Clinic complexities

Midwives magazine: August 2010

Like other maternity services, we have maternity support workers (MSWs) in our community midwifery teams in Bradford. The role of MSWs has been controversial for some midwives (McKenna et al, 2003). Concerns have been raised about reduced continuity of carer and quality of care for women, and erosion of the role of the midwife (RCM, 2006). However, the crisis in midwife numbers and the increasing birth rate, as well as the need for effective use of public resources through appropriate skill mix has led to MSWs being employed in most maternity settings. This has required the midwifery profession to develop the role in a way that is meaningful and rewarding for women, midwives, the service, and MSWs themselves (NHS Employers, 2006; RCM, 2006).

The workload in community antenatal clinics is a widespread and growing challenge, as care becomes more complex and the number of births increases. Asking women to return between 15 and 18 weeks for the triple test (TT) was identified as possibly not the best use of clinic time, and so in response to this, MSW-run TT clinics were set up in three team-linked locations across the city (after being piloted in one area). An administrative system including all paperwork necessary for effective communication (with women, the screening co-ordinator and midwives) was developed. The participating MSWs undertook training in both venepuncture, the TT itself, and the limitations of their role in relation to this.

The community midwives continue to give information and discuss the issues surrounding the test with women and partners at the booking visit. Once the woman has opted to proceed with the test and informed the midwife, an appointment is set up for her to attend the team’s TT clinic.

At the 20-minute appointment, the MSWs take blood and also discuss smoking cessation services again with smokers, and/or the advantages of breastfeeding as appropriate, as well as sign-posting to a range of other local services. They also explain how results are fed back and give women a follow-up telephone number.

Women attending get to know the MSW, who may visit them postnatally, or who they may meet in the antenatal clinic, at a drop-in session, or have already met at booking. The MSW has an opportunity to create a service, which they run and have control over, and to offer their skills to women. This sense of autonomy and trust is important in job satisfaction (Ball et al, 2002) and is something that is valued. A midwife is always at the end of a telephone or nearby if needed.

Some midwives do not use the clinics, as they prefer to give full continuity of care to women antenatally, and this decision is respected. However, the three clinics are full with more being planned. The reduction in visits has increased community antenatal clinic capacity, so midwives are better able to meet individual needs within their clinics. Two of the clinics are in community centres, one of which is a children’s centre, which brings women into places they may be more likely to use in the future as a result.

This is just one of the ways in which MSWs contribute to Bradford’s maternity services, but it is one that works well for women, midwives and MSWs alike. We do not want to fragment care or make it complex for women – we feel we have introduced this service without doing either, enabling MSWs to develop areas of practice where they take responsibility for the organisation and delivery of care without eroding the midwife’s role. This in turn encourages them to consider career development and provides job satisfaction (Ball et al, 2002; RCM, 2006). 


What do they think

‘It gives women a chance to ask questions about appointments and care, and things they may have not taken in at booking’ (MSW)

‘I like doing it (triple test clinic) – it’s my ‘own’ thing’ (MSW)

‘There are fewer problems with the MSWs’ triple test than with the midwives!’ (antenatal screening midwife)

‘It saves me time in my antenatal clinic, so I can give women a bit longer or fit in another woman for whom something has come up’ (community midwife)



References

Ball L, Curtis P, Kirkham M. (2002) Why do midwives leave? RCM: London.

McKenna H, Hasson F, Smith M. (2003) Training needs of midwifery assistants. Journal of Advanced Nursing 44(3): 308-17.

NHS Employers. (2006) Maternity support workers: enhancing the work of the maternity team. NHS Employers: London.

RCM. (2006) Position paper: maternity care assistants. RCM: London.