The ‘Know Your Midwife’ scheme—a randomised trial of continuity of care by a team of midwives

doi:10.1016/S0266-6138(89)80059-2

Midwifery

Volume 5, Issue 1, March 1989, Pages 11-16

https://doi.org/10.1016/S0266-6138(89)80059-2 Get rights and content

A team of four midwives provided the majority of care during pregnancy, labour and the puerperium to 503 women at low obstetric risk, over a 2-year period. Compared with standard hospital care randomly allocated to 498 women this ‘Know Your Midwife’ scheme was associated with greater continuity in all phases of maternity care. The scheme appeared very acceptable to women: they spent less time in the antenatal clinic, and overall, felt more satisfied, better prepared and better able to discuss problems. The scheme was characterised by less obstetric intervention particularly in respect of augmentation of labour and intrapartum analgesia; labours tended to be longer. Neonatal outcome was generally similar in the two groups but the size of the trial did not allow a precise assessment of differential effects in these terms. The ‘Know Your Midwife’ scheme is feasible. It should now be introduced more widely but in a way which allows continuing evaluation.

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There is a paucity of research on experiences and views of women at higher risk of preterm birth of midwifery continuity of care.
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Face-to-face, semi-structured interviews with 16 women identified as at increased risk of preterm birth and experienced continuity of midwifery care across pregnancy, birth and the postnatal period. Care had been provided by the pilot intervention group for the pilot study of midwifery practice in preterm birth including women’s experiences (POPPIE) trial.
Women valued continuity of midwifery care across the care pathway and described the reassurance provided by having 24 h a day, seven days a week access to known midwives. Consistency of care, advocacy and accessibility to the team were described as the main factors contributing to their feelings of safety and control.
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Midwifery is based on the philosophy of woman-centred care. The continuity of care experience in pre-registration education programs exemplifies this philosophy. Wide variation in how education providers implement ‘Continuity of Care Experiences’ into their programs of study can challenge this valuable learning opportunity.
To provide a comprehensive analysis of the governance and empirical evidence of knowledge, practice and enablers to support continuity of care experiences within pre-registration midwifery education.
A scoping review of research, policy and professional documents pertaining to the continuity of care experience in pre-registration education programs was conducted with 46 articles meeting the inclusion criteria.
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In countries where the predominant model of maternity care is fragmented and not woman-centred, further research is required to understand the pedagogical intent of the continuity of care experience.
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Citation Excerpt :
In most cases, a known midwife takes care of a woman in pregnancy, during birth and the postnatal period, and sometimes with help from a co-midwife who is known to the woman. Depending on the organization of care, caseload midwives could work within the organization or be self-employed with visiting rights to a hospital [6,7]. In all studies about caseload midwifery the midwives are self-selected into this work form which makes it difficult to find cause-relation.
Continuity models of midwifery care are rare in Sweden, despite its well-known positive effects. The aim was to describe pregnancy and birth outcome in women participating in a continuity of care project in a rural area of Sweden.
A register-based study of 266 women recruited to the project and a control group of 125 women from the same catchment area. Midwives provided antenatal care and were on-call 7 a.m. to 11 p.m. for birth. Data were collected from the antenatal and birth records. Crude and adjusted odds ratios with 95% confidence intervals were calculated between women in the project and the control group.
There were more primiparous women and highly educated women recruited to the project, and fewer foreign-born and single women, compared to the control group. Women in the project met more midwives and were less likely to have a pregnancy complication. During intrapartum care, women recruited to the project were less likely to need labour augmentation and less likely to have an instrumental vaginal birth and elective caesarean section. They had fewer second degree perineal tears and were more likely to fully breastfeed at discharge. No differences were found in neonatal outcome. The continuity of a known midwife at birth was quite low.
This study shows that women self-recruited to a continuity of care project in a rural area of Sweden had a higher rate of normal births. There were few differences if having a known midwife or not. Long distances to hospital and lack of staff affected the level of continuity.
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Working out what works: The case of midwife led care - Commentary on: Is model of care associated with infant birth outcomes among vulnerable women? A scoping review of midwifery-led versus physician-led care
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Twenty-five years since the Shearman Report: How far have we come? Are we there yet?
2016, Women and Birth
In 1989, the first major state-wide report into maternity services, known as the Shearman Report after its author, was released in New South Wales, the most populous state in Australia.
This paper reflects upon the report and tracks the progress of five of its key recommendations. The recommendations are still some of the major issues facing maternity services across the country. These are: community-based maternity care, rural maternity services, hospital visiting rights for privately practising midwives, obstetric intervention, and midwifery continuity of maternity care.
In some ways, much has changed in 25 years including the terminology used in the report, the importance of midwifery continuity of care and the woman-centred nature of many services. However, in other ways, there is still a long way to go to address these major issues. Despite more than a quarter of a century, many recommendations have not been fulfilled, especially access to care in rural areas, rates of obstetric intervention, and the issue of visiting rights for privately practising midwives which has gone backwards.
A continued and renewed effort is needed to ensure that the forward thinking recommendations of the Shearman Report are ultimately realised for all women and their families.

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The ‘Know Your Midwife’ scheme—a randomised trial of continuity of care by a team of midwives

Controlled Clinical Trials

American Journal Obstetrics Gynecology

The vision—proposals for the future of the maternity services

The Know Your Midwife Scheme

Midwife, Health Visitor and Community Nurse

Maternity care in action: Part 1—antenatal care