Comment: What we really need is Call The Same Midwife
By Belinda Phipps
The third series of the BBC's Call the Midwife, which ends today, should be required viewing for NHS managers and health policymakers who could learn a lot before the midwives cycle off into the distance.
In the afterglow of birth the majority of women report a good experience of UK maternity care. Other measures show too many still receive elements of substandard service. Recent research by NCT and the Women's Institute, for example, found that 88% of women had not met any of the midwives caring for them before labour.
Having the same one or two midwives throughout pregnancy and birth is not just ideal, there is increasingly strong evidence that it brings improvements in clinical results for women and their babies. In the late 1950s this system, now known as continuity of carer, was taken as given. Resurrecting similar principles today could save money and ease many of the problems that currently exist in maternity services.
Continuity of carer means a woman being supported by a midwife or a small team of midwives that she gets to know and with whom she is able to build a relationship of trust. This relationship starts in early pregnancy and continues until the mother feels settled and confident with her new baby.
Women are more likely to mention concerns to someone they trust and it is easier for midwives to spot a problem in someone they have come to know, as demonstrated frequently by the storylines in Call the Midwife. It results in better outcomes for women and babies – research shows that women who receive continuity of carer are less likely to give birth prematurely and have fewer complications than those receiving standard care.
Numerous studies have shown that continuity of carer does not cost any more than any other system, partly because of the savings made as a result of more straightforward births.
It also leads to higher levels of job satisfaction for midwives. This is significant as nearly a quarter of the workforce are thinking of getting a job in a different profession – an appalling waste of talent and training. According to the Royal College of Midwives there are currently around 5,000 fewer midwives than there should be in the UK.
It's not just a question of numbers – midwives need to be used more effectively. The roster system used in hospitals means that at times there aren't enough on duty which results in midwife stress and poor support for parents. At other times there are more midwives than pregnant women.
The best system is known as caseload midwifery, where a midwife cares for an agreed number of women throughout their pregnancies. This type of care gives women a much better chance of giving birth with a midwife they know and the outcomes, in terms of the number of straightforward births and satisfaction rates, are high.
Here again Call the Midwife leads by example, showing Chummy et al working on a case-by-case basis, getting to know the family, their concerns and their history.
Having a midwife popping around for a cup of tea and a chat is a good first step on the road to parenthood. Of course medical science has led to big improvements for expectant mothers and their babies and no-one wants a return to the late 50s. But adopting continuity of carer and caseload midwifery as guiding principles today could improve UK maternity services dramatically.
Belinda Phipps is chief executive of the National Childcare Trust
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