Child and Maternal Health
Best Start focus on: Continuity of Carer
Best Start Factsheet – Continuity of Carer
What is it?
The Best Start recommends moving to a continuity of carer model of care for maternity. This represents a fundamental change in the way services are currently delivered. In the new model, midwives will work in small teams and manage a caseload of 35 women at any one time. Every women will have a primary midwife and will see that midwife or one of the small team the midwife works in throughout her pregnancy from antenatal care, through labour and birth and finally during postnatal care.
The women and her primary midwife will build a plan of care around each woman and her individual needs. Women who require the input of an obstetrician will have a primary obstetrician who she will see throughout her antenatal and postnatal care.
Why are we doing it?
During the review of maternity and neonatal services, women and midwives both expressed a desire for greater continuity of carer to improve relationships. In addition, evidence shows that midwifery continuity of carer models have proven benefits in terms of improved outcomes for women and babies. These include a potential reduction in preterm birth and miscarriages, a reduction in medical interventions during birth and an increase in natural births. The benefits for midwives include improved relationships with the women they care for, increased autonomy and increased job satisfaction.
How are we doing it?
Five Early Adopter Boards (EAB) were identified in September 2017 to lead the way across Scotland in implementing a suite of recommendations relating to continuity of carer and local delivery of care. Pilot teams are now operating in all five Boards and the EABs are now planning for full roll out of the new model in their Board over the next year or so. Learning from the five EABs will be shared with the remaining Boards to allow them to begin their planning locally. The Scottish Government has invested £5.6m over the next two years in the implementation of continuity of carer to allow Boards to carry out training and buy equipment needed.
A Facebook group has been set up to allow staff to share information and resources, ask Early Adopter Boards questions and hear how the new model is working in reality. A series of learning sessions will take places in June, September and December 2019 to continue sharing the learning.
The development of a monitoring and evaluation toolkit to allow Boards to capture data throughout implementation is underway and is being produced in conjunction with the Continuity of Carer sub group, the Early Adopter Boards and researchers from the University of Stirling NMAHP team, and will be available to Boards shortly.What have the results been?
March 2019 saw the first Best Start babies born where their mother received the new model of care for her entire pregnancy. Early data from these teams is already showing an increase in natural deliveries compared to the rest of the Board. Midwives from the pilot teams are enthusiastic about the new way of working and there has been unanimous feedback about preferring the new model of working to the old model. Women have also responded favourably to the new model of care and appreciate having a closer relationship with their midwife. In particular, women who have previously had a baby in the old model have reported preferring the new model of care.
Hear what continuity of carer means for midwives and women and download the video at: