Continuity of carer matters for childbearing women
What is continuity of care?
The National Maternity Service Plan defines ‘Continuity of Care’ as: “the practice of ensuring that a woman knows her maternity care provider(s) and receives care from the same provider, or small group of providers, throughout pregnancy, labour, birth and the postpartum period” (Commonwealth of Australia, 2011, p. 121).
The philosophy behind continuity models includes: an emphasis on the natural ability of women to experience birth with minimum intervention and monitoring the physical, psychological, spiritual and social wellbeing of the woman and family throughout the childbearing cycle.
What are the elements of continuity of Care?
All the care required to achieve a healthy pregnancy is provided by one person or a small team. This includes:
- Monitoring the progress of the pregnancy.
- Providing education on pregnancy, labour, birth, post-natal recovery, breastfeeding and parenting.
- In labour, monitoring and care is provided by the health professional who provided your ante-natal care or another known to you.
- Provides the post-delivery care
- Supports the commencement of infant feeding – breastfeeding or other.
- Supports transitioning to parenting.
Why does it matter?
Research has shown that continuous support in labour from a person other than the woman’s partner or family member delivers a better experience for women.
Furthermore Midwifery continuity models of care are associated with longer prenatal visits, more education on pregnancy and breastfeeding; prenatal counselling, fewer hospital admissions & a more positive birthing experiences for women, easing a woman’s transitioning to parenting and in meeting the demands of a new baby,(Leslie & Storton, 2007).
Continuity of care with a known midwife has significantly better outcomes for a woman and her child. A Cochrane Systematic Review based on a review of 13 trials involving 16,242 women, concluded that most women, unless they have significant risk factors, should have the option of midwife-led continuity of care. Midwife-led continuity of care – in which a pregnant woman sees the same midwife during pregnancy, labour and postnatally – is associated with a higher level of spontaneous vaginal birth; women are less likely to experience interventions such as episiotomies or use of forceps; more likely to be satisfied with their care; had a lower risk of foetal loss before 24 weeks’ gestation and at least comparable adverse outcomes for women or their infants than women who received other models of care. Midwifery care has also been found to result in fewer women suffering from debilitating post-natal problems such as illness or injury associated with some interventions (particularly operative deliveries) and postnatal depression, (Sandall et al, 2016 @ http://www.cochrane.org/CD004667/PREG_midwife-led-continuity-models-care-compared-other-models-care-women-during-pregnancy-birth-and-early) ).
Regrettably most women in Australia do not to receive comprehensive continuity of care with a known carer.