How optimal caseload midwifery can modify predictors for preterm birth in young women: Integrated findings from a mixed methods study

Abstract

the institutional infrastructure and managerial support for caseload midwifery should value and prioritise the philosophical commitments and personal attributes required to optimise the model. Furthermore the location of visits, between appointment access to primary midwife, and back-up system should be organised to optimise the midwife-woman relationship in order to promote the young woman's engagement with maternity care.

Implementing continuity of midwife carer – just a friendly face? A realist evaluation

“…Trusting relationships are the foundation on which CMC is built and become the cement that holds it together over time. Relationships matter, not only because women want them, but because it is the woman-midwife relationship that triggers change in women's behaviour [69] and midwives' practice resulting in better outcomes and care giving experience. The importance of womanmidwife relationships are already recognised, as are the supportive, sustaining and enabling relationships between midwives within CMC teams [48].…”

“…Allen et al, [69] identified 'Synergistic Health Engagement' as the mechanism by which optimal caseload midwifery (comprising philosophical commitment, institutional infrastructure and support, and personal attributes) modified the risks of preterm birth through women both attending and buying in (emotional investment and commitment) to services. In our study this mechanism might also explain the impact of caseloading on the midwife who through her relationship with women 'bought in' to CMC to ensure women had good experiences and outcomes.…”

“…Positive experience of CMC then motivates midwives and managers to engage with the opportunity to implement CMC either by volunteering or actively supporting implementation from within the wider workforce. In our study, and the literature, midwives chose to trial (or work in) CMC models, which could suggest that they might be intrinsically different to other midwives who did not put themselves forward; for example, they may have a stronger philosophical commitment to physiological pregnancy and birth or woman centred care or have different personal attributes [51,52,69]. In support of this we identified that many of the midwives who volunteered to test CMC were motivated by a lack of belief in or negative experience of the current fragmented model.…”

The motivation and capacity to go ‘above and beyond’: Qualitative analysis of free-text survey responses in the M@NGO randomised controlled trial of caseload midwifery

“…A systematic review of women's satisfaction with childbirth reported that feeling supported by caregivers, having a high quality caregiver-patient relationship, and feeling involved in decision-making were factors so important to women that they overrode differences in age, ethnicity and socioeconomic status (Hodnett, 2002). The midwife's personal characteristics and philosophical commitments affect the nature and quality of the partnership in caseload midwifery models (Allen et al, 2016). In the largest trial of caseload midwifery (n=2,314), participants allocated to the intervention: "felt more in control during labour, were more proud of themselves, less anxious, and more likely to have a positive experience of pain" compared to participants in standard care (McLachlan et al, 2016, p.465).…”

Implementing Continuity of Midwife Carer – Just a Friendly Face? A Realist Evaluation

“…Trusting relationships are the foundation on which CMC is built and become the cement that holds it together over time. Relationships matter, not only because women want them, but because it is the woman-midwife relationship that triggers change in women's behaviour(69) and midwives' practice resulting in better outcomes and care giving experience. The importance of woman-midwife relationships are already recognised, as are the supportive, sustaining and enabling relationships between midwives within CMC teams(48).…”