Better Births: early findings from North-West London
To measure changes from implementing a continuity of carer approach, in terms complicated or uncomplicated births.
In North-West London in 2017-2018, funding was allocated to establish an early adopters' programme across six maternity units. The implementation of this programme and the outcomes in terms of birth complications and women's feedback are described.
Although most changes were not statistically significant, positive maternal views, and some changes in the use of diet control or insulin for women with gestational diabetes, were found.
The evaluation was limited by missing data, and in future, maternity outcomes should be extracted routinely from women's records without requiring manual data entry by midwives.
The national maternity review in England, Better Births, recommends that all women should have a named midwife to care for them through pregnancy, birth and the postpartum period, in order to provide safe, joined up services (National Maternity Review, 2016). This transformative work has an established evidence base, and has reduced regional anaesthesia, instrumental or caesarean birth, pregnancy loss and preterm birth. It has also provided women with the reassurance of having continuity of a midwife or midwifery team (Sandall et al, 2016).
The purpose of this evaluation was to measure changes that arose from implementing a continuity of carer approach, in terms of a complicated or uncomplicated birth. The original outcomes defined by the North-West London team included:
Other outcomes were:
Secondary outcomes included the place of delivery. This article concentrates only on changes to complicated births (ie caesarean or instrumental versus spontaneous vaginal birth), as the focus was on potential cost savings using the 2017-18 NHS tariff. A more detailed evaluation was carried out by Imperial College Health Partners, which looked at all the primary and secondary outcomes described; here the focus is only on outcomes affecting the complicated or uncomplicated tariff.
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