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Women identified with psychosocial risk factors are at higher risk of interventions during labour and birth and adverse maternal outcomes. Midwifery Continuity of Care (MCoC) reduces interventions and improves maternal outcomes among low-risk women; however, evidence on MCoC's impact among women with psychosocial risk factors is limited. This study aimed to investigate whether an MCoC model targeting women with psychosocial risk factors improved maternal outcomes in Sweden.

We conducted a retrospective cohort study using data from the Swedish Pregnancy Register. The cohort included 14 956 women with psychosocial risk factors such as mental health conditions, fear of birth requiring counselling, foreign-born status, need for an interpreter, single household, unemployment, or low educational attainment, who received either MCoC or standard care. All women gave birth at a Swedish university hospital between 2019 and 2024. Modified Poisson regression was used to estimate adjusted risk ratios (aRRs) with 95% confidence intervals.

Compared with standard care, MCoC was associated with an increased likelihood of normal vaginal birth (aRR 1.09; 95% CI 1.06-1.13) and a reduced overall risk of caesarean section (aRR 0.71; 95% CI 0.63-0.80), particularly caesarean section on maternal request (aRR 0.24; 95% CI 0.15-0.40). MCoC was also associated with reduced risks of obstetric interventions including labour induction, oxytocin augmentation, epidural/spinal analgesia and episiotomy.

Among women with psychosocial risk factors, MCoC was associated with reduced use of obstetric interventions and improved maternal outcomes, without evidence of increased risk of adverse maternal outcomes.