Midwifery care has long been recognised as a necessary and important part of most women’s birthing process, but often the mother can be faced with limited options and choice – We spoke to the experts at Private Midwives about how there are more options available for them and the importance of continuity of care when getting the most out of your midwife.
Models of midwifery care
In the UK, there are varying models of midwifery care depending on where you live and if you have any ongoing medical needs. In most cases, you will be offered ‘traditional midwifery care’ which means that you have about six, brief appointments with a midwife before birth; these will normally be scheduled appointments at a set time at a local clinic. Often, you won’t be able to see the same person each time, so it’s important to keep a record of what you’ve already discussed to ensure you're getting the most out of your midwife. When you go into labour, a different midwife cares for you and this person may change during your labour as midwives work in shift patterns, so make sure you have somebody reliable with you, such as a partner or parent, through the process.
Some women are fortunate to be offered care within a case-loading model. This means that a midwife is allocated to you and you see the same person all the time, before, during, and after the baby is born. There are still about six appointments in a clinic at set times, but it’s important to know your midwife, and getting the same person with you throughout will go a long way when getting the most out of your midwife.
Some women choose a private midwife. This gives them all the benefits of a case-loading model, but also, visits before and after the baby has been born are more frequent, longer duration and normally in your own home. All care is tailor made around you. This is an elite model, and the benefits will give you a physical and emotional foundation for a happy transition into parenthood.
What is continuity of carer?
Many women say that they had conflicting advice during their pregnancy. This is confusing and can be stressful for them. Sometimes, women are given consistent advice but by different people. This is usually described as ‘continuity of care’ because all members of the team caring for you make the same recommendations, providing a better-rounded service. The third option, which is generally offered from private midwifery, provides you with a single person who you have built a relationship with, who knows about you and your family and could tailor that advice accordingly. This is called ‘continuity of carer’ or 'relationship continuity' and it has many proven benefits in ensuring you're getting the most out of your midwife.
Why is relationship continuity important?
Sadly, there is enormous variation in care provision, and we know from surveys that women are not always listened to. In the last UK national survey, almost a quarter said that when they contacted their midwife, they did not get the help they needed, about seventy-five percent were cared for during labour by a midwife they had never met before. During labour and birth, twenty-seven percent of women said they did not have confidence in the person caring for them, and twenty-two percent were unhappy as they were left alone during labour or soon after birth.
There has been a lot of research published to show the benefits of relationship continuity. One of the largest included thirteen clinical trials and sixteen thousand women. Women who had relationship continuity from a midwife had fewer epidurals, instrumental or assisted births and episiotomies. These women were more likely to have a healthy birth and needed less pain relief. Clinical outcomes for the baby were also better with fewer babies born before 24 weeks gestation and improved breastfeeding rates.
Another very recent study included two thousand women who looked into women’s satisfaction. The women who were cared for in a case-loading model with relationship continuity, reported much higher levels of satisfaction before, during and after birth. Typically, the factors that influence satisfaction are advice, information, explanation, preparation, choice, control and the behaviour of the person caring for you.
How can the benefits be explained?
During labour and birth, it is essential to keep the stress hormones at bay and allow the natural hormones associated with birth to flourish. One of the most important is a hormone called Oxytocin. It plays a vital role in ensuring labour and birth progress smoothly. We know that feeling out of control, uninformed, not listened to, fear, stress and anxiety can all stop the flow of Oxytocin. This can intensify pain, disrupt the labour and birth process and lead to a cascade of interventions. These interventions, in turn, may result in further loss of control, stress, fear and anxiety. The vision of a relaxed and positive birth experience drifts further and further out of reach.
Relationship continuity involves the development of a meaningful relationship between you and your midwife. Different women need different things at different times, and sometimes they need the information presented to them in a variety of ways. Getting the most out of your midwife with frequent, meaningful and unhurried appointments enables this process.
Being cared for by a midwife who you know, trust and have confidence in, can empower you to take control. You are given all of the information in a meaningful way to enable you to make choices that are best suited to you as an individual person. You have time to explore these options. You feel confident. You feel prepared. When labour commences, you are relaxed and in control. You are never left alone and always have your very own midwife by your side throughout. In this environment, it is more likely that Oxytocin flows freely, labour progresses smoothly, and a calm and confident birth experience follows. This forms the foundation for a happy and healthy transition into parenthood, giving you and your baby the best possible start.
Private Midwives offer private midwifery services in the UK, Ireland and channel islands, priding themselves on delivering high quality, safe and effective care; tailor made to your individual needs and circumstances.
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