“There is compelling evidence that ongoing supportive relationships between women and their maternity care provider improves health outcomes for women and babies, and women’s experience of care.”
(Sheila Kitzinger Symposium, 2015)
The Templeton report is based on the work carried out at the Sheila Kitzinger Symposium on relational continuity of care in maternity. The purpose of the Sheila Kitzinger Symposium, held at Green Templeton College in 2015, was to explore relational continuity within maternity services in the UK. The symposium comprised health professionals, leaders, service user representatives and academics. Using current research and examples from the UK, the report emphasises the benefits and potential barriers with recommendations for future research.
No. of pages: 39
A few of the key areas in the report are highlighted below.
Continuity of Care Models
Relational continuity refers to a supportive relationship between a woman and her maternity care provider. Aspects of this include:
· Providing relational continuity through a case loading or small team model
· Models can be community or hospital based
· Provision of care can include low and high risk women.
The main emphasis is that a woman’s care is provided by a single midwife who sees her consistently during pregnancy and is her main point of contact. The midwife should be supported by the wider multi disciplinary team.
Benefits to women and babies include improved health outcomes and increased satisfaction with care. More limited research has shown potential benefits to midwives of working within this model. There is some indication that these models are cost neutral although implementation would involve an initial financial outlay.
Barriers include lack of local support, inter-professional tension and midwives not wanting to work within the model due to financial or time management concerns. The report details how to address this through good inter-professional communication and engagement and addressing midwives fears regarding working within these models
Implementation and Scale up
A clear implementation strategy necessitates regional and system wide leadership. Monitoring and evaluation is required, with incentives and flexibility offered to those working in the model. An initial small scale implementation can provide proof of concept leading to scale up of the service that should be sustainable and acceptable to providers.
The report identified:
· Need for systematic reviews of range of interventions and outcomes
· Cost-effectiveness studies
· Research on how to implement and scale up services
· Research into staff experience of working in continuity models.
Vlora Hindley, the team leader for the Best Beginnings service based in Greenwich and Lewisham Trust. They specialise in supporting women who suffer from mental health problems, providing one to one care for the continuum of carer. This team has one team leader and seven midwives and work at home and in community centres as well as other similar settings in the borough. The team started working within the Local Authority in 2006 and it was included as part of the mainstream maternity services provided by the NHS Trust.
In this video, Vlora describes the way the team works, how they identify women in vulnerable situations and the support they can provide to improve health and social outcomes. The Best Beginnings Team works with all the other relevant services including specialist mental health teams (including the Time Team), GPs, women’s refuge and other organisations supporting women experiencing domestic violence. The service wraps around the requirements of the women and their families.
The toolkit outlines the rationale for increasing access, auditable standards, key factors for implementation and sustainability. There are also four case studies for caseloading and team midwifery taking place in London with an outline of the service, the model of care and key messages for success:
1. Guy’s and St Thomas’ NHS Foundation Trust on continuity of care models for pregnant women with medical and psychological conditions
Providing women with continuity of care from a small team of midwives has ensured high risk women have a multidisciplinary care plan. This improves access to specialist care whilst promoting normal birth, preventing unnecessary appointments, readmissions and the likelihood of pre-term birth.
2. Imperial College Healthcare NHS Trust on achieving antenatal and postnatal continuity
Within one year 82 per cent of women’s antenatal and postnatal appointments were with the named midwife or buddy within the specified teams.
3. King’s College Hospital NHS Foundation Trust on case loading midwifery care
Achieving 18 per cent caesarean section rate, 30 per cent homebirth rate and 88 per cent exclusive breastfeeding at six weeks.
4. Royal Free London NHS Foundation Trust on antenatal and postnatal continuity for complex women
Improving outcomes for complex women – increasing birth weight, reducing neonatal complications and improving women’s engagement with services.
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