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Green Templeton College | Oxford

The Sheila Kitzinger symposium at Green Templeton College

There is compelling evidence that women and babies benefit from maternity care provided by a single midwife, or a small group of midwives, through pregnancy, birth and the post-natal period. However, few women in England currently experience this type of continuity in midwife care, where they get to know their midwife.

A new report, produced jointly by Green Templeton College and King's College London and published today (Wednesday 13 April 2016), provides a comprehensive review of the current evidence of the benefits to women, their families and the National Health Service, of continuity of midwife care.

Entitled Relationships: the pathway to safe, high-quality maternity care, the report draws together the most recent evidence supporting continuity of midwife care and contains wide-ranging testimony from mothers, midwives, doctors and NHS managers about effective models of midwife care. It follows the publication in February of the National Maternity Review which highlighted seven key priorities to ensure women and their babies receive excellent care, including continuity of carer.

The report comes out of a symposium held at Green Templeton in October 2015, which was curated by Professor Lesley Page, President of the Royal College of Midwives. The symposium was hosted by Green Templeton under the auspices of the Sheila Kitzinger Programme, which aims to build on the work and broad interests of the renowned social anthropologist and the concerns that she championed.

Professor Page explains: "The symposium brought together health service leaders, academics and patient groups to help understand how the NHS might implement, scale up and sustain continuity in maternity care, and ensure that more women in the UK have access to this type of care."

The report highlights the medical and health benefits for women of receiving continuity of care from a midwife they know, rather than receiving medical-led or shared care.

These women are:

- 24 per cent less likely to experience preterm birth,
- 19 per cent less likely to lose their baby before 24 weeks' gestation, and
- 16 per cent less likely to lose their baby at any gestation.

Women are also more satisfied with the information and advice they receive, the place where they give birth, their preparation for labour, their choice of pain relief, and their overall birth experience.

This is true for women at both low and high risk of medical and obstetric complications, and those with complex social problems, socio-economic deprivation and those from black and minority ethnic backgrounds. These groups are at higher risk of maternal and infant death as a result of pregnancy and birth and who often experience failures in care.

The report also suggests that although there are start-up costs associated with introducing a new model of care, the result - shorter hospital stays, and fewer tests and interventions - means that it will cost no more than current services, as well as leading to improved job satisfaction for midwives.

Drawing on examples from across the UK, the report describes different models of continuity of care, which can be based around a geographical area or aimed at women with medical complications, and which can be community-based - for example, at a GP practice - or in a hospital.

Most contain around six midwives in self-managing practices, with each midwife supporting 28-40 women per year.

One of the report's authors, Jane Sandall, Professor of Social Science and Women's Health at King's College London, and lead for the maternity theme at NIHR CLAHRC South London, says: "The most important thing for continuity models to be a success is to control the caseload of midwives and to give them the autonomy to manage their working hours."

The report also highlights challenges, including differences of working cultures when midwives working in a continuity of care model work alongside multidisciplinary teams based in hospitals.

Louise Locock, Research Fellow and co-convener of the Sheila Kitzinger Programme at Green Templeton College, added: "This report of the first Sheila Kitzinger symposium makes an important contribution to the debate about continuity models in maternity care. We are grateful to all the participants who joined us at the College for a truly stimulating discussion last autumn: given Sheila's commitment to improving the quality of women's birth experience, the symposium seemed a particularly apt event to launch the Sheila Kitzinger Programme at Green Templeton."

  Read the full report here.  

Read about the Sheila Kitzinger Programme here.