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What is ‘Caseloading’?

During my first year at university, students were encouraged to get together a small number of women from our community placement, of whom we could ‘caseload’. This could be between 3 to 5 women (along with their families), where we would attend most, if not all, of their antenatal appointments, be on call for and attend the birth where possible and be present at the postnatal visits too.

This way of working aims to promote the ‘Continuity of Carer’ model outlined by the National Maternity Review / Better Births document, meaning women should be under the care of a named midwife (who might be part of a community team of 4 to 6 midwives). This midwife then has the opportunity to get to know the woman and her family, therefore continuing the care through the pregnancy, birth and the postnatal period.

While this model is taking time to be implemented in National Trusts, student midwives are beginning to roll out this practice and are starting to care for women on a more continual basis. This being said, I can’t be certain that all universities are incorporating this in the 3-year course – so don’t hold me to it!

Why are we promoting ‘continuity of carer’?

It would be normal for you to think ‘but that is a lot of work for us, right?’. And this is true for an already very demanding course. You might have to miss the occasional lecture, get up in the middle of the night and devote a lot of your spare time to placement. BUT, the benefits of providing continuity are actually amazing, and not just for the women.

  • Women in this model of care were nearly 8 times as likely to have a known midwife attend the birth
  • Women report more satisfaction with their care in terms of how well they were given information and advice, how well they were prepared for the birth, their choice of pain relief and the control they had over their birth
  • Women experience more empathetic care
  • Complications are identified easier
  • Statistically, clinical outcomes such as the need for analgesia, episiotomy and experiencing pre-term labour were significantly less for women in the continuity model (found in a Cochrane review of 17,674 women)

And as for the students…

  • They feel more prepared in their role as an autonomous practitioner
  • Skills such as decision-making are more easily acquired
  • Students describe it as a positive learning experience which is completely satisfying (something I definitely agree with!)

The only downside to caseloading is that students often feel disheartened if they missed the birth (as you can imagine, this can happen very easily!) and that they experienced feelings of letting the woman down. I can account for this as out of my 5 caseloading women, I missed one birth. I did manage to go and congratulate them in the hospital afterwards though!

My experience of a successful caseload

After having gained permission from the family, I’d like to talk about an experience which I will remember forever.

As soon as we were given the ‘go-ahead’ from the uni, I couldn’t wait to start caring for women continually. I had attended a few of this woman’s antenatal appointments already and when I informed her about caseloading, we mutually agreed that it could be something really brilliant and we decided to give it a go! Little did I know that she would start labouring two days later…

I was called about 2am (yes, 2am. Babies come whenever they want to!), asking whether I wanted to come into hospital and help this lady through her labour and birth. Of course I was going to say yes! The midwife gave me a small handover and welcomed me into their birthing room. A calm, hypnobirthing environment had been created and I was inspired at how the mother and father of the baby worked together through the contractions! They had such a partnership that neither the midwife or I needed to do very much (except listen to the baby’s heart rate and some other more clinical bits).

Immediately I could feel the benefits of continuity, as I was able to ask about their first child and I already knew her birth wishes from our antenatal chats. She mobilised wonderfully and soon enough she recognised the urges to guide her baby into the world.

I was in the room with the family for a few hours before a beautiful baby girl was born. We encouraged skin-to-skin and the first breastfeed before leaving them to welcome their new addition in what is known as ‘the golden hour’. Later we examined the baby and I just felt such honour to have been present at this birth.

Luckily enough I was on a community placement at the time so I could go to all of the postnatal visits too!

I am beyond grateful