Implementation and evaluation of the effectiveness of the continuous midwifery care model in socially vulnerable women: a convergent parallel mixed methods study protocol

J Health Popul Nutr. 2026 Jun 19. doi: 10.1186/s41043-026-01364-0. Online ahead of print.

ABSTRACT

BACKGROUND: Social vulnerability during pregnancy correlates with an increased risk of negative maternal and neonatal outcomes. The World Health Organization (WHO) and the International Confederation of Midwives (ICM) endorse the implementation of continuous care strategies to enhance outcomes. This project aims to implement and evaluate the effectiveness of a continuous midwifery care model during pregnancy and delivery, as well as its impact on various maternal and neonatal outcomes for socially disadvantaged women in Iran.

METHODS/DESIGN: This research will utilize a convergent parallel mixed-methods framework. The study will be executed in two simultaneous phases: a quantitative randomized controlled trial and a qualitative descriptive analysis. In the quantitative phase, 92 socially disadvantaged pregnant women facing poverty or domestic violence or unplanned pregnancies will be recruited from health centers in Bonab, Iran, and randomly allocated to either an intervention group (n = 46) or a control group (n = 46). The intervention group will receive continuous midwifery care from 14 weeks of gestation until 6 weeks postpartum, whereas the control group will receive standard care. The primary outcomes encompass the experiences related to pregnancy and childbirth, as well as evaluations of maternal depression. Secondary outcomes encompass the mode of delivery, maternal and neonatal complications, and satisfaction with care. The qualitative phase will employ conventional content analysis of comprehensive, semi-structured interviews with women in the intervention group to investigate their perceptions and experiences regarding the care model. The outcomes from both phases will be amalgamated to yield a holistic comprehension of the model’s influence.

DISCUSSION: This study is the inaugural investigation in Iran assessing a continuous midwifery care model designed for socially disadvantaged women, utilizing a mixed-methods approach. The findings are expected to yield substantial evidence to inform the formulation of national policies and clinical guidelines designed to mitigate health disparities and enhance maternal and child health outcomes in at-risk communities.

TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) (IRCT20120718010324N84/ Date of registration 20250823). URL https://irct.behdasht.gov.ir/trial/74,206.

PMID:42321901 | DOI:10.1186/s41043-026-01364-0