Continuity of Carer Catherine Ricklesford Continuity of Carer

Continuity of Carer Catherine Ricklesford Continuity of Carer Lead Midwife

Better Births • A national maternity review of services, chaired by Baroness Julie Cumberlege in 2016. • The findings of the Better Births review has been incorporated into updated NICE Guidelines. • The review has clarified two key tenets - the importance of women being able to make choices about their care, and the safety of the mother and baby. • The Better Births review revealed a unanimous response from women that they would like continuity of carer throughout the pregnancy, birth and postnatal continuum. • Research has shown that continuity of carer leads to safer pregnancy outcomes for mothers and babies.

Continuity of Carer • “Consistency in the midwife or clinical team that provides care for a woman and her baby throughout the three phases of her maternity journey: pregnancy, labour, postnatal period. ” • “Enables the co-ordination of a woman’s care, so that a named individual takes responsibility for ensuring all the needs of a woman and her baby are met, at the right time and in the right place. ” • “Enables the development of a relationship between the woman and the clinician who cares for her over time. ” • (Implementing Better Births 2017)

Improved pregnancy outcomes • 5% more spontaneous births. • 19% fewer preterm births. • 16% less likely to lose their baby and 19% less likely to lose their baby before 24 weeks. • 13% more likely to use birth centre. • 21% less likely to want an epidural. • 24% more likely to be referred for domestic violence advocacy as more likely to disclose domestic violence in a continuity of carer relationship with midwife. • Improved perinatal mental health.

Improved Multi-Disciplinary Working • Safer Care – Professionals work together across boundaries to ensure rapid referral and access to the right care in the right place. • Multi-professional working – breaking down barriers between professionals: midwives, obstetricians, GPs and other professionals to deliver safe and personalised care for families. • Data collection – to support sharing of data and information between professionals and organisations, use of an electronic maternity record rolled out nationally. • Useful information – to minimise the burden on women and their professionals. Nationally agreed indicators help local maternity systems track, benchmark and improve the quality of maternity services.

WHH Models of Continuity of Care • Elective caesarean section team • Facebook midwives group • Out of area continuity to be provided by core MLU midwives (booking, key points through pregnancy including 28/40 and 36/40, maternity unit tour, possibility of postnatal clinic) • Already provide excellent continuity of care through antenatal and postnatal period. • Better Births states it is not true continuity unless it includes the facilitation of continuity of care through the intrapartum time

Goals! • At least 35% of women are to be on a continuity of carer pathway by March 2020. • At least 51% of women are to be on a continuity of carer pathway by March 2021.

Future plans for continuity • Develop existing continuity models • Elective caesarean section team to increase the scope of the care they provide and to include postnatal visit. • Out of area MLU model. • Introduction of pilot caseloading model for mixed complexity. • Specialist team to care for women with diabetes in pregnancy.

Case loading model – Example in Practice • Sadie Holland is a midwife from the Electric team at Kings College, London. • Each one of the Electric Midwives has a caseload of women who are cared for before, during and after the births of their babies. They will deliver the babies in hospital or at home.

Queries? • Please contact Catherine Ricklesford on c. ricklesford@nhs. net if you have any queries.