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UK policy is advocating continuity of midwife throughout the antenatal, intrapartum and postnatal period in order to improve outcomes. We explored the working patterns that midwives are willing and able to adopt, barriers to change, and what would help midwives to work in continuity models of care. A cross-sectional survey. 27 English maternity providers in the seven geographically-based 'Early Adopter' sites, which have been chosen to fast-track national policy implementation. All midwives working in the 'Early Adopter' sites were eligible to take part. Anonymous online survey disseminated by local and national leaders, and social media, in October 2017. Descriptive statistics were calculated for quantitative survey responses. Qualitative free text responses were analysed thematically. 798 midwives participated (estimated response rate 20% calculated using local and national NHS workforce headcount data for participating sites). Being willing or able to work in a continuity model (caseloading and/or team) was lowest where this included intrapartum care in both hospital and home settings (35%, n = 279). Willingness to work in a continuity model of care increased as the range of intrapartum care settings covered decreased (home births only 45%, n = 359; no intrapartum care at all 54%, n = 426). A need to work on the same day each week was reported by 24% (n = 188). 31% (n = 246) were currently working 12 h shifts only, while 37% (n = 295) reported being unable to work any on-calls and/or nights. Qualitative analysis revealed multiple barriers to working in continuity models: the most prominent was caring responsibilities for children and others. Midwives suggested a range of approaches to facilitate working differently including concessions in the way midwife roles are organised, such as greater autonomy and choice in working patterns. Findings suggest that many midwives are not currently able or willing to work in continuity models, which includes care across antenatal, intrapartum and postnatal periods as recommended by UK policy. A range of approaches to providing continuity models should be explored as the implementation of 'Better Births' takes place across England. This should include studies of the impact of the different models on women, babies and midwives, along with their practical scalability and cost. [ABSTRACT FROM AUTHOR]

Background According to the woman-centred care model, continuous care by a midwife has a positive impact on satisfaction. Comprehensive support is a model of team midwifery care implemented in the large Geneva University Hospitals in Switzerland, which has organised shared care according to the biomedical model of practice. This model of care insures a follow up by a specific group of midwives, during perinatal period. Aim The goal of this study was to evaluate the satisfaction and outcomes of the obstetric and neonatal care of women who received comprehensive support during pregnancy, childbirth and the postpartum period, and compare them to women who received shared care. Methods This was a prospective comparative study between two models of care in low risk pregnant women. The satisfaction and outcomes of care were evaluated using the French version of the Women’s Experiences Maternity Care Scale, two months after giving birth. Findings In total, 186 women in the comprehensive support group and 164 in the control group returned the questionnaire. After adjustment, the responses of those in the comprehensive support programme were strongly associated with optimal satisfaction, and they had a significantly lower epidural rate. No differences were observed between the two groups in the mode of delivery. The satisfaction relative to this support programme was associated with a birth plan for intrapartum and postnatal care. Conclusions Team midwifery had a positive impact on satisfaction, with no adverse effects on the obstetric and neonatal outcomes, when compared to shared care. [ABSTRACT FROM AUTHOR]

The publication of the Place of Birth Study (Birthplace in England Collaborative Group et al, 2011) provided the impetus for a West Midlands NHS Trust to develop a long-desired dedicated homebirth team. In 2013, Birmingham Women's hospital successfully bid and won a £750 000 Service Development Improvement Plan from Birmingham South Central Commissioners to lead a 3-year homebirth service pilot project. The aim of the project was to increase the homebirth rate and produce positive results in three key areas: improve women's experience of maternity services, signpost low-risk women out of hospital into the home setting, and improve outcomes and deliver care within tariff. This report reflects on the initial set-up and the launch of the new service. [ABSTRACT FROM AUTHOR]

The need to provide woman-centred maternity services which take account of womens’ views and specifically address their need for choice, control and continuity has been advocated and team midwifery has been suggested as one of the ways to achieve these objectives. This paper explores women’s descriptions of their maternity care experiences in England, specifically focusing on: their experiences of communication; being informed and making choices; being involved in the process of care; and their own perceptions of care. It is suggested that the midwife–woman relationship is an important aspect of satisfaction which needs greater recognition. Analysis of the data highlighted the importance of the quality of women’s relationships with caregivers. Findings revealed how positive relationships facilitated conditions which influenced satisfaction with care and suggest that, for the development of genuine woman-centred services where women exercise informed choice, and are involved in, and have some control over, the process of care, the nature and quality of the midwife-woman relationship must be accepted as an integral and crucial aspect of the service. [ABSTRACT FROM AUTHOR]

The fragmented nature of maternity services in the UK has led to the introduction of various forms of team midwifery scheme. The aim of such schemes is usually to increase continuity through the provision of antenatal, intrapartum and postnatal care to women by a small team of midwives. Few published studies of this organization of midwifery care exist, and even fewer consider the impact of such schemes on related health professionals. This paper presents the results of an independent survey of health visitors working alongside one team midwifery scheme in the south-east of England. Eighty per cent of the health visitors thought that team midwifery was a good idea in theory; however, just 27% thought it was working well locally and 70% reported that they would like to go back to working in the way they did before the introduction of team midwifery. The survey highlighted the health visitors’ concerns in relation to team midwifery locally. Two issues were paramount: firstly a reported deterioration in interdisciplinary communications, and secondly a perceived loss of continuity for the women. Thus team midwifery, as implemented in this locality, may not attain the goals aimed at by the organization of care in this way. [ABSTRACT FROM AUTHOR]

For maternity services in Blackburn, Lancashire, the Changing Childbirth (Department of Health, 1993) document was a long awaited publication. Prior to 1993 there had been radical change in local maternity service provision facilitated by inspirational leadership and enthusiastic midwives. Small, under-utilized and expensive GP led maternity homes were closed with an aim to provide one equitable service by blending the philosophies and expertise of low and high risk caregivers. From that time the service has continually striven to improve the continuity of care for women through the development of midwifery led care and team midwifery. In early 2004 a midwifery group practice was established in Blackburn. The development was made possible through an effective partnership between a hospital Trust, a Primary Care Trust, a Sure Start local programme and a Higher Education Institution. This paper tracks the setting up of this midwifery group practice. Future papers will address the ongoing management of the project, impacts and outcomes associated with it, and the arguments used to mainstream, sustain and develop it. [ABSTRACT FROM AUTHOR]