Midwifery continuity of care: Why patients should be more vocal advocates

Midwifery continuity of care has the potential to improve outcomes and birth experiences, but maternity teams need to be given the right resources to make it a success, says Stephanie O’Donohue

Midwifery continuity of care is a model used in some maternity services to limit the number of different healthcare professionals a person sees throughout their pregnancy, labour, and during the postnatal period. It means the midwife caring for you when you give birth would be someone you have met before, enabling a more consistent patient experience. 

Evidence shows that it can have both immediate and lifelong health benefits. In short, working in this way improves outcomes for women and babies. But how widely is this understood among patients and families? I’d argue that if it was, we would all be much more vocal advocates. 

Why continuity matters     

Seeing the same few familiar faces throughout the perinatal period allows time and space for staff and patients to develop trusting relationships, for conversations to deepen rather than be repeated, and for people to feel safe to raise concerns or worries they may have. 

Continuity can create more opportunities to discuss options and to explain their benefits and risks, supporting people to make informed decisions that feel right for them. This is essential to building a maternity service that is inclusive, respectful of individual rights, and committed to working in partnership with patients. 

Safeguarding concerns and mental health issues can also be more easily recognised when continuity exists, and the appropriate support put in place to help reduce any negative impact on the patient, their family, and the development of the child. Positive intervention during this period can make a huge difference to the long term outcomes for the child and for family wellbeing.  

Perhaps most significantly, within continuity models, women are less likely to experience a preterm birth or to lose their babies. They are also more likely to have a spontaneous labour and less likely to need an episiotomy. 

I believe if more people knew about this, they would be asking the same question I did at my first antenatal appointment: “Do you offer continuity of care?” As a patient, I wanted my preference for this care to be known.

Empowering staff to deliver better care

In my role I speak regularly to midwives, many of whom sit within a continuity of care model and are fiercely passionate about this way of working. They’ve given examples of the benefits of the model they have witnessed firsthand for the families they’ve cared for, but the impact reaches further still. Many midwives have personally found greater job satisfaction and a renewed sense of purpose, delighted to feel that they are having such a positive and long lasting impact. 

With the midwifery profession hugely understaffed, and several maternity inquiries highlighting unsafe systems of care and internal cultures, this secondary effect cannot be undervalued. The potential for the continuity model to empower and inspire maternity staff is enormous and as patients we too would reap the benefits. 

Transformation in challenging times

A national NHS programme is pushing for continuity of care to be rolled out within our maternity services, with some fantastic work happening to embed this patient centred model. Rightly so, pregnant people who are more at risk of adverse outcomes are being prioritised. 

But change of this magnitude will take time and transformation is not easy in drastically under-resourced circumstances. Adequate staffing and continued investment are needed to implement the model consistently and for leaders to support staff through change. Underinvestment could leave the continuity model vulnerable to misplaced criticism, staff feeling disenchanted and burnt out, and patients and their babies unsafe.

Concerns have been raised that implementing continuity has, in some circumstances, led to a two tier system, with fears that women who are not on the pathway experience poorer care as a consequence. There are further worries about how the model might be misinterpreted, and that it could reinforce cultures where birth without intervention (sometimes referred to as “normal childbirth”) is prioritised at the expense of individual choice and safety

Continuity can also present frontline staff with huge changes to the way they work and without the right culture, resourcing, or leadership to support this, there is a risk that excellent midwives will leave the profession. 

In some areas, implementation of continuity has now been paused in response to these varying safety concerns. 

Clearly, robust measures need to be put in place to ensure that no one is left less safe and that rights are respected—otherwise the core intentions and proven benefits of this model will be lost. Making sure the foundations of safer care exist before local implementation could help teams work out if they are ready to work safely within this model. 

Making patients’ voices heard

I hugely admire those who are leading on this important transformation within such challenging times, giving practical advice and support to those at the forefront. I believe that given the right support, continuity will ultimately improve outcomes and birth experiences. There is a lot of evidence to underpin this. 

I’m 30 weeks pregnant with my second baby and have not seen the same midwife twice. Although each one has been very professional, I would feel better supported (and safer) if I’d had more continuity and if I knew that I would be met by a familiar face when giving birth. 

As patients we need to make sure our voices are heard in this area. We need to understand the benefits of continuity of care for pregnant people and babies, but also to listen to, and advocate on behalf of, maternity services. More widely, as a society, I believe we should all be demanding better resourced maternity teams so that models of care like this are able to continue being rolled out and are given the best chance of success. After all, we will all benefit from our next generation being given the best start. 

Stephanie O’Donohue is content and engagement manager for Patient Safety Learning, a charity whose vision is to help transform safety in health and social care, creating a world where patients are free from avoidable harm. O’Donohue is a writer and editor with 15 years’ experience working in healthcare communications and a degree in childhood and the early years. Her areas of interest include women’s health, the early years, and patient engagement. Twitter @odonohue_steph

Competing interests: none declared.