This information has been provided by Michelle Harrison, midwife working at King’s College Hospital NHS Trust and is a personal account of caseloading as it works today in an NHS trust.

I have been a qualified midwife for 20 years and for approximately 16 of those years I have worked as a caseload midwife . I consider myself a versatile, renaissance midwife, having the ability to be all things to women at all times, building a relationship that helps guide them through pregnancy, labour and the postnatal transition into parenthood, sometimes more than once. This versatility is an important aspect of the job for me and reflects the vision of midwifery that I had at the very beginning.

Michelle Harrison with grandchild born in 2017 (published with permission)

Caseloading provides a very different perspective compared to that experienced when working within the in-patient services alone. I have worked in this way too, but for me, the way midwifery feels as a caseload midwife is just more “whole”, providing much of the care at home and within the woman’s community and following them wherever they chose to have their baby.

In my experience the level of commitment that caseloading requires ensures that women get the best from their midwife and the midwife gets a real sense of job satisfaction. This satisfaction is not just experienced on a professional level but on a personal one too. It is this commitment and passion that I have always intuitively believed enables the provision of a “gold standard” care, producing best possible outcomes. Caseloading allows the midwife to work autonomously, encourages “thinking outside the box” care planning and multi professional working. I have a real sense of pride as a caseload midwife, achieving great outcomes for women but also fulfilling a need within myself to always do my best for those under my care.

None of this is possible without help. Developing a caseload team has many challenges and, taking on my current role as a team leader, I had many concerns. A team including junior midwives as well as some with a little more experience required careful planning. Making sure support was always available as the team became established, delegating tasks as experience grew, building team confidence and ensuring good lines of communication with our inpatient colleagues was important ground work that needed to be done. I put a lot of myself into the team, leading by example even when others felt challenged by my philosophy. Over time the team has become well established, self-sufficient, supportive and a place that students eagerly seek out to gain valuable insight into holistic midwifery. I am always conscious of my physical and mental limitations – this is an important aspect of maintaining resilience and avoiding burn out. Knowing that sleep is sometimes the most important thing you can do at the end of a day is a vital survival mechanism. Recognising that you can’t be present at all your deliveries means you have to have faith in your colleagues to provide a high standard of care and caring in your absence.

Many people ask about how this way of working impacts on my family life. It’s a good question. I have a very supportive husband and he and my children adapted to my coming and going at odd times. It is sometimes hard to leave them or to miss family events in order to care for others and their families, but they understand how important this is to me and those families. They know that if I am happy in my work then I am happier overall, if not a little tired at times! Plus when called out, it is always for women that I know and have invested 9 months of care in. It helps soften the call.

Caseloading can be a challenging choice but I would not practice in any other way. It is tough at times but also joyful. Am I a “lifer”? Maybe. For me caseloading epitomises what it means for me to be “with woman”, what it has always meant for me to be a midwife.



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