By Marie Lewis, Cate Langley
This paper aims to outline the evidence base for continuity of carer models and describe the importance of understanding what continuity of carer means to women. We consider the implication to midwives in practice and how we worked through the issues with staff to develop a pilot project for staged implementation of a continuity of care model.
Maternity services are keen to develop their facilities to ensure that women and their families are looked after in such a way as to maximise their satisfaction and achieve positive outcomes. There is often debate amongst teams regarding the provision of greater continuity of carer and models of care to enable women to have a known midwife look after them throughout pregnancy, birth and the postnatal period, whilst ensuring a good work–life balance for staff. This is a challenge for many maternity services in the UK.
Sandall et al (2016b:2) described the philosophy underpinning midwife-led continuity of care models: ‘The philosophy behind midwife-led continuity models is normality, continuity of care and being cared for by a known and trusted midwife.’ The authors go on: ‘midwife-led continuity is based on a premise that pregnancy and birth are normal life events…..the model of care includes continuity of care, monitoring the physical, psychological, spiritual and social wellbeing of the woman and family.’ Sandall et al (2016b:3).
These definitions seem appropriate and in agreement with the philosophy of Powys maternity services.
There is currently much debate in midwifery literature about the benefits of continuity of carer. The benefits are presented by Sandall et al (2016b) in their updated Cochrane Review, Midwife-led continuity models versus other models of care. They found that women who received midwife-led continuity models of care were more likely to experience a spontaneous birth without intervention and to be cared for by a known midwife; there was no noted difference in adverse outcomes. The reviewers suggested that the noted benefits were most likely associated to the process of midwife-led care itself rather than birth environment as many of the studies reviewed had taken place in obstetric units. Tracy et al (2013) highlighted the benefits to women of caseloading schemes compared to standard midwifery care. No difference was noted in caesarean section rates, neonatal Apgar scores or preterm birth. Caseload midwifery was noted to reduce women’s use of pharmacological pain relief, be related to a reduced incidence of induction of labour, and increase the chance of a spontaneous physiological birth. The study also noted a reduction in the incidence of postpartum haemorrhage and an increase in breastfeeding rates at both six weeks and six months, and overall concluded that caseloading models were a cost-effective way of providing midwifery care.
The benefits of caseloading midwifery were also highlighted by Dahlen (2016), although the author does emphasise a need for further research into the benefits specifically for younger mothers. A large study in Australia (the COSMOS trial) exploring caseloading models of care found that women’s satisfaction with care was increased when continuity of carer was implemented (Forster et al 2016).
Read the whole article
Keep up to date with the latest research and news from MIDIRS by subscribing to our quarterly academic journal. Subscribe to MIDIRS Midwifery Digest