The NHS’ most senior midwife says 2018 will be a year of opportunity for promoting continuity of carer maternity standards for mums-to-be across England.

NHS England has today published new guidance to help local areas to provide women with more consistent care and support, including a named midwife, before, during and after birth.

The Continuity of Carer Guidance – designed in collaboration with women, midwives, clinicians, leaders, managers, researchers and commissioners – sets out two main models of approach that will support the introduction of national targets. It also outlines areas of the country that are trailblazing new ways to provide maternity services. The NHS is committed to introducing continuity of carer to all new mums by 2020/21.

For example, a pilot scheme delivered by a social enterprise in Waltham Forest, north east London is ensuring that 80 per cent of women giving birth know their midwife, whilst the national figure is currently 12 per cent.

Evidence shows that the continuity of carer model can improve safety and outcomes and could contribute to the prevention of around 600 stillbirths each year. It could also significantly reduce the number of babies born prematurely – by nearly 25 per cent – reducing the risk of long-term problems and need for specialist care.

Professor Jacqueline Dunkley-Bent, Head of Maternity, Children and Young People for NHS England, said: “All local areas now have a blueprint to provide continuity of care for mums-to-be in line with our ambitious national targets.

“2018 will be an important year for local health systems to ensure that midwives have a strong say in local maternity system plans. We hope this latest guidance will provide further evidence and practical support to ensure the successful implementation of continuity of carer for expectant mums.

“Trailblazers across the country are showing what can be achieved – evidence shows this can reduce the chances of stillbirth and improve maternity experiences for women, babies and their families.”

There are two main models in the ‘Implementing Better Births: Continuity of Carer’ guidance:

  • Team continuity – where each woman has an individual midwife, who is responsible for co-ordinating her care, and who works in a team of four to eight, with members of the team acting as backup to each other.
  • Full case loading – where each midwife is allocated a certain number of women and arranges their working life around the needs of the caseload.

Nearly three-quarters of women told the NHS how important it is for them to know and form a relationship with the professionals caring for them. Women have said that they see many midwives and doctors over the course of their pregnancy and birth, and that they do not always know who they are and what their role is.

For some women this has led to confusion when navigating maternity services, building a relationship or personal continuity over time has been found to improve outcomes and experience for both women and their babies. It is particularly important when assessing for reduced fetal movement and growth, known causes of stillbirth in the later months of pregnancy.

Familiarity and trust is also found to be most beneficial for women with complex or specialist needs such as mental health conditions.

The guidance also highlights the importance of each team having an obstetrician that the midwife can call for advice and to plan obstetric care as appropriate.

Case study

London’s neighbourhood midwives pioneer new approach that gives mums-to-be safer and more personalised care

A team of midwives – known as London’s ‘Neighbourhood Midwives’ – are shaping the future of maternity services by offering expectant mums greater continuity throughout their pregnancy, labour and postnatal care.

The trailblazing approach sees 80 per cent of women give birth with a midwife they know and who knows about their individual care needs and wishes , compared to 12 per cent of women receiving continuity nationally.

NHS England has committed to ensure that mums-to-be will have a named midwife and continuity of care throughout their pregnancy rather than see a different midwife at every appointment. Neighbourhood Midwives from Waltham Forest, North East London apply the ‘continuity of carer’ approach for women in their care.

One year on the pilot is already demonstrating better outcomes and experience for women and their babies.

Women having their first or second baby have experienced fewer interventions during birth with all new mums taking up breastfeeding which has known health benefits for a mother and her baby. Two-thirds of women were still breastfeeding at 6-8 weeks.

Emiko, a mother who gave birth with Neighbourhood Midwives, said: “It really makes such a difference getting to know the person who will assist you during what is a very personal experience.

“I could not have asked for a more perfect birth for my daughter.  It was very calm, I had everything exactly how I wanted it.  At no point did I feel intruded upon whilst in the zone.  My midwife Rebecca was a massive support, quietly there if I needed her, and providing gentle encouragement.”

The pilot was commissioned by Waltham Forest Clinical Commissioning Group (CCG), an NHS England Maternity Choice and Personalisation Pioneer, in 2016 to run a two year trial to increase choice and continuity for women.

After demonstrating what can be achieved, evidence and best practice from the trailblazing pilot has helped develop the national blueprint to support all maternity services roll-out continuity of care giving every family in the country the very best start in life.