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Continuity of CARER


Talking to a group of women recently about their antenatal classes, one of them commented rather wistfully that while she had enjoyed the sessions and was very grateful that even women not expecting their first babies were invited to attend the five weeks’ course, she would have liked to have had the same facilitator throughout. She spoke about the inevitable overlap between sessions when a new facilitator came in and attempted to dovetail the topics she covered with those covered by previous facilitators. The woman also said that the time taken by the facilitator to get to know the parents by asking them for information that they had already shared, could have been better spent helping the parents get to know each other.

Interestingly, when I attended a workshop on the recently published review of the maternity service (see ‘Better Births’: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf) the Chair spoke about the importance of ‘continuity of carer’ - of ensuring that women and their families are cared for by the same midwife or doctor throughout the maternity care ‘episode’ or, at the very least, a small group of midwives.

The interviews carried out to inform the ‘Better Births’ review had revealed that women were fed up of having to ‘tell their story’ to a series of health care professionals. This was especially distressing for women who had suffered a previous tragedy such as a stillbirth or neonatal death and whose distress was constantly resurrected as they tried to engage with and enjoy their new pregnancy.

One speaker after another emphasised the importance of continuity of carer. For those of us in the audience old enough to remember ’Changing Childbirth’ in 1993, this seemed like an echo from the past – although the echo was not quite true. Changing Childbirth had emphasised continuity of ‘care’ – a concept that didn’t catch on because nobody was ever able to satisfactorily explain what ‘continuity of care’ actually looked like.

Everybody in maternity care, the very early years and transition to parenthood education is currently talking about relationships: the relationship between the mother and her baby; between the father and his baby; between the mother and father, but perhaps not enough about the relationship between the mother/father/baby and those caring for them. Just as we recognise that there is a small number of relationships that are key in the lives of mothers and fathers becoming parents, so we need to understand that parents need a small number of reliable, consistent relationships with carers. This continuity enables trust to be built up so that parents can be honest with midwives, health visitors and educators, and professionals can avoid giving blanket advice rather than embedding it in the context of families’ real lives.

And building a relationship with new parents means that professionals are able to avoid applying stereotypes based on characteristics other than women’s and men’s unique individuality.

Speakers at the maternity review conference spoke repeatedly of the challenge of providing continuity of carer and one or two slipped into talking about ‘continuity of care’ as we did 23 years ago. Personalising services through ensuring ‘continuity of carer’ is challenging, but as Baroness Cumberlege said, we have no choice but to get on with it because without it, choice and control for women and their families are inevitably and seriously limited

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