Catherine Ricklesford Continuity of Carer Lead Midwife

Better Births A national maternity review of services, chaired by Baroness Julie Cumberlege in 2016. The findings of the Better Births review has been incorporated into updated NICE Guidelines. The review has clarified two key tenets - the importance of women being able to make choices about their care, and the safety of the mother and baby. The Better Births review revealed a unanimous response from women that they would like continuity of carer throughout the pregnancy, birth and postnatal continuum. Research has shown that continuity of carer leads to safer pregnancy outcomes for mothers and babies.

Continuity of Carer “Consistency in the midwife or clinical team that provides care for a woman and her baby throughout the three phases of her maternity journey: pregnancy, labour, postnatal period.” “Enables the co-ordination of a woman’s care, so that a named individual takes responsibility for ensuring all the needs of a woman and her baby are met, at the right time and in the right place.” “Enables the development of a relationship between the woman and the clinician who cares for her over time.” (Implementing Better Births 2017)

Improved pregnancy outcomes 5% more spontaneous births. 19% fewer preterm births. 16% less likely to lose their baby and 19% less likely to lose their baby before 24 weeks. 13% more likely to use birth centre. 21% less likely to want an epidural. 24% more likely to be referred for domestic violence advocacy as more likely to disclose domestic violence in a continuity of carer relationship with midwife. Improved perinatal mental health.

Improved Multi-Disciplinary Working Safer Care – Professionals work together across boundaries to ensure rapid referral and access to the right care in the right place. Multi-professional working – breaking down barriers between professionals: midwives, obstetricians, GPs and other professionals to deliver safe and personalised care for families. Data collection – to support sharing of data and information between professionals and organisations, use of an electronic maternity record rolled out nationally. Useful information – to minimise the burden on women and their professionals. Nationally agreed indicators help local maternity systems track, benchmark and improve the quality of maternity services.

WHH Models of Continuity of Care Elective caesarean section team Facebook midwives group Out of area continuity to be provided by core MLU midwives (booking, key points through pregnancy including 28/40 and 36/40, maternity unit tour, possibility of postnatal clinic) Already provide excellent continuity of care through antenatal and postnatal period. Better Births states it is not true continuity unless it includes the facilitation of continuity of care through the intrapartum time

Goals! At least 35% of women are to be on a continuity of carer pathway by March 2020. At least 51% of women are to be on a continuity of carer pathway by March 2021.

Future plans for continuity Develop existing continuity models Elective caesarean section team to increase the scope of the care they provide and to include postnatal visit. Out of area MLU model. Introduction of pilot caseloading model for mixed complexity. Specialist team to care for women with diabetes in pregnancy.

Case loading model – Example in Practice Sadie Holland is a midwife from the Electric team at Kings College, London. Each one of the Electric Midwives has a caseload of women who are cared for before, during and after the births of their babies. They will deliver the babies in hospital or at home.

Queries? Please contact Catherine Ricklesford on c.ricklesford@nhs.net if you have any queries.