Cystic fibrosis and caseload midwifery
Midwives must provide woman-centred, holistic care for the diverse UK childbearing population. As the NHS moves to adopt the recommendations made in the ‘Better Births’ report, is there an argument to invest in protected caseload midwifery contacts for women with cystic fibrosis? Caseload midwifery refers to a continuity model where a small team of midwives provide care throughout the antenatal, intrapartum and postnatal continuum. Cystic fibrosis affects multiple organ systems and requires specialist medical management during pregnancy. Living with cystic fibrosis has many psychosocial implications and pregnancy presents additional challenges. Health and wellbeing outcomes are improved when individuals are treated holistically in the non-pregnant population; therefore, during pregnancy, birth and postnatally, caseload midwifery may provide a legitimate intervention to improve health outcomes in pregnant women with cystic fibrosis.
Historically, midwives have been considered experts in normality, acting as the primary carers for clients experiencing uncomplicated pregnancy and birth (Royal College of Midwives, 2005). As a result of changes in public health, advancements in modern medicine, increased recognition of risk factors and the growing medicalisation of birth, the UK childbearing population are presenting to maternity services with a rising incidence of medical and social complexities (Smith and Dixon, 2008). Accordingly, the knowledge base and skills required for health professionals to provide safe, holistic midwifery care to the diverse UK childbearing population is growing (Smith and Dixon, 2008).
The traditional definition of midwives as experts in normality could now be considered too narrow, and modern midwifery can be defined as working in partnership with women to optimise physiological mechanisms of childbirth, while prioritising safe and holistic care and promoting cultural experiences of childbearing (International Confederation of Midwives, 2017). Seemingly, modern midwives must exist in both the medical and social models of care, but stay true to the woman-centred principles of midwifery. Caseload midwifery refers to a small team continuity model where 4–6 midwives, known to the woman and family, provide care throughout the antenatal, intrapartum and postnatal continuum (Cumberlege, 2016). With NHS care moving towards small team, caseload midwifery, what will the growing population of women with very complex pregnancies experience? Arguably, all women benefit from midwifery care, regardless of risk status (World Health Organization, 2019).
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