A Concise Guide to Continuity of Care in Midwifery

Ellen Kitson-Reynolds, Kate Ashforth, Ellen Kitson-Reynolds, Kate Ashforth

• Publisher: Taylor & Francis
• Year: 2021
• eBook ISBN: 9781000418071
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Continuity of care in midwifery – the most traditional way of practising – has been overlooked for much of the last century but is re-emerging as an evidence-based model of care, one which is known to benefit women. This book is a vital companion to students and qualified midwives as continuity of care is integrated into midwifery education and services.

A practical, easy-to-read guide to practising caseload midwifery, this book outlines the contemporary political and professional context for midwifery care, different models of care, and the evidence and outcomes associated with continuity of carer. It discusses the real-life concerns, challenges and opportunities of working closely with women throughout their pregnancy and birth, covering key issues such as risk assessment, consent, boundaries, time management, documentation, communication, burnout and decision-making. Supporting the development of midwives from students to newly qualified professionals and beyond, it ends with a chapter containing a range of resources for reference, including helpful tools and worksheets.

Including vignettes from students, qualified midwives, and women and their partners, this book is designed for anyone new to practising midwifery continuity of care.

1 Introduction

Ellen Kitson-Reynolds

Introduction

Midwifery, as a global profession, provides care for women throughout the childbirth continuum, newborn infants, partners, and families in all care settings (World Health Organisation (WHO), 2019). Midwives across the globe have the ability to enhance quality care, reducing maternal and newborn mortality and morbidity through engaging with quality, lifelong education (Nursing and Midwifery Council (NMC), 2019). Through an initial period of high-level education, as a student midwife, you have agreed to embark on a lifelong journey of self and reflective learning and discovery. As you navigate your way through challenging, emotional, personal yet rewarding circumstances, your self-less giving to your profession and more importantly women locally, nationally, and internationally, will undoubtedly result in ‘better’ outcomes and greater satisfaction for all involved in this partnership. The implementation of the Better Births (NHS England, 2016b) recommendations is impacting all maternity services and midwives’ working patterns. You are at the centre of continuity of carer policy implementation. Ultimately, you will have developed resilience skills required to enhance overall public health and wellbeing, thus supporting women and their families through their next generations to come. The NMC (2019) ‘Standards for Pre-Registration Midwifery Programmes’ and International Confederation of Midwives (ICM) (2017) ensure that:

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

(ICM, 2017)

The book is for anyone who is interested in midwifery practice and it is underpinned by a set of beliefs and values that espouse a ‘humanised’ holistic woman centred approach to care, provided by competent and knowledgeable practitioners with kindness, compassion, trustworthiness, respect and a nurturing manner. Throughout this book, the use of the term ‘woman/women’ refers to all those individuals who are pregnant and/or birthing. It is the intention of the authors throughout to recognise the diversity of people who may or may not identify as women. This is consistent with the principles of the 6 Cs (Cummings and Bennett, 2012), Better Births (NHS England, 2016b), the United Kingdom’s (UK) National Health Service (NHS) five-year plan (2019), the NHS Constitution (Department of Health, 2015), The Lancet series for midwifery (Renfrew et al., 2014) and the ICM (2017; 2010) definition of a midwife. This book has adopted a values-based approach from recruitment through to lifelong learning. It recognises the need for midwives to have a clear vision of their own potential to promote excellence, embrace a greater public health role and to meet the challenges of reducing global to local inequalities and improving maternal and family health and well-being thus incorporating the evidence-informed framework for maternal and newborn care (Renfrew et al., 2014). For those of you completing the activities throughout this book, you will be able to demonstrate the strength, flexibility and resourcefulness required to work in stressful, difficult yet rewarding situations (NMC, 2019a). You will have the potential to become future leaders within the midwifery profession with capabilities to respond flexibly and effectively, to the changes and technological advances in the health care environment.

Your local, national, and international midwifery colleagues are committed to the provision of high-quality education that is responsive to the changing state and knowledge in health and midwifery provision, and to meet client needs and expectations (WHO, 2019; The Lancet Series, 2014; NHS England, 2016b) to support the future workforce. In essence, midwives work together as one big ‘family’ to support the future of the profession and ultimately the safe delivery of care excellence for all women and their families. As a midwife, you have the opportunity, and indeed are expected, to develop an evidence informed approach to care provision (NMC, 2015; WHO, 2019; Ciliska et al., 2010)

Box 1.1 Activity 1.1

By the end of this introductory chapter, you will have started to devise your personal philosophy of care. As you read each section make a list of the things that hold a strong truth to your personal values and beliefs, and why you have decided to become a midwife.

For many women, midwives are the first or main health care professional that they and their family will have encountered. Within many communities, and through changing levels of austerity, many families live with several generations in one residence (Tapper, 2019; Office for National Statistics, 2019). It is likely that midwives will be the main healthcare professional providing health promotion advice and education for the whole family. Midwives are likely, therefore, to be the person who risk assesses the family environment and identifies where assistance may be required. An example of this would be where an elderly family member resides with younger family and may be subtly developing dementia or Alzheimer’s, but the family may not have realised this or, as the level of care increases, they are not aware of the social support that may be available to support them in continuing to provide safe care at home. This will impact on the level of mental well-being for the whole family which may then impact on the safeguarding of the unborn baby. Whilst this appears dramatic as an example, it remains a reality for many families. It is essential therefore, that midwives have knowledge on wider health and social care issues to signpost families to the multidisciplinary team, thus role modelling positive health care support systems for the wider family. How does this fit with case-loading or continuity of carer models I hear you ask? Well, families who build a relationship with a known and consistent carer are more likely to trust and disclose (Huber and Sandall, 2006). The midwife is more likely to elicit information from other forms of communication, not just verbal, through serial contacts. The power of observation cannot be underestimated for subconscious decision-making processes in these circumstances (Kitson-Reynolds, 2010). This will be considered further throughout the chapters.

