‘The responses have been enlightening, as women embrace the opportunity to take back control of their own birth journey and utilise their right, one that all women should have, to choice, within a safe, evidence-based service that puts the woman and her family at the very centre of its being’.
Jeanette Jones, Clinical Midwifery Lead & Supervisor of Midwives, reports on a new approach to free maternity care which has resulted in a rise in the number of home births in the Wirral area.
Choice – challenging the NHS
Choice and continuity of care are not new concepts. The benefits and merits have been discussed, documented and procrastinated over in the last two decades within the childbearing arena and yet very few women actually have access to midwifery care that truly focuses on either.
Over 19 years have now passed since the Health Committee second report: maternity services (House of Commons Health Committee 1992), which was followed by other documents and reports, including Changing childbirth (DH 1993), the National Service Framework for children, young people and maternity services: maternity services (DH 2004), the Department of Health’s Maternity matters: choice, access and continuity of care in a safe service (DH 2007), and the Commissioning framework for health and well-being (DH 2007), all highlighting the importance of choice, control and continuity of carer for women and their families when accessing maternity services.
The challenge to date has been to have a consistent, coordinated approach to women-centred care that was sustainable and not influenced by the political agenda and financial constraints so familiar to the NHS. One to One (North West) Ltd aims to redress the imbalances women are exposed to across the maternity services, where care is often fragmented and choices restricted, dependent on rigid guidelines and policies. One to One, the first Any Qualified Provider (AQP) for maternity services in the UK, was contracted to provide an alternative maternity care choice for women residing in the Wirral area. The concept was simple: to provide a full midwifery care pathway offering choice and continuity of care to all women regardless of risk. This is nothing new you may say and you would be right – except in reality with One to One, the women are offered true choice and real continuity and the benefits to this model are quickly unfolding.
The service is delivered in the primary care setting, ensuring accessibility. The majority of women ‘self refer’ to the service, making their choice of who they want to book with, at the very beginning of their journey. The full care pathway One to One provides encompasses preconception, antenatal, intrapartum, and extended postnatal care for up to six weeks, and triage. To achieve continuity for the women and the midwives the caseloading model was adapted with great success. Each midwife has a rolling caseload of 35 women and coordinates her own diary to manage her caseload. The benefits of this model to women and their families include:
- having a known and trusted midwife caring for them throughout their whole maternity experience
- access to a flexible model of care delivered within the local community
- the knowledge that when care deviates from the ‘norm’ the named midwife will continue to give support and coordinate the care.
If a woman has a ‘complex pregnancy’ her named midwife will offer her referral to a Local Acute Trust of her choice; the named midwife becomes the ‘care navigator’ for the woman, coordinating referrals, appointments, investigations, the majority of which are carried out in the community, liaising with the Consultant Specialist of the woman’s choice, to ensure her care is not fragmented.
Since One to One successfully acquired its own insurance in November 2011, to deliver intrapartum care, the service has achieved a home birth rate of 35% within an area that traditionally had a home birth rate of 1 -2%. Women, with the support of their named midwife are choosing to birth in a familiar environment where they feel safe and secure.
The women offer feedback on their encounters with the One to One service via several routes: Facebook, web page and questionnaires completed confidentially, and at discharge on the midwives iPads. The responses have been enlightening, as women embrace the opportunity to take back control of their own birth journey and utilise their right, one that all women should have, to choice, within a safe, evidence-based service that puts the woman and her family at the very centre of its being.
- Department of Health (1993). Changing childbirth. Part 1: report of the Expert Maternity Group. London: HMSO.
- Department of Health (2004). National Service Framework for children, young people and maternity services: maternity services. London: DH.
- Department of Health (2007). Maternity matters: choice, access and continuity of care in a safe service. London: DH.
- House of Commons. Health Committee (1992). Second report [session 1991-1992]: maternity services. Volume 1: Report together with appendices and the proceedings of the committee. [Chair: Nicholas Winterton]. London: HMSO.
Contributor: Jeanette Jones, Clinical Midwifery Lead & Supervisor of Midwives
Photo credit: One to One