One of the most important decisions to be made about birth is choice of caregiver. The key to making the right choice is having a dedicated midwife who has trusts that your body knows how to labour. After recently giving birth to my first child, naturally at home, I can honestly confirm that the impact of caregivers on the atmosphere in the birthing room is enormous. My midwives gave me strength and confidence to face the birth. I wondered if I could do it without running to the hospital for an epidural. Afterward, I felt empowered, connected, supported and cared for by my midwives. For me it was worlds apart from having a midwife who is there just to attend and it was the primary reason my partner and I chose the UK Birth Centres as our maternity provider.
The UK Birth Centres have risen to the challenge of providing women-centred care and implemented caseloading as a way of organising maternity care provision. The underpinning philosophy of caseloading encompasses the principles of holistic care, normality and continuous attendance during antenatal, intrapartum and postnatal periods (Sandall et al, 2013). Furthermore, subsequent publications including Maternity Matters (Department of Health (DH), 2007) and Midwifery 2020 (DH, 2010) emphasised the greater relationship of continuity between the mother and the midwife in a caseloading model.
One mother said: ‘This is midwifery as it should be practised. Individualised care from start to finish from a midwife with vast experience and total commitment to women and their babies’.
Additionally, recent developments in the field of midwifery-led models have shown that caseloading offers many advantages to women in comparison with traditional models of care (Sandall et al, 2013). For example, greater continuity has been advocated as a contribution to safety and quality of care (Nutting et al, 2003). Further evidence in support of caseloading model comes from the UK Birth Centres.
Linda Bryceland, Head of Midwifery, Associate Director—Midwifery, Quality and Safety said: ‘100% of mums are satisfied with care based on anonymous feedback questionnaire, we link in with NHS England and have had no adverse clinical incidents or formal complaints in the last year. Many of our mums are repeat clients or come to us via a friend's recommendation. Over 85% of our clients breastfeed and over 90% of those are still breastfeeding at 6 weeks. Also, we are the only fully insured, national provider outside of the NHS.’
Paulina with baby Luis
In spite of the evidence that caseload midwifery leads to an increase in maternal satisfaction and a more positive experience of childbirth (Sandall et al, 2013), the model has not been adopted nationwide and abroad. From the evidence discussed it would seem that increasing the number of women who have access to caseloading midwifery will improve the quality of care they receive. Therefore, it could be argued that women should have that option. This would be no small feat, however, since it would involve service reconfiguration in the majority of countries in the world.
A powerful birth experience changes us so that we relate differently to the world. Right now as I'm sitting here, it's impacting on my life. Easy, magnificent births happen when women and midwives acknowledge what a rite of passage the birth process is. As caregivers, we can let birth become very routine, so it's important to stop and remember that this is an enormous event taking place (Sheldon, 2010) and one that will stay with a woman forever.