Continuity of Carer
As set out in Implementing Better Births: Continuity of Carer, means each woman:
- Has consistency in the midwife or clinical team that provides hands on care for a woman and her baby throughout the three phases of her maternity journey: pregnancy, labour, and the postnatal period.
- Has a named midwife who takes on responsibility for coordinating her care, and for ensuring all her needs and those of her baby are met, at the right time and in the right place, throughout the antenatal, intrapartum and postnatal periods.
- Has “a midwife she knows at the birth”.
- Is enabled to develop an ongoing relationship of trust with her midwife who cares for her over time.
Cochrane Review by Sandall et al (2016)
The relationship between Mother and Midwife can bring so many benefits, such as:
- gives the woman the confidence to be open with her midwife and helps the midwife to identify and manage risks.
- enables the midwife to provide care with greater empathy, provides women with a greater sense of control, and reduces stress and anxiety felt by the woman.
- assists with care co-ordination and liaison with other specialists and the obstetric team, the women gets the level of care that she needs.
- reduces missed care as the midwife is proactive in ensuring missed appointments are rescheduled, acting as a safety net across complex care pathways.
There are two main models which meet these principles which Local Maternity Systems will want to consider for implementation locally:
- Team continuity, whereby each woman has an individual midwife, who is responsible for coordinating her care, and who works in a team of four to eight.
- Full case loading, whereby each midwife is allocated a certain number of women (the caseload).
Neither of these models need to be operated in their pure forms and may be mixed. For example, grouping case loading midwives together in teams/group practices, with midwives in teams organising their time to make the best use of their availability and arranging scheduled care with the same midwife as much as possible. Both models can operate with a buddy system, whereby each woman has a first alternative point of contact within the team.
Where possible the model should be implemented in both the hospital and community settings.