The Senior Midwifery Practitioner and Team Leader for Caseloading at University Hospitals Southampton Foundation Trust answered some of our about how Sure Start Central, their caseloading team, works as they provide midwifery continuity of carer.

What area is covered?
Central Southampton

How does the team work? 
7 midwives work an on-call system with 314 women which does not include women who move into or transfer out of area.

Is the work across care settings, e.g. covering routine hospital care etc.?
Yes.  Community (children’s centre and women’s homes), home births, hospital births (labour ward and low-risk birth environments).

Do midwives in the team have to contribute to other services (e.g. labour ward)?
Yes, but only as part of a contingency plan for peaks in service demand.

Is there an emphasis on ensuring that midwife is present at the time of birth?
Yes, this is key.  However, our team is not caseloading for a period of 24/7 for an individual, they are covering this as a team.  We therefore rotate the on-calls so it may not always be the lead midwife for the individual at the birth. We try to meet each other’s women antenatally by utilising parentcraft sessions for example, which helps with knowing your midwife and we introduce each other to women whilst in the children’s centre.

How long midwives stay working in this team/group (turnover)?
The longest is 10 years, another is 7 years, the average is 3-4 years.

Any thoughts or comments about the set-up and structure of the team/group?
It is very effective and works well when fully staffed (8 for central Southampton).  It is a way of working that enables midwives to experience all areas of midwifery practice and to work as true autonomous practitioners whilst working cohesively with the multi-disciplinary team.

What happens for intrapartum care for the women in the care of this group/women depending on home, birth centre or obstetric unit births?
They will be looked after by the team.  They have all midwives phone numbers and should aim to contact team directly 24/7 for labour.  We always aim to assess women at home where appropriate and we believe that giving women the confidence to stay at home contributes to a higher normal birth rate.  We then accompany them to the chosen/appropriate birthing environment.

Are there measurements on how many midwives a woman would see or any particular areas that are monitored?
The aim is to see no more than 2 different midwives antenatally.  Postnatally this would be one maternity support worker and one midwife.

What are your thoughts and comments about providing women care through the same small group of midwives in your Trust/Health Board?
I personally feel that this is one of the best ways to provide care to women.  I have personally worked as a caseload midwife for some women now (for 5 different pregnancies).  I get to know them and their families really well and I know that women do appreciate continuity of caregiver.



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