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Continuity of carer and application of the Code: how student midwives can be agents of change

02 August 2017
11 min read
Volume 25 · Issue 8


Despite continuity of carer being signalled in policy in 1993 (Department of Health, 1993), it remains a largely elusive aspiration in the UK. This has implications for midwives with regards to how well they can apply the Nursing and Midwifery Council (NMC) Code (NMC, 2015) and their navigation of some of its inherent tensions. From the perspective of a new student midwife, this article discusses the advantages of caseloading in applying the Code and suggests ways in which student midwives might draw from the caseload model, bringing some of its strengths into mainstream practice.

It is clear from the literature that there can be many significant advantages to caseload midwifery in terms of health outcomes for women and their babies. These advantages include reduced incidence of episiotomies (Benjamin et al, 2001), reduced rates of caesarean section (Hartz et al, 2012), fewer neonatal unit admissions (Rayment-Jones et al, 2015) and higher breastfeeding rates (Huber and Sandall, 2009; Homer et al, 2017). These advantages have the potential to positively affect women, babies and families throughout their life (McAra-Couper et al, 2014).

In Scotland, while there have been improvements in continuity of carer in antenatal services, there are still significant issues in postnatal provision and the elusive known care giver at birth is arguably further away than it was when promoted in Changing Childbirth (Department of Health, 1993); the rising number of planned caesarean sections, continued high percentage of hospital births (Cheyne et al, 2015) and the dominant care model all being barriers to continuity of carer. This has led to a focus on continuity of carer in the recently published 5 year plan for maternity services in Scotland (Scottish Government, 2017), which points to caseloading and a reconfiguration of the existing midwifery and obstetric workforce as a route to this.

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