A year of opportunity
Jacqueline Dunkley-Bent believes 2018 will ensure midwives have a strong say in local maternity system plans.
In December, I published continuity of carer guidance that aims to provide new mothers with more consistent care and support. All local areas now have a blueprint to provide continuity of care for mums-to-be in line with our ambitious national targets. The guidance includes having a named midwife who provides care for women and their babies during pregnancy and birth, and postnatally.
I believe that 2018 will be a year of opportunity for local health systems to promote continuity maternity standards for mothers-to-be across England.
Continuity of carer enables midwives to provide personalised care, where a relationship of mutual trust and respect is fostered, and safe care is provided.
Evidence shows that continuity models improve safety and outcomes (see figure, right), although further research regarding the clinical benefits, sustainability and women’s satisfaction may be required.
We know that nearly three-quarters of women have said knowing the professionals caring for them is most important to them (NHS England, 2016). They see many midwives and doctors over the course of their pregnancy and birth, and they do not always know who they are and what their role is.
For some women, this has led to confusion when navigating maternity services (NHS England, 2016). Evidence shows that women who had midwife-led continuity models of care were seven times more likely to be attended at birth by a known midwife (NHS England, 2017). Building a relationship or keeping personal continuity over time has been found to improve outcomes and experience for both women and their babies (CQC, 2017).
When implemented properly, providing continuity of carer enables midwives to build a relationship with the women and families they care for, supports midwives in having greater flexibility to manage their own working lives and ultimately provides greater job satisfaction.
Blazing a trail
Areas of the country are already trailblazing this way of working, showing what can be achieved. For example, a team of London midwives – known as Neighbourhood Midwives (NM) – see 80% of women give birth with a midwife they know and who knows about their individual care needs (NM, 2018a). This is compared with 12% of women receiving continuity nationally (NM, 2018a).
One year on, the pilot is already showing better outcomes and experiences for women and their babies. Women having their first or second baby have experienced fewer interventions during birth, with all new mothers taking up breastfeeding, known to give health benefits to a mother and her baby (NM, 2018b). Two-thirds of women were still breastfeeding at six to eight weeks (NM, 2018b).
Other areas such as north-west London are testing a full caseloading model across five or six locations. This includes a complex social care caseload, obstetric complex care including multiple pregnancies, and an enhancing of the antenatal and postnatal experience for women who are ‘out of area’.
Pilots are proving that this type of care is scalable. There are two main models in the Implementing Better births: continuity of carer guidance (NHS England, 2017) (visit bit.ly/implementing_better_births to read it):
- Team continuity – each woman has an individual midwife who is responsible for co-ordinating her care, working in a team of four to eight, with members of the team acting as back-up to each other.
- Full caseloading – each midwife is allocated a certain number of women and arranges their working life around the needs of the caseload
It also recognises the importance of ensuring that each team has a linked obstetrician or team advice and plans obstetric care as appropriate.
Implementing continuity of carer is undoubtedly a challenge. It requires a reorganisation of the way NHS maternity services are staffed.
However, I can say from direct experience that it is a model that delivers positive results for women, babies and their families, and for the midwives and other professionals providing their care. The key to successful implementation is incremental increase of continuity of carer that is manageable.
The guidance has been produced collaboratively, with midwives, clinicians, leaders, managers, researchers and commissioners who have had experience of leading and working in services providing continuity of carer, and with academics who have contributed to the continuity of carer evidence base.
I would encourage you all, no matter what your role, to find out more about how your maternity services could provide greater continuity of carer. This will help to provide better outcomes and experiences for the women and babies we care for. The benefits speak for themselves.
Professor Jacqueline Dunkley-Bent is head of maternity, children and young people at NHS England, and national maternity safety champion for the Department of Health
CQC. (2017) 2017 survey of women’s experiences of maternity care: statistical release. See: http://www.cqc.org.uk/publications/surveys/maternity-services-survey-2017 (accessed 20 February 2017).
Neighbourhood Midwives. (2018a) NM statistics: Waltham Forest NHS practice. See: http://www.neighbourhoodmidwives.org.uk/news/nm-statistics-waltham-forest-nhs-practice/ (accessed 20 February 2018).
Neighbourhood Midwives. (2018b) Providing an NHS midwifery service for women living in Waltham Forest. See: http://www.neighbourhoodmidwives.org.uk/nhs-care/ (20 February 2018).
NHS England. (2017) Implementing Better births: continuity of carer. See: www.england.nhs.uk/wp-content/uploads/2017/12/implementing-better-births.pdf (accessed 29 January 2018).
NHS England. (2016) Better births: improving outcomes of maternity services in England. See: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf (accessed 12 February 2018).