Continuity of carer – what does it mean and does it matter to midwives and birthing women?

This paper discusses key themes from a large-scale, long-term multi-perspective evaluation of caseload midwifery practice in the United Kingdom (UK). Caseload practice was introduced in several UK settings, on a pilot scale, following the publication of Changing Childbirth intended to put into practice its core principles of continuity, choice and control for women. A range of new midwifery practices were piloted and evaluated across the UK. Relatively little attention was given to defining and exploring the nature and meanings of the new models of practice, or to midwives in this new practice context. This has led to difficulty in comparing the impact of different models of practice. We draw on two aspects of our work – an ethnographic study of the experiences of midwives (with and without caseloads) and a study of the women's experiences and responses to care – to explore in greater depth the concepts involved in the caseload model and their meaning for women and for midwives in practice. Interviews were conducted with 40 women and 36 caseload midwives. Other forms of data collection, including questionnaires and observation were used and were analysed thematically using grounded theory principles. Themes emerging included autonomy, confidence, reciprocity and relationship: the idea of knowing and being known. On this basis we have argued that continuity is not an end in itself but an important means towards the end of women-centred care and should be considered in relation to other key themes such as autonomy and environment