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Can continuity bring birth back to women and normality back to midwives?

02 October 2018
17 min read
Volume 26 · Issue 10


Continuity of midwifery care, and caseload care in particular, is associated with a vast and varied array of improved outcomes for mothers and their families, including reduced intervention, reduced need for analgesia in labour, reduced preterm birth, and improved satisfaction with the birth experience. Caseload models of care may also increase midwives' satisfaction with their role and, contrary to what is often thought, may result in an improved work-life balance, and reduced burnout when compared to models of standard care. This article discusses how caseload midwifery might result in both women and midwives becoming more empowered and autonomous, and may facilitate a redirection of midwifery philosophy back to promoting and protecting normal birth.

There has been much research in recent years into midwifery-led models of maternity care, and this has produced considerable evidence that it can significantly improve outcomes for mothers and their babies. Continuity of care has been shown to reduce obstetric intervention, which interferes with physiological birth; reduce women's need for pain relief by improving her confidence and ability to deal with normal labour pain; and through both of these factors has been shown to improve outcomes, reduce physical and psychological morbidity, and improve satisfaction with birth (McLachlan et al, 2015; Rayment-Jones et al, 2015; Wong et al, 2015; Sandall et al, 2016; Homer et al, 2017) (Figure 1). In addition, despite concerns around increasing hours and reduced work-life balance, continuity of care models can provide midwives with a sense of fulfilment with their role, and greater autonomy and flexibility, thereby providing a better work-life balance, and protecting against psychological stress and burnout (Dahlen and Caplice, 2014; Dawson et al, 2018; Fenwick et al, 2018).

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