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Continuity of care 'boosts quality of midwife provision'

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The quality of maternity care for women is greatly enhanced by seeing the same midwife or group of midwives but many still do not get continuity of care, says a report by the Royal College of Midwives.

The updated publication, based on the latest research findings, says continuity of care not only improves women’s experiences of childbirth but also makes it safer.

“There is no doubt that continuity of care and carer improves care for women”

Louise Silverton

A recent review of trial evidence found women who had continuity of care were 16% less likely to lose their baby and 24% less likely to have a pre-term birth.

Yet the paper highlights the fact many do not benefit from ongoing support from a midwife or team of midwives they know and trust – despite it being a key policy or ambition in all four UK nations.

In the latest national survey of more than 20,600 women’s experiences of maternity care in England in 2015, 36% did not see the same midwife every time or almost every time.

“Continuous support in labour from a person other than the woman’s partner or family member has been shown to be effective,” said the report – titled The contribution of continuity of midwifery care to high quality maternity care.

It added: “In busy maternity units, it is often difficult for midwives to give such one-to-one support and 25% of women reported being left alone in labour and shortly after the birth and being unhappy about it.”

The most recent Scottish maternity survey showed “very similar results”, according to the report.

“Continuity of midwifery care has the potential to improve the quality of care for all women”

RCM report

Continuity of midwifery care can be provided through a team of midwives who share the caseload – known as “team midwifery”.

Another model is “caseload midwifery”, which aims to ensure woman get all their care from one midwife before, during and after birth.

“Continuity of midwifery care has the potential to improve the quality of care for all women, both low and high clinical risk and women with social complexity,” said the report.

For example, caseload midwifery has been used to provide intensive support for vulnerable women.

However, the RCM paper acknowledged that implementing continuity of care could be a challenge as it “involves complex large scale transformation”.

It also highlighted the importance of the right support and work-life balance for midwives to ensure they are able to deliver continuity and “avoid burnout”.

“Low job control and long working hours are associated with higher levels of burnout in midwives,” said the college’s paper.

“Ways of working that engender greater job control, meaningful relationships with women and collegial support help midwives maintain work-life balance,” it said.

Royal College of Midwives

Quarter of stillbirth investigations ‘not good enough’

Louise Silverton

While midwife-led models of care give midwives more professional freedom, there can be “a problematic interface with host units, and a clash of culture”, the report added.

Key factors affecting midwifery morale include staffing levels, flexible working and work-life balance, working relationships and organisational issues.

Nevertheless, Louise Silverton, RCM director for midwifery, said it was possible to re-organise services to provide continuity of care.

“There is no doubt that continuity of care and carer improves care for women. We also know that it is a way of delivering services that women value. This is why it is at the heart of government policies for maternity services,” she said.

She added: “The challenge is to organise our services to deliver it in a way that meets the needs of women and the staff who will work in this way. But it can be done as those services that have introduced it have shown.”

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