There has been a great deal of academic research into “continuity of care” in a midwifery context. Put simply, if you are going to have a baby, this means that the same midwife looks after you throughout your pregnancy, is there for your birth and looks after you and your baby postnatally too. The evidence is quite clear that this model of care has great benefits for women, and those who have continuity of care are more likely to have a positive birth experience.
A Cochrane review of midwife-led continuity of care models found that women looked after in a continuity of care model were more likely to have a midwife they knew during labour and birth, more likely to have a spontaneous vaginal birth, less likely to have epidural analgesia, episiotomies, instrumental births or preterm births.
This is quite logical: If you feel safe and you trust your midwife you will feel more sure about yourself in labour, more holistically supported and your choices better understood. Fear in labour can slow it down, make it more painful and lead to further interventions and complications. Knowing your midwife and having the midwife know you and your choices and ideals will of course make the whole process more positive.
I am a student midwife undertaking my final year of the Bachelor of Midwifery. As part of my course I conduct my own “continuity of care” experiences, I see women throughout their pregnancy appointments, am on call for their births and catch up with them postnatally as well. Although these women are still seen in the routine hospital midwife clinics, the relationships they develop with me as their student midwife sees them better equipped for labour.
When I am discussing this part of my course with women to recruit, I always say the same little spiel:
“This is a really beneficial experience for me, because I get to know you and your partner and see the whole process of pregnancy, birth and initiation to parenthood, which is invaluable in terms of my learning. It’s also very beneficial for you, because it means a familiar face at every point in your journey, where otherwise you could go through your pregnancy, birth, postnatal experience never having seen the same midwife twice.”
In a big hospital, despite the absolute best efforts of the midwives, there are huge limitations in holistic care.
How can we ensure a woman is fully informed and educated about the process of labour and birth, common complications and possible pain relief options if she is only allocated 20 minutes for a visit? In this time, the midwife has to take her blood pressure, ask questions about the baby’s wellbeing along with her own, check bloodwork and ultrasound results, palpate the abdomen and listen to the baby’s heartrate, then, document all of these things in multiple places and consult with the medical team if there’s anything out of the normal and of concern. The care simply cannot be as thorough as if you had your own midwife who could make your visits at home.
Obviously, there are not enough caseload midwives to go around!
Despite an astounding amount of research showing clear benefits and no adverse effects for continuity in maternity care, implementing programs and these models of care into hospitals is a challenging process. Undoubtedly though there are many experts and midwives (many of them expert midwives!) in the field rallying and advocating and working towards this care for as many women as possible, and I imagine in the future continuity of care will be much more common.
Every woman deserves their own midwife, and at the very least, a student midwife.
If you are pregnant and unable to get into a caseload or midwifery group practice model of care at your hospital (because of high demand spots fill up rapidly!), enquire at your pregnancy appointments about pairing with a student midwife. Even in my first year when, looking back, I was probably as clueless as the women I cared for, they expressed a true gratitude to me and I felt I was able to transform their birth experiences.
And if you are a student midwife, or an aspiring student midwife, don’t underestimate the effect you can have on a woman’s experience. Having a familiar face and someone who you can trust in labour is an incredible thing, and you will be so very appreciated.