It’s been over a year and a half since I’ve written on the blog, or even written at all, because 2019-2020 felt like a very sad year with so many losses for midwifery (the closure of Neighbourhood Midwives & One to One Midwives & the loss of My Midwife & Me indemnity insurance for Independent … Continue reading Continuity Matters & So Do You
‘WELCOME HOME’... They were the words of a friend who understands my need to work in caseload midwifery in response to me sharing that I’d been to my 1st birth with my new team back in September. Those words sum it up perfectly because it so feels like home, where I can finally be the midwife I want to be!!! I thought after a month of being with Neighbourhood Midwives NHS team I would share a bit about my experience so far.
This is a plea for those who have successfully implemented continuity of carer to get in touch. We have all the literature, government and health policy and union support to start continuity, but how exactly can we start something ourselves? I think inspiration would be helpful from those who have done this already to help others see how achievable it is.
This story is one that sadly I am sure echo the stories of many women, every day, around the world. One which this amazing woman has offered to share and whose voice I believe every single person who comes into contact with women during labour and birth needs to listen to. A woman who believes that continuity of carer would have made a difference to her experience. You only have to look up the #metoointhebirthroom hashtag on Twitter to have a glimpse into the unacceptable treatment women are experiencing, but these stories only just scratch the surface.
It is a woman’s human right to make choices about her care (NMC, 2015, Birthrights, 2013) and women must be provided with the information they need to make an informed choice (NMC, 2009), including discussing risks and benefits of the options available to women, which is both the legal and professional responsibility of midwives and obstetricians (The Supreme Court, 2015). It is important to be aware that the way in which risk is discussed can exaggerate risks (Van Wagner, 2016) and that lack of adequate time and follow up when discussing risks with women during pregnancy can direct care towards interventions (Van Wagner, 2016). The provision of relational continuity can counteract this and is shown to improve outcomes for women with perceived risk factors (Sandall et al 2016).
Chloe Mulholland - Midwife and Hypnobirthing Teacher tells us about her experience of pregnancy with the added insight of having also worked as a caseload midwife, so knowing how important this model of care is. She shares the anxieties she felt knowing this model of care wasn't offered at her local trust and then the impact that continuity had on her pregnancy and birth.
Dr Susan Crowther, Professor of Midwifery and advocate for caseload midwifery gives an insight into her experience. Susan has vast experience across all models of care provided in the UK and overseas, which gives a valuable insight into the caseload model of care - as she rightly puts it, the barriers to this way of working can be overcome with the support, desire and inspiration to succeed!!
The perception of what it would be like to be a caseload midwife is often that it involves working 24/7, lots of overtime, no work/life balance and the inability to spend any time with family, which admittedly does sound pretty awful. But you only have to speak to midwives working in this model to know it is far from the reality.
The evidence for the benefits of continuity of care during pregnancy, birth and during the postnatal period, for both women and midwives is strong (Sandall 2014, Sandall et al 2016a, 2016b, Forster 2016) and repeatedly highlighted in government publications both nationally (Department of Health [DoH] 1993, 2007, 2010, NMR 2016) and internationally (WHO, 2016), it is recommended by both midwifery (RCM 2016) and obstetric trade unions (RCOG 2011), and is within the recommended guidelines for maternity care (NICE 2016, 2017a, 2017b) yet it is still not available in the large majority of the UK.