Who is this resource for?

This resource has been crafted to support the development of your midwifery professional prowess and provide you with the detailed knowledge and skills necessary to equip you for a career in Midwifery (NHS England, 2016b; NHS five-year plan, 2019; The Lancet Series, 2014; WHO, 2019). It is anticipated that the readership is predominantly, although not exclusively, UK-based and thus the book aims to develop your competence in applying professional skills to the autonomous practice of typical midwifery in accordance with the ‘The Code: Standards of conduct, performance and ethics for nurses and midwives’ (NMC 2015 updated 2018).

The compilation has been written as a resource to support you from the first day of the first year of your pre-registration midwifery programme through to your pre-ceptorship period and beyond as a qualified midwife. Whilst the initial intention is to achieve a continuity of carer skills base, the content of the book aims to equip you with skills for contemporary midwifery practice regardless, hence you may recommend this text to your qualified clinical colleagues as well as your peers.

Although the focus is primarily on student midwives through their pre-registration education, others such as midwife educators, academic assessors, qualified and practising midwives, practice educators, Local Maternity Systems and continuity of carer implementation teams, front line health care professionals and Doulas may also find usefulness with the content.

How to use this resource

The book has been constructed as a companion for you throughout your course as a student midwife taking you into your preceptorship period as a newly qualified midwife and your future practice as a practice supervisor/assessor supporting the next generation of midwives and workforce. Your Approved Education Institution (AEI) will be invested in a research and evidence-based approach to its education delivery that cares about the real world and how research changes the world we inhabit. Your learning will follow an inclusive evidence-based approach and you will develop the research knowledge and skills for an inquiring mind (implementing the Research-Teaching Nexus (Healey and Jenkins, 2009)) to provide a critical and evidence-based reasoned argument to enhance practice, individual woman and family collaborative care planning and decision-making as well as the application to your theoretical learning and assessments.

Sustainability and climate change factor widely in the national context (Richardson et al., 2017) and will impact upon the midwifery profession and health care generally. This resonates with contemporary health care policy locally, nationally, and internationally (Renfrew et al., 2014; Cummings and Bennett, 2012; The NHS England, 2016b; NHS, 2019; Naylor, 2019; NHS, 2020; NHS Employers, 2020). With this in mind, this resource embraces these core education values with identified reflective and professional development activities for you to complete along the way. As a future leader and change agent (Stefancyk et al., 2013) it is essential that you remain true to your values and belief systems and consider honestly where your personal blockers and facilitators lay as well as where you consider them to sit professionally at local, national, and international levels. It is when you truly open yourself up to being ‘vulnerable’ (Brown, 2015) that you undertake personal and professional development that is sometimes painful and other times enlightening, in order to move forward proactively. Domain 5 within the NMC (2019) standards concern you taking ownership for your own learning and development; this resource intends to support this.

The chapters can be read and re-read as you develop your skills and knowledge base. As the depth of your knowledge expands, you will view the chapters differently on re-reading and hopefully will glean more useful assistance from within. Vignettes provide an elaboration of and insight into aspects related to others’ experiences linked to their own participation in case load held practices and/or continuity of carer experiences to support your thinking, skills development and planning of care using collaborative decision-making with all involved.

Terminologies used throughout the book

The contemporary midwifery professional world is fast evolving to meet the needs of complex and ever-changing health care requirements of the public, changing telehealth technologies (Wessex Institute, 2020; Salisbury et al., 2017), workforce (Emmanuel et al., 2020; Dall’ora, 2020), societal and professional expectations, changing policy and implementation science (BioMed Central Ltd, 2020). The NMC published their new suite of education standards in 2018 (Part 1: Standards framework for nursing and midwifery and Part 2: Standards for student supervision and assessment (SSSA) culminating in 2019 with the Part 3: Standards for pre-registration midwifery programmes (that include the standards of proficiency for midwives)). The standards of proficiency for midwives are immense, to reflect the current realities of the practising midwife and future proofing the ever-expanding role of the registered midwife. They reflect the changing global world of midwifery and the impact on women’s human right to health (WHO, 2020) locally, nationally, and internationally (WHO, 2019). Childbirth should be safe, transformative, and rewarding for all women and their families across the globe hence, midwifery education and practices must be set at an international standard to embrace the transient local, national, and international community thus aiming to improve overall health across the continuum of care, reducing maternal and newborn mortality and morbidity (WHO, 2019; pp. iv and vi). Terminologies equally have changed. This book aims to use the most contemporary terminologies throughout but will occasionally refer to outgoing phrases that remain common place in the practice arena amongst clinical colleagues. As such, we have used the phrase ‘case load held practice’ intercha...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• List of boxes
• List of contributors
• Acknowledgements
• List of abbreviations
• 1 Introduction
• 2 Case load held practice and the national and international political/professional context
• 3 Evidence base on case load held practice and outcomes
• 4 Practicalities
• 5 Considerations for practice supervisors, practice assessors and academic assessors
• 6 The emotional aspects of continuity of carer
• 7 Case load held experience lifelong learning and professional development
• 8 Final project and quality monitoring
• 9 Transition from student to newly qualified midwife
• 10 Resources
• Index