Continuity of Carer

What does Better Births say?

Women told the review team that they see too many midwives and doctors over the course of their pregnancy and the birth, and that they do not always know who they are and what their role is. For some women this leads to confusion and they are not able to build a rapport with healthcare professionals. Relationship or personal continuity over time has been found to have a positive effect on user outcome and experience.

Just as importantly for safety and clinical effectiveness, if too many health professionals are involved without proper coordination, there may not be effective oversight of the care provided. Evidence shows that continuity models have an impact on improving safety, clinical outcomes, as well as a better experience. In particular, there is evidence that for women who find services hard to access and navigate, they have improved access to care and better coordination of their care between midwifery, specialist and obstetric services. Pre-term births have also been found to be reduced through continuity of care.

Therefore, the NHS should offer greater continuity of the healthcare professional supporting the woman, her baby and the family. It should involve:

  • a midwife who will normality provide continuity throughout a woman’s journey, if that is what she and her partner want;
  • the midwife will usually work in and be supported by a small team of four to six midwives, one of whom could be a buddy and take responsibility for the woman’s care if her midwife is not available;
  • each team of midwives should have an identified obstetrician who can get to know and understand their service and can advise on issues as appropriate;
  • having a midwife the woman knows at the birth. Ideally this will be her own midwife, but if that is not possible, a midwife from the same team of four to six; and
  • where a woman needs on-going obstetric support, this should be from a single obstetric team and the care should be fully integrated across the midwifery and obstetric services.

The provision of care by a known midwife throughout the pregnancy, labour, birth and postnatal period can be associated with improved health outcomes for the mother and baby, and also greater satisfaction levels.

The Implementing Continuity of Care presentation can be found here: