and how to fill the gaps of a struggling maternity system.
In 2016, the NHS published a report setting out “a vision for the planning, design and safe delivery of maternity services; and how women, babies and families will be able to get the type of care they want."
This report called Birth Better highlighted the overwhelming demand from pregnant people to access midwife-led continuity of care; meaning that the same midwife – or team of midwives – would care for them throughout their pregnancy, birth and the early parenting period.
Now seven years down the line and the objective set by the NHS to provide a ‘gold-standard’ maternity care based on a continuity of carer model, is far from being achieved. Implementation targets that were initially set "for all women to be able to access a continuity team by March 2023" were in fact scrapped in England last year. This is mainly due to the critical lack of resources, but also likely due to the lack of support and constructive leadership allowing trusts to set-up services that work for them, depending on their location and the populations they serve.
That’s because the first thing that comes to mind when we think of continuity of care is a sense of trust and emotional safety. But studies show that it goes far beyond the emotional wellbeing.
Strong evidence shows that continuity of care benefits women. You might be thinking “yeah, it would be nice to have a chance to know your carer and build that relationship”. That’s because the first thing that comes to mind when we think of continuity of carer is a sense of trust and emotional safety. But studies show that it goes far beyond the emotional wellbeing. In fact, if you are pregnant and receiving continuity of care, you are:
more likely to have spontaneous vaginal birth;
more likely to have a shorter birth;
less likely to have an epidural;
less likely to have an episiotomy;
less likely to have an instrumental vaginal birth (using forceps or ventouse);
less likely to experience preterm birth (birth before 37 weeks of pregnancy);
at lower risk of losing your baby.
So here are the questions that you might be asking yourself:
How can I influence the type of care I am receiving within the NHS maternity services?
Visit your local NHS trust website to see whether continuity of care is mentioned there.
Speak to your midwife about it at your first appointment (or as early on as possible).
Consider planning to give birth in your local freestanding midwife-led unit or to birth at home – those will give you the best chance to be supported by the same team of midwives. Remember that you can always change your mind at any stage of your pregnancy or even during labour if you wish (or need) to transfer to an Obstetric Unit.
What else can I do to access continuity of care outside the services offered by my local trust?
Choose an independent midwife. Due to the ludicrous cost of insurances, only a few private midwives offer birth support - if you can afford it. However, many independent midwives offer (more) affordable antenatal and postnatal services if you wish to explore this option.
Choose a Doula. Doulas are not medically trained professionals, but studies show that hiring a doula can have a very similar impact on your birth as the continuity of care model. For more information about what Doulas do, click here.
Choose your birth partner/ birth team early in your pregnancy, and prepare for the birth together. Attend appointments together, and book an empowering antenatal course to get all the tools you'll need to feel confident and fully prepared to advocate for your birth preferences.
For more information and support, feel free to get in touch.
Quick note about Birth Partners...
For most women, their chosen birth partner will be the only person in the birth space they'll know. Making sure that you're prepared and equipped to provide that loving support and emotional safety is absolutely key. My Hypnobirthing and Antenatal courses have a strong focus on preparing birth partners to take on that role. To find out more, click here.
Photo by Jessica Vi Photography