postnatal care | The known provider/team continues support for maternal recovery, newborn care and parenting. | Recognize danger signs and arrange prompt assessment or referral when needed. |
| Records | Consistent information supports shared understanding across contacts and facilities. | Protect confidentiality, data security and access to essential records. |
Referral & escalation
Continuity never replaces specialist care when it is needed
A strong model combines relationship-based midwifery care with clear pathways for consultation, referral and emergency management.
Recognize change
Identify maternal, fetal or newborn findings that require additional assessment or escalation.
Consult early
Seek appropriate multidisciplinary input when a condition moves beyond the midwife’s scope or requires specialist assessment.
Coordinate
Support clear communication between the woman, family, midwife, receiving clinician and referral facility.
Transfer safely
Use an appropriate referral pathway and ensure emergency transfer is not delayed by administrative processes.
Maintain continuity
Where possible, the known midwife or team remains involved in communication and follow-up after referral.
Close the loop
Document the referral and integrate relevant information back into the ongoing maternity care plan.
Important: A woman can have continuity while also receiving obstetric, medical, neonatal or other specialist care. The appropriate level of care should be determined by clinical need and local scope-of-practice and referral arrangements.
Implementation
What health systems need for a safe continuity model
WHO's 2025 implementation guidance describes midwifery models as system-level models requiring governance, workforce, service delivery, partnerships and sustainability.
Workforce
Adequate numbers of appropriately educated and regulated midwives are needed, with sustainable caseloads and reasonable workload.
Governance
Define roles, accountability, scope of practice, escalation pathways, referral arrangements and clinical governance.
Training
Assess additional education, continuing professional development, emergency skills and teamwork needs before and during implementation.
Service design
Design appointment, labour, postnatal and backup systems around continuity while preserving timely access to higher-level care.
Data & quality
Monitor continuity, experience of care, safety, referral patterns, workload, outcomes and equity rather than measuring only attendance.
Sustainability
Review staffing, burnout, workload and resource use so the model remains safe and feasible over time.
Continuity documentation checklist
- Care planDocument relevant history, priorities, risks, care goals and planned follow-up.
- Provider/teamRecord the primary midwife/team and the appropriate backup arrangement.
- Referral informationKeep consultation, referral and receiving-facility information accessible.
- PreferencesRecord informed preferences and update them as circumstances change.
- Postnatal follow-upDocument discharge advice, newborn/maternal follow-up and safety-netting.
Quality indicators to consider
- Continuity experienced by womenTrack whether women actually see a known provider or small known team.
- Experience of careUse feedback on communication, respect, involvement and accessibility.
- Clinical safetyMonitor escalation, referral, adverse events and access to emergency services.
- Workload & wellbeingReview caseloads, staffing, backup, leave and provider wellbeing.
- EquityCheck whether continuity is accessible to women who face geographic, financial or social barriers.
Frequently asked questions
Continuity of maternity care FAQs
What is continuity of maternity care?
Continuity of maternity care is an approach in which a woman receives care from a known and trusted midwife or a small group of known midwives across the antenatal, intrapartum and postnatal continuum. WHO describes this as midwife-led continuity-of-care (MLCC) and recommends it in settings with well-functioning midwifery programmes.
What is the difference between caseload and team midwifery?
In a caseload model, one primary midwife is responsible for a defined group of women, with appropriate backup. In team midwifery, a small group of midwives shares responsibility and the woman becomes familiar with the team. Both are continuity models.
Does continuity of care mean the midwife works alone?
No. WHO describes MLCC within a multidisciplinary network. Midwives coordinate consultation and referral when women need obstetric or other specialist attention. Safe continuity requires effective collaboration and access to emergency and specialist services.
Who is continuity of midwifery care intended for?
WHO recommends MLCC for pregnant women in settings with well-functioning midwifery programmes as a context-specific recommendation. The exact eligibility, service configuration and referral arrangements depend on the health system and local clinical governance.
Can women with complications receive continuity of care?
Continuity models must be adapted to clinical need. The WHO evidence base includes models involving some women with higher-risk pregnancies, but continuity does not replace specialist care. Women requiring obstetric or medical care should receive timely consultation, referral and co-management as appropriate.
Why are backup arrangements important?
A safe continuity model cannot depend on one person being continuously available. Named backup, team coverage, workload management, leave arrangements and emergency pathways help preserve safety and sustainability.
What role does the woman play in continuity of care?
The woman is an active participant. Continuity supports communication, informed choice, individualized education, shared planning, access to records and participation in decisions about her care.
Does continuity of care guarantee a particular birth outcome?
No. Continuity is a model of care, not a guarantee of a particular mode of birth or clinical outcome. Pregnancy and childbirth remain dynamic, and care should change when maternal or fetal needs require it.
Guideline references
Evidence base
Key WHO resources supporting the continuity-of-care framework used on this page.
WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience (2016)
WHO recommends midwife-led continuity-of-care models, in settings with well-functioning midwifery programmes, as a context-specific recommendation. The model is described as a known midwife or small group of known midwives supporting women through antenatal, intrapartum and postnatal care.
WHO ANC guideline
WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience (2018)
WHO includes midwife-led continuity of care among recommendations for care throughout labour and birth and places it alongside respectful maternity care, effective communication and continuous support.
WHO intrapartum care guideline
WHO Recommendations on Maternal and Newborn Care for a Positive Postnatal Experience (2022)
The postnatal guideline integrates the MLCC recommendation and describes continuity across antenatal, intrapartum and postnatal periods.
WHO postnatal care guideline
WHO Recommendations on Maternal Health (2nd edition, 2025)
The consolidated maternal-health recommendations retain the context-specific recommendation for midwife-led continuity of care in settings with well-functioning midwifery programmes.
WHO maternal health recommendations
WHO Implementation Guidance on Transitioning to Midwifery Models of Care (2025)
This implementation guidance addresses service delivery, workforce development, policy and regulation, governance, partnerships, community engagement and sustainability when transitioning to midwifery models.
WHO implementation guidance
WHO Global Position Paper: Transitioning to Midwifery Models of Care (2024)
The position paper describes midwifery models as person-centred, integrated and rights-based approaches across the continuum from pre-pregnancy to the postnatal period.
WHO global position paper
Educational information: This page explains the WHO continuity-of-care model for education and service-design purposes. It does not establish a legal scope of practice or replace local laws, professional regulation, facility protocols, emergency systems or clinical judgement. The exact configuration of continuity models should be adapted to the local health system, available workforce, referral capacity and clinical needs of women and newborns.