Search the hub

The benefits of Continuity of Carer (CoC) within antenatal and postnatal care, and the implications for patient safety are well reported. As a midwife, to know the person from booking to postnatal means I am aware when their mental health may be deteriorating, or when they may be experiencing relationship difficulties. It also makes me feel more confident to challenge situations, including potential safeguarding concerns or welfare issues. If a person trusts in their relationship with their midwife, they are more likely to confide that they are struggling, and we'll be better placed to support their health needs. Supporting people within their wider context Community midwifery is not just caring for a person’s physical needs. It’s knowing their family, their housing situation, their past social history, understanding their vulnerabilities and hearing them when they tell us that something isn’t right – whether that be in relation to their pregnancy, their relationship or their mood. This is incredibly difficult to achieve without CoC and is frustrating for both midwives and pregnant people. Midwives want to offer excellent care and pregnant people deserve excellent care. I recently visited a family who were struggling financially. Although I was aware of their financial predicaments, I had no idea the extent of the issue. I went one afternoon for an antenatal visit. The atmosphere was very tense, and I had heard raised voices upon approaching the house. When I entered the house, their child was crying and shouting, and the parents were distressed. Because of the strength of the relationship we had developed during the pregnancy, I felt able to challenge the couple about what was happening and what I was experiencing with regard to the tension between them. I was informed they had no food and had to get through the weekend with nothing to eat. The mother had been too scared to tell anyone in case her children were taken away from her. This opened up a conversation about their welfare generally and we were able to work together, with other support services, to meet the immediate crisis and attempt to start dealing with the ongoing issues. Monitoring mental health Another person disclosed at booking some historical mental health issues. She had been fine for a few years and had not required treatment recently. During an appointment a few months later, I felt I wasn’t experiencing her like I usually did. It wasn’t anything obvious just a ‘sense’ that she was holding something back. I gently probed her, and she informed me she had been struggling with anxiety in relation to hypervigilance regarding the baby’s movements. We spent some time working on strategies to manage this anxiety and, aware of the clock ticking during a short antenatal appointment, I arranged to see her for a double appointment at my next clinic and referred her to the mental health midwife for ongoing support. In times of loss Something we rarely talk about as midwives is loss. Caring for a family from booking, to finding out the baby had died, to birth and beyond, taught me a lot about the power of CoC. Being present when the couple met their baby and supporting them for as long as they needed postnatally was an enormous privilege. Although challenging because of the depth of grief, knowing I could make a small difference to their experience, because I knew them and they trusted me, meant we were able to discuss very difficult decisions over a cup of tea whilst the other children ran around us bringing a level of normality to a very awful situation. Relationships matter I have received some amazing feedback from families regarding CoC. Recently a woman said that the strength of our relationship was important to her because she trusted my judgement and ability to advocate for her. She said her experience of CoC had made something that was terrifying to her “not so scary”. Thank you cards I have received always comment on the strength of the relationship. Over and above any other element of care a person has received during the pregnancy continuum, the relationship and the patient feeling like I ‘know’ them is what they reflect on when we are saying goodbye (which is the hardest part of this model of care!). As a midwife I get amazing job satisfaction from taking a family from booking to birth to discharge. The privilege of being present during such a life altering time in a family’s life whether it be a first baby or tenth baby, leaves a mark. Every family I look after leaves a footprint. If you'd like to share your thoughts on the Midwifery Continuity of Carer model, you can join the conversation here.

How can we better support nurses and midwives to flourish and thrive in their work? Join the King's Fund at this free online event to discuss the changes needed to empower nurses and midwives to shape and provide the compassionate, high-quality care that they aspire to in a sustainable way – through the COVID-19 pandemic and beyond. The conversation will explore: workplace stressors, work conditions and ways of working – including workload, shift patterns and supervision – that have an impact on nurse and midwife wellbeing, and how these can be positively transformed organisational cultures and leadership styles – including those around diversity and inclusion, psychological safety and compassionate leadership at all levels – that need to be cultivated, and how progress can be achieved lessons and examples of good practice from across the health and care system, from both before and during the COVID-19 pandemic. Register

Unicef UK Baby Friendly Initiative has updated its policy guidance in the light of these investigations and some organisations are using posters and checklists to help staff understand and carry out their responsibilities. HSIB has also observed the impact of high task load, environment and staffing levels on the ability of staff to detect SUPC. Recommendations Maternity services should consider the following learning observations to ensure safe delivery of skin-to-skin care. • Based on the evidence, a baby who is born apparently well, with good Apgar scores, can be safely laid skin-to-skin with the mother or parent and requires close observation in the first minutes after birth. • Apgar scores must be attributed using close clinical observation of the baby. This can be achieved with the baby remaining in skin-toskin contact. There may be a need to interrupt skin-to-skin contact briefly to ensure Apgar scoring is assessed accurately. • Vigilant observation of the mother and baby should continue, with prompt removal of the baby if the health of either gives concern. • Mothers should be encouraged to be in a semirecumbent (half lying, half sitting) position to hold and feed their baby, ensuring the mother can see the baby’s face. • Care should be taken to ensure that the baby’s position is such that their airway remains clear and does not become obstructed. • Staff should have a conversation with the mother and her companion about recognising any changes in the baby’s condition. • Always listen to parents and respond immediately to any concerns raised. • Medicines given to the mother should be considered when discussing skin-to-skin contact. Pain relief given to mothers can affect their ability to observe and care for their baby. • Additional risk factors should also be considered. The level of risk for SUPC when a baby is in skin-to-skin contact can increase with, for example, increased maternal body mass index, antenatal use of opiate medication, sedation, and staff’s focus on other tasks.