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Support from day one – can continuity of care in pregnancy make a difference?

Posted on 24 April 2018

“Continuity of care could potentially save 700 babies’ lives a year,” said Jeremy Hunt MP as he announced plans in March to provide mothers in England with the reassurance of seeing the same NHS midwife through pregnancy and labour.

The new plans will mean that by 2021 the majority of women will receive care from the same midwives throughout their pregnancy, labour and birth, with targets set at 20% of mothers receiving this type of care by March 2019.

But can continuity of care really save so many lives? And can this new policy work in action?

To accomplish these targets Hunt announced that 3,000 additional midwifery training places will be added over the next four years, with 650 in 2018, and 1,000 a year until 2022.

Additionally, midwives will see their pay increase by at least 6.5% over the next three years.

However, this has only been made possible by the scrapping of bursaries for the course as of 2017.

The impact this type of care could have on mothers and babies is not news. As far back as 1993 the Department of Health reported that what women wanted and needed during pregnancy and labour was choice, continuity and control.

Furthermore, a 2013 review by the Royal College of Midwives (RCM) found that midwife-led continuity was strongly linked to fewer deaths of newborn or unborn babies and far fewer preterm births. Additionally, the NCT’s 2017 research found that for the majority of women, “knowing their midwife allowed them to feel more relaxed, more confident, and safer;” therefore improving their chances of a healthy pregnancy.

While the benefits of continuity of care are clearly evident, are the government’s targets achievable?

Gill Walton, Chief Executive of the RCM welcomed Hunt’s announcement, however she advised that these measures would “not transform maternity services right now,” as these extra midwives would not qualify until 2022.

"The other key issue is ensuring that when these midwives qualify they actually get jobs in the NHS. Trusts are going to need an increase in the money they get so they can employ the new midwives."

Alison Edwards, senior lecturer in midwifery at Birmingham City University added, “It isn’t as simple as recruiting thousands more students as this requires the infrastructure to support it. You need more tutors, more on site resources and perhaps more importantly, more mentors and capacity in placement areas – which currently is under immense strain.

“Not only that, currently numbers of applicants are being put off by lack of funding and we have seen a drop in applicants ever since.”

Figures from UCAS (the university admissions service) show there has been a 35% decrease in applications to midwifery courses than four years ago. In 2013 there were 22,630 applications, versus 14,625 in 2017. This is undoubtedly due to the removal of the bursary.

Added to this, more midwives, particularly younger ones, are leaving the profession than qualifying. In the last five years 7,700 newly-qualified midwives joined the profession. In that same time 8,500 have left – often due to burnout and pay restraints.

The NHS has only been able to increase the number of midwives by recruiting from abroad, but the RCM has estimated that services in England are still 3,500 midwives short.

There is no doubt that a continuity of care model could change the lives of hundreds of women and their babies, however it would seem the government needs to go further in its measures if it wants to achieve this goal.