Midwifery Continuity of Carer: “Embrace the journey”

Summary

Caitlin Wilson is a Consultant Midwife, currently leading the development and implementation of the Midwifery Continuity of Carer (CoC) model in Worcestershire.

In this interview, Caitlin tells us more about the benefits to both staff and families, and offers advice for anyone thinking about adopting this model of care.

Content

Can you tell us a bit about yourself and your role?

I am a Consultant Midwife, there are around 100 of us in the UK. I have a relatively unique role in that I spend 50% of my time in the Trust and 50% of my time at the University. I’m currently leading the development and implementation of continuity in Worcestershire. 

When did you first work in a Continuity of Carer (CoC) model?

I became a caseload midwife (CoC) within weeks of qualifying as I knew this was the way that I wanted to practice, and the first team was being set up locally within a designated Sure Start area. Although I have had a number of different roles in the NHS, this was definitely one of the most formative.

Can you tell us more about your experience?

It was an amazing job. I had a fantastic and supportive team and the families cared about us too. Because of the relationship we had with our women, we could see when things were not well or had deviated from what would be expected. 

Women never called us in the middle of the night unless they needed us, so when those calls came in, we knew how to react based on the woman herself and navigate the system on her behalf. This was especially important where some of our families could not advocate for themselves as they were new to the country, had limited English or were socially vulnerable. We became a part of that community. 

How would you describe the CoC model you are rolling out in Worcestershire?

We have a mixed risk model, based on postcodes. Midwives work in a small team of no more than eight, organising their own workload and availability. The teams cover 24/7 availability sharing the responsibility of this.

How do you think CoC can impact on patient safety?

Continuity of carer absolutely impacts patient safety, both physical safety and psychological safety. 

Pregnancy and childbirth are intense, life changing events and each woman and her family will have different needs as well as perception of risk/safety. The relationship that is built over time gives a platform for women and midwives to work through these together, advocating and working with the multi-disciplinary team (MDT) to ensure the safest care is achieved with the woman in control of her care.

CoC midwives also have flexibility in the way that they work to meet the needs of those in their care. If more time is needed with a family, then that is what happens. 

Do you have any statistics or data to highlight the impact of CoC?

Our first year statistics showed an overall decrease in medical intervention and an increased choice to have babies at home and in midwifery led units. Care is wrapped around the women and they drive the choices about their care and their birth. The midwives support them and navigate the system with them. The diagram below shows data for the first two teams at the end of their first year (there is a downloadable version attached at the bottom of this page too). 

What are the barriers to implementing CoC?

There remains significant mythology about what continuity of carer is and isn’t. 

For this reason, many midwives may be reluctant to work in these models as they perceive that they will be working more than they are now. The relationship established with women actually reduces workload, as when they call you, or are in labour, you know who they are and their history. 

Also, the NHS has had a fairly prescriptive approach to system set up and this all changes when you work in continuity of carer teams. The team is given the autonomy to self-manage their daily work, their annual leave and how they cover availability.

What support do maternity teams and individual staff members need to successfully implement CoC?

This needs to be a whole system approach. Individual midwifery CoC teams can support each other, but the wider maternity team need to understand the role of the CoC midwife and how all members of the multi-disciplinary team are involved with care. 

Teams also need to learn to work together and negotiate their time with each other. There is a learning curve to this. The whole system is learning as well as teams and the individuals within it. 

Also, there is a 'bedding in' period that can take some time. This is so new and because each team will develop their 'own way' there is no one size fits all (much like the care that they provide!). 

Do you have any advice for maternity teams considering setting up the CoC model?

Do it! It is an incredible way to work. Empowered teams will empower families.

Embrace the journey, work together, establish team rules and philosophy at the start and review regularly and most of all, communicate. 

Any final thoughts?

I’m really passionate that we roll out CoC for most women and that we do it in a sustainable and effective way. 

I think that it is a bold and brave move forward, and is of significant benefit to service users, midwives and the system. I have worked in this way and found that the relationship and trust built with the families and the team was unmeasurable. 

On a more personal note, I gave birth to all of my children in this model and know first-hand how much this can impact confidence and trust not only in yourself, but those caring for you.