Midwives’ views of changing to a Continuity of Midwifery Care (CMC) model in Scotland: A baseline survey

Martin, Caroline J. Hollins; MacArthur, Juliet; Martin, Colin R.; McInnes, Rhona J.

doi:10.1016/j.wombi.2019.08.005

Cited by 16 publications

(23 citation statements)

References 32 publications

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“…Previous attempts to introduce CMC in this area were small scale and not sustained. Our baseline survey [25], developed to understand the local context, highlighted that local midwives supported the principles of CMC but opposed its implementation [26].…”

Section: Local Contextmentioning

confidence: 99%

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

McInnes

Aitken-Arbuckle

Lake

et al. 2020

BMC Health Serv Res

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Background: Good quality midwifery care saves the lives of women and babies. Continuity of midwife carer (CMC), a key component of good quality midwifery care, results in better clinical outcomes, higher care satisfaction and enhanced caregiver experience. However, CMC uptake has tended to be small scale or transient. We used realist evaluation in one Scottish health board to explore implementation of CMC as part of the Scottish Government 2017 maternity plan.Methods: Participatory research, quality improvement and iterative data collection methods were used to collect data from a range of sources including facilitated team meetings, local and national meetings, quality improvement and service evaluation surveys, audits, interviews and published literature. Data analysis developed contextmechanism-outcome configurations to explore and inform three initial programme theories, which were refined into an overarching theory of what works for whom and in what context. Results: Trusting relationships across all organisational levels are the context in which CMC works. However, building these relationships during implementation requires good leadership and effective change management to drive whole system change and foster trust across all practice and organisational boundaries. Trusting relationships between midwives and women were valued and triggered a commitment to provide high quality care; CMC team relationships supported improvements in ways of working and sustained practice, and relationships between midwives and providers in different care models either sustained or constrained implementation. Continuity enabled midwives to work to full skillset and across women's care journey, which in turn changed their perspective of how they provided care and of women's care needs. In addition to building positive relationships, visible and supportive leadership encourages engagement by ensuring midwives feel safe, valued and informed.Conclusion: Leadership that builds trusting relationships across all practice and organisational boundaries develops the context for successful implementation of CMC. These relationships then become the context that enables CMC to grow and flourish. Trusting relationships, working to full skill set and across women's care journey trigger changes in midwifery practice. Implementing and sustaining CMC within NHS organisational settings requires significant reconfiguration of services at all levels, which requires effective leadership and cannot rely solely on ground-up change.

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Section: Local Contextmentioning

confidence: 99%

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

McInnes

Aitken-Arbuckle

Lake

et al. 2020

BMC Health Serv Res

Self Cite

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“…Engaging clinical leaders is crucial, particularly in the first phase of changes when a new model co-exists with established ways of working. Starting the process incrementally with volunteer midwives already committed to continuity acting as ‘change champions’ may enhance embedding the model and motivating more resistant colleagues to participate [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study

Mills

Roberts

Camacho

et al. 2022

BMC Pregnancy Childbirth

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Background Around 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS). Methods A prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks’ gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8). Results Overall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited. Conclusions Women and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities. Trial registration ISRCTN17447733 first registration 13/02/2018.

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“…Midwives either 'love it or hate it' (Fontein-Kuipers et al, 2016;Fontein-Kuipers et al, 2021;Fontein-Kuipers, de Groot, et al, 2019;Hollins Martin et al, 2020;Newton et al, 2021;Petit-Steeghs et al, 2019;Taylor et al, 2019Taylor et al, , 2009. Loving woman-centred care is a combination of desire, joy, fulfilment and satisfaction, connected with existentialism and purpose in and value of life, but constraint from duty (Comte-Sponville, 2002).…”

Section: Lovementioning

confidence: 99%

Exploring the uses of virtues in woman‐centred care: A quest, synthesis and reflection

Fontein-Kuipers

2022

Nursing Philosophy

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Woman-centred care is a philosophy authentic to the midwifery profession, scaffolding and preceding the capacity and utility of woman-centred care in daily practice. Through providing guidance on the philosophical capacities-the virtues-the practical capacity and utility of woman-centred care becomes more clear and more tangible. This paper discusses the virtues of woman-centred care in midwifery practice. Eighteen virtues, described by Comte-Sponville, serve as a philosophical lens to explore and understand how each specific virtue integrates into the woman-centred care concept or vice versa, herewith becoming woman-centred care virtuous acts. The virtues are politeness, fidelity, pru-

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Midwives’ views of changing to a Continuity of Midwifery Care (CMC) model in Scotland: A baseline survey

Cited by 16 publications

References 32 publications

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

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

Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study

Exploring the uses of virtues in woman‐centred care: A quest, synthesis and reflection

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