What women value in the midwifery continuity of care model: A systematic review with meta-synthesis

Perriman, Noelyn; Davis, Deborah; Ferguson, Sally

doi:10.1016/j.midw.2018.04.011

Cited by 134 publications

(100 citation statements)

References 32 publications

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“…Trust can therefore be interpreted as a part of the phenomenon of PS. Thus, caring relationships should include respect, dignity (Shakibazadeh et al, ), trust, and empowerment (Perriman & Lee Davis, ), which make a substantial contribution to safe maternity care (Sandall et al, ).…”

Section: Discussionmentioning

confidence: 99%

Qualitative study of women's experiences of safe childbirth in maternity care

Rönnerhag

Severinsson

Haruna

et al. 2018

Nursing & Health Sciences

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Few studies have focused on women's childbirth experiences in relation to patient safety. The aim of this study was to explore the meaning of safety as a process phenomenon by outlining women's positive and negative experiences of safety in childbirth. A descriptive explorative design was chosen and 16 interviews were conducted. Qualitative content analysis was used. One main theme emerged: safe childbirth through involvement and guidance, based on four subthemes. The characteristics of women's experiences of safe childbirth included the need to be informed and involved by sharing and receiving trustworthy information. Women's experiences of unsafe childbirth included lack of meaningful and trustworthy information that resulted in feelings of being misled or lulled into a false sense of security. Not being involved evoked feelings of being ignored. In conclusion, this study highlights issues of importance for safe maternity care. The perspectives of childbearing women can contribute to an understanding of how to achieve meaningful improvements to provide safer maternity care.

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Section: Discussionmentioning

confidence: 99%

Qualitative study of women's experiences of safe childbirth in maternity care

Rönnerhag

Severinsson

Haruna

et al. 2018

Nursing & Health Sciences

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“…CMC aims to build relationships through frequent care contacts with the same midwife during a woman's care journey [12]. These relationships result in better clinical outcomes and care experiences for women [36,38,41,[44][45][46][47][48][49][50][51][52][53][54] and are thought to work through various mechanisms such as: trust [38, 47-49, 52, 53, 55]; feeling known [49,51,52,56]; feeling empowered or confident [52,53,57], feeling relaxed [52]; emotional support [45,55,58,59]; advocacy [60] and feeling safe [47]. Women in our evaluation said they liked having a relationship with their midwife, 'seeing a friendly face', feeling known and feeling confident in their midwives' abilities.…”

Section: Programme Theory 2: Relationshipsmentioning

confidence: 99%

“…Continuity midwives work differently from midwives in fragmented care [41,51,63]. This difference encompasses working more autonomously [36,51], with greater responsibility [51,65]; flexibly [44,48,51,55], feeling in control [42,66]; providing high-quality care that is evidence-based [41], holistic [45] and individualised/woman-centred [44,53,56], and working with the full scope of midwifery practice [1,39,51,55,67]. This different way of practising results in greater job satisfaction and emotional wellbeing for midwives [41,55].…”

Section: Programme Theory 3: Midwifery Practicementioning

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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“…The value of connection between a woman and her midwife has been discussed extensively in the literature. Several authors have identified that midwifery-led continuity of care models facilitate the development of a midwife-woman relationship based on trust and respect, which improves women's experiences of childbearing[23][24][25][26] .Continuity of carer is defined as enabling a pregnant woman to build a relationship with a midwife (and a small team of midwives) through her childbearing journey with a named primary midwife who gives the majority of care during pregnancy, birth and the postnatal period27 . The models of care evaluated in our study were continuity of carer models where one named midwife provided care to a specified number of women each year as their lead maternity care provider.…”

mentioning

confidence: 99%

Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework

et al. 2020

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Problem: Midwifery-led continuity of care has well documented evidence of benefits for mothers and babies, however uptake of these models by Australian maternity services has been slow. Background: It is estimated that only 10% of women have access to midwifery-led continuity of care in Australia. The Quality Maternal Newborn Care (QMNC) Framework has been developed as a way to implement and upscale health systems that meet the needs of childbearing women and their infants. The Framework can be used to explore the qualities of existing maternity services. Aim: We aimed to use the QMNC Framework to explore the qualities of midwifery-led continuity of care in two distinct settings in Australia with recommendations for replication of the model in similar settings. Methods: Data were collected from services users and service providers via focus groups. Thematic analysis was used to develop initial findings that were then mapped back to the QMNC Framework. Findings: Good quality care was facilitated by Fostering connection, Providing flexibility for women and midwives and Having a sense of choice and control. Barriers to the provision of quality care were: Contested care and Needing more preparation for unexpected outcomes. Discussion: Midwifery-led continuity of carer models shift the power dynamic from a hierarchical one, to one of equality between women and midwives facilitating informed decision making. There are ongoing issues with collaboration between general practice, obstetrics and midwifery. Maternity services have a responsibility to address the challenges of contested care and to prepare women for all possible outcomes to ensure women experience the best quality care as described in the Framework. Conclusion: The QMNC Framework is a useful tool for exploring the facilitators and barriers to the widespread provision of midwifery-led continuity of care.

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What women value in the midwifery continuity of care model: A systematic review with meta-synthesis

Cited by 134 publications

References 32 publications

Qualitative study of women's experiences of safe childbirth in maternity care

Qualitative study of women's experiences of safe childbirth in maternity care

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

Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework

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