Background: Maternal mortality remains unacceptably high in low-resource settings, with obstetric emergencies (postpartum haemorrhage, eclampsia, sepsis, obstructed Labor) driving most deaths. Fragmented facility-based care often fails women in remote areas due to critical delays in recognition, transport, and treatment. Midwife-led continuity of care (MLCC), when extended into communities, offers a transformative solution by ensuring known, trusted midwives enable early detection and prompt emergency referrals.

Objective: To evaluate the impact of a community-embedded MLCC model on maternal emergency mortality, emergency response times, and maternal agency in low-resource settings.

Methodology: A mixed-methods, quasi-experimental study was conducted over 24 months across four low-resource communities. The intervention group (n=1,250 women) received continuous care from a named community midwife from early pregnancy through 6 weeks postpartum (including home visits, 24/7 phone access, emergency birth kits, and facilitated referral pathways). The comparison group (n=1,230 women) received standard fragmented care. Primary outcomes included emergency-attributable maternal mortality ratio (MMR) and response time (danger-sign recognition to emergency facility arrival). Secondary outcomes measured maternal agency using the Mothers' Autonomy in Decision Making (MADM) scale and Childbirth Self-Efficacy Inventory (CBSEI). Qualitative interviews were conducted with 80 women, 40 midwives, and 20 facility staff.

Results:

• Maternal Mortality: MMR from obstetric emergencies was 74% lower in the intervention group (38 vs. 146 per 100,000 live births; aRR=0.26, 95% CI: 0.11– 0.61; p=0.002). Postpartum hemorrhage deaths fell by 83% and eclampsia deaths by 68%.
• Emergency Response Time: Median time decreased from 210 to 58 minutes (p<0.001).
• Maternal Agency: MADM scores increased by 52% (p<0.001) and CBSEI scores by 45% (p<0.001).

Qualitative feedback emphasized trusting relationships, describing the midwife as “my sister who arrives before I call.” Midwives cited early recognition and streamlined referral pathways as key mechanics.

Conclusion: A community midwife-led continuity model dramatically reduces maternal mortality from obstetric emergencies while significantly strengthening women's agency and decision-making autonomy. Continuity of care is not merely a service philosophy, but a lifesaving clinical intervention adaptable to low-resource settings globally.

To be Updated