3 months into my new job as a caseload midwife and I wanted to share more about the practicalities of this way of working. I have looked back on my diary over the last 2 months to provide a detailed idea of how many appointments are done, how many on calls we have and importantly how many of those we are actually called out. This post is also a reflection of my learning points in terms of self care, things I have picked up on which I am sure are common themes for caseload midwives.
A truly heart warming story of a midwives journey to becoming the midwife she really wanted to be. Tina talks about what influenced her throughout her life, in a journey that led to her becoming such a positive influence and role model herself.
‘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.
Shauna shares her experience of being cared for by the wonderful Valley Midwives. She tells us how the care helped deal with anxieties, needle phobia, mental health worries as well as some health concerns in the final few days of pregnancy.
Ali qualified as a midwife in the US, where she had her first baby and experienced receiving and providing continuity of care, before moving to the UK where she had her 2nd baby and is now retraining as a midwife.
My story of post traumatic stress triggered after a difficult day on placement, the subsequent difficulty of accessing the right help and diagnosis and finally the profound impact of the continuity of support received as a student from a team of caseload midwives. How love, support and encouragement from likeminded midwives aided my healing and made me the midwife I am today.
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.
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).
Professor Lesley Page CBE is a visiting Professor at King’s College London and Adjunct Professor at UTS and Griffith University, Australia. She is one of the most (if not THE most) knowledgeable people around relational continuity in maternity, its implementation and its sustainability. Here she shares her infinite wisdom on the topic.
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 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.