Continuity of carer and local delivery of care: implementation framework

Chapter Two: Implementing Change

Enabling Change

Enabling change – Board level

This chapter of the Implementation Framework focuses on the lessons learned from the EABs with regards to implementing the continuity of midwifery carer model and includes links to resources that Boards might find helpful.

A wide group of stakeholders and service users will have an interest in implementation. It was clear from the EABs that it was important to have engagement from an early stage with this wide range of stakeholders and service users, and these groups will differ at both a Board and team level.

Enabling change – team level

Women receiving continuity of carer have been positive about their experience and a selection of their feedback is shown below

What women said:

• "I felt at ease with everything. I really do think this change is a great step forward. My experience this time felt so much more personal and I wasn’t afraid to ask questions this time round." Second time mum, NHS Forth Valley

• "My third pregnancy, I was part of the best start initiative in the community which was fantastic from start to finish... This was a much more holistic, patient focused approach and the outcome was a much happier mum, dad and baby." Third time mum, NHS Lanarkshire

• "I felt particularly close to my named midwife…having a friendly and familiar face there was not only important for me but also my husband." First time mum, NHS Highland

• "I've just had my baby last week at the RAH. The whole pregnancy experience with my midwife Stephanie has been great as she was very flexible with appointments, coming to see me at home, and we communicated easily by text in case I needed something. This was my second pregnancy and all this was not in place during the first one. I couldn't be happier with the whole experience I've had." Second time mum, NHS GG&C

• "My experience was really good when I was pregnant because it was my first time and I was quite nervous about it but I had the same midwife all the way through and we grew quite a good bond with each other." First time mum, NHS Tayside

• "I’ve been part of the Best Start Pilot and been under the care of midwives from the Blue Team, in particular Holly. She made me feel comfortable and relaxed at every appointment and I had complete confidence in her throughout." NHS GG&C

• "It was nice knowing who you were going to see at every appointment and helped build a relationship with our midwife making us feel comfortable at appointments." Second time parents, NHS Forth Valley

• "The benefit for me is that I have felt heard and that my concerns and wants have been taken on board." Second time mum, NHS Lanarkshire

• "I felt safe and confident that my wishes were being met and while my birth was far from what I had imagined or planned it was calm and I felt fully supported that Nicky was there beside me." First time mum, NHS Highland

Midwives working in a continuity of carer model had a range of views and a selection of their feedback is shown below

What staff said:

• "Because you have so much freedom in arranging your diary you really can individualise the care and give them what they need." Midwife, NHS Lothian

• "One of the biggest challenges is on-call, especially with children and families. Midwives are worried that they will be on-call and what if they don’t get called out. Do they have to have childcare when they are on-call and if they don’t get called out they have to make up the hours." Midwife, NHS Forth Valley

• "Very fulfilling day spent as a Named Midwife, following my Red Pathway patient and her partner to the Consultant Unit being actively involved in her birth process and care in the immediate postnatal period." Midwife, NHS Highland

• "The benefits are that we can build that relationship and build rapport which means we can recognise deviation more quickly." Midwife, NHS Forth Valley

• "It’s the reality of work life balance that most midwives worry about." Midwife, NHS Lothian

• "I have such great job satisfaction now that I have not had for a long time." Midwife, NHS Lanarkshire

• "Transport was a bit of an issue in the beginning but that’s ok now." Midwife, NHS GG&C

• "What works for one midwife won’t necessarily work for another so that’s why there is scope within teams to manage that." Midwife, NHS Lothian

• "I feel I now have a better work/life balance. Even though I am working more days, my time is more flexible and I feel working less nightshifts is having a positive effect on my mood/relationships and social life."Midwife, NHS Lanarkshire

• "It’s much more autonomous now and I’m really enjoying it." Midwife, NHS GG&C

• "You actually feel really invested in your women, you really feel that professional relationship. You want to see them, you want to visit them at home, you want to hear how they’ve got on." Midwife, NHS GG&C

• "My challenge at the moment is learning when to shut off and have some downtime." Midwife, NHS Lanarkshire

• "It’s just such a completely new way of working, it’s a big change for everyone." Midwife, NHS Lothian