Continuity of carer: positive for all?

By Aviva Attias on 07 March 2018 Midwives Magazine RCM Annual Conference Midwifery Continuity of Carer - MCOC

This is the second of our series in which we take a closer look at the Question Time-style sessions from last year’s conference.

It may not always feel like it, but we have a real opportunity to make a once-in-a-generation improvement in maternity services in England – so that they’re safer and more personal.’ That was the opening statement from Matt Tagney (pictured), at the Question Time-style session at the 2017 RCM annual conference on 1 November. Matt is programme director for the Maternity Transformation Programme, NHS England, and was one of a five-strong panel for the conference session, including a mother who benefited from continuity of carer.

Making it happen

‘It starts with the Better births report and its 28 recommendations,’ Matt went on to say. ‘We have a broad coalition nationally to deliver this... and we believe it’s what women and staff want.’ Matt conceded that continuity of carer, as set out in the report, is ‘not without its complexities’, which is why NHS England has issued help with implementation.

‘For most of us, the difficulty with continuity of carer is how to implement it,’ said Jaki Lambert, consultant midwife, NHS Highland, who knows continuity of carer works from first-hand experience. Jaki explained how remote and rural geography challenges affected Scottish policy, but also noted that because Scotland is a small country ‘we have ownership of change’. And one change she would like to see is where services are provided. ‘We need to follow women. Women don’t have to travel. We could save lots of money by providing services in the house, electronically, with the midwife. We’re piloting this at the moment.’

Kathy Murphy, deputy director of nursing and HoM at Saint Mary’s Hospital, Manchester, said that the evidence for continuity of carer was solid and strong.

‘The challenge is to have a life balance and survive and thrive in our roles,’ she said. ‘What I ask you to think about as midwives is how we will deliver on continuity of care.’ She shared some examples they’ve been working with in central Manchester, which focus on more vulnerable women. Asylum-seeking women, for instance, know the main midwife to ask for by name; they understand they will get continuity antenatally and postnatally, but that she won’t be there for birth, and they accept that – what matters to them is having a midwife who is kind and competent at the birth.

Moving forward

The session was opened up to all delegates to share concerns as well as success stories, and to raise any questions. One delegate asked: ‘How do you balance the needs of midwives, women and families?’

Kathy said that the ‘overarching theme’ was to offer midwives ‘ownership of some of their working patterns’.

Jacqueline Dunkley-Bent of NHS England endorsed this view. ‘The ask from NHS England is to implement continuity of carer incrementally within the context of where you’re at,’ she said.

Another asked what resources would be available to women around continuity of carer. Mary revealed that a whole suite of resources was coming from the RCM to help support those conversations.

Since conference, NHS England, the Scottish Government, the RCM, and others have been producing valuable resources on continuity of carer with more in the pipeline. Its progression this year further highlights how important it is to stay involved in local discussions and to be a part of finding ways to help make continuity of carer work for everyone.

Why CONTINUITY of carer matters

Genevieve Porritt gave a moving account of the huge difference continuity of carer made to her and her son, Dylan. Her midwife visited her at home antenatally and postnatally, and was with her during the birth.

‘If even the smallest of elements of our amazing care can be repeated for other women, I truly believe it can make a difference to the wellbeing of both women and children,’ she said.

‘I suffered from depression and anxiety in adolescence, and I was concerned about the possibility of postnatal depression,’ Genevieve continued. ‘Due to the continued one-to-one relationship I had with my midwife, she had a clear understanding of pregnancy and my lifestyle in general. She also knew when I wasn’t quite myself at appointments, and was able to ask the right questions. I felt comfortable in her presence and confident enough to talk about my concerns and my emotional state. During each appointment, we had time to focus on the present and future rather than having to repeat conversations.’

As Genevieve continued, it became clear that this continuity proved vital for her.

‘We had planned a home birth with the home-birth team in Croydon,’ she explained. ‘I went into labour at home at 42 weeks, but Dylan ended up being born by emergency CS at Croydon University Hospital. My midwife stayed with us and ensured the labour ward midwife and the obstetrician understood my birth plan and my wishes for labour and afterwards. I wanted to hold on to any part of that plan where possible.

‘Sadly, when Dylan was born he wasn’t breathing properly. So it was difficult to continue with those wishes. I’d worked so hard to inform myself about everything and had made decisions that were really important to me. But one by one they slipped away from me.

‘The last thing I had left was breastfeeding, which my midwife knew was really important to me. So when Dylan was in the special care unit, that was my focus. I expressed and managed to produce milk for him (I went on to breastfeed him for well over a year). My midwife also ensured I was being supported in the way that I needed in all the different wards, even though we didn’t have appointments then.

‘That same midwife took our postnatal appointments once we got home and helped us settle in. After a few weeks, she visited for a debrief on the birth – standard practice for the home-birth team. This was really important for my emotional wellbeing and mental health as I had a cloud of guilt and feeling of failure that I needed to talk about. Having my midwife there made me feel comfortable doing it. I needed to know that we did everything we could to give Dylan the best possible opportunity to arrive safely. I have friends who weren’t given the opportunity to debrief and had very traumatic births who are probably still dealing with that.’

‘We could almost stop there,’ concluded Mary Ross-Davie, RCM Scotland director, who chaired the conference session.

Tell us what you think

What are your success stories in implementing continuity of carer? What barriers have you faced or overcome? Now that more guidance exists, is it making it any easier? Whatever your thoughts, contact us at [email protected]