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The importance of continuity of carer in maternity services

Next Tuesday (27 March) marks the two year anniversary of the publication of Better Births, and Professor Jacqueline Dunkley-Bent, Head of Maternity, Children and Young People at NHS England and National Maternity Safety Champion for the Department of Health reflects on the importance of continuity of carer in maternity services.

Some would say that implementing midwifery continuity of carer is a ‘no brainer’ others think it is ‘nigh on impossible’ to achieve continuity of carer for most women. Whatever your views, empirical evidence shows that women want and benefit from continuity of carer. The Cochrane review (2016)found that women who received midwife-led continuity of care were less likely to experience preterm births or lose their baby in pregnancy or in the first month following birth:

  • 16 per cent less likely to lose their baby
  • 19 per cent less likely to lose their baby before 24 weeks
  • 24 per cent less likely to experience pre-term birth

Equally, safety is not just about whether their baby lives or dies, safety for childbearing women and their partners and families also means emotional, psychological, and social safety. This holistic sense of safety is what they receive through continuity models of care.

Being a recipient of continuity of care from the same one or two midwives is very different to experiencing the care delivered through more traditional models of midwifery which in some areas can mean meeting a different midwife at every appointment. Becoming comfortable with someone, building a relationship with them which grows and deepens over time, enables trust to develop and women begin to share their deeper anxieties and insecurities as well as enjoying the more positive aspects of growing knowledge and confidence through a supported journey of discovery.

Midwives benefit too. For a midwife, getting to know the woman, and developing a trusting relationship with her during her pregnancy, is the best way to help her have a safe, positive and empowering experience of pregnancy birth and parenthood, whilst maintaining and strengthening clinical expertise across all areas of maternity care.

In a continuity model, the midwife’s responsibility, in close collaboration with her colleagues from across the multidisciplinary team, midwives have a critical role to play in ensuring that women are physically and psychologically well, so that they can develop a responsive and nurturing relationship with their children.

Respecting a woman’s values and beliefs during their maternity experience, whilst supporting them to make safe choices in the context of a mutually respectful, trusting relationship with the midwife is key to this.

Continuity of carer is being rolled out throughout England in 2018. Local maternity systems and maternity providers are considering ways of implementing continuity of carer over the next three years.

Naturally some maternity providers will implement at pace and move further faster. Others are starting small and planning to increase continuity of carer year on year. Regardless of the pace, sustainability is key. The continuity of carer guidance provided by NHS England and the continuity of carer visits offered by my team should ensure that women experience this model of care.

Please come and join us in Manchester on 27 March and find out how we can make maternity care personal and safe for everyone.

Jacqueline Dunkley-Bent

Professor Jacqueline Dunkley-Bent has vast experience in healthcare provision.

She has worked as a midwife and a nurse and held senior positions in clinical practice, education, leadership and management including: Director of Midwifery and Nursing positions for Women’s and Children’s services at Imperial College Healthcare Trust & Guy’s & St Thomas’ NHS Foundation Trust.

Academic roles have included: Senior Lecturer, Curriculum Leader, LME and Professor of Midwifery.

Jacqueline is currently Head of Maternity, Children and Young People at NHS England and National Maternity Safety Champion for the Department of Health. She is also visiting Professor of Midwifery at Kings College London and London South Bank University.

Her experience has seen her leading and influencing national maternity standards and guidance. She also influences healthcare, nationally and internationally through research, education and publications and is frequently invited to speak at national and international conferences. She is a member of the British Journal of Midwifery editorial board and until recently was an active member of the Maternity and Newborn Forum at the Royal Society of Medicine.

She has joined the Tommy’s Charity National Advisory Board as Midwifery advisor, and the Women of the Year management committee. Her voluntary work currently includes Midwifery Advisor for the Wellbeing Foundation Africa and until recently a trustee.

In 2014 she received the HSJ, BME Pioneers award and in 2015 she was selected from over 100 nominations for inclusion on Nursing Times’ Leaders 2015 list that celebrates nurses and midwives who are pioneers, entrepreneurs and inspirational role models in their profession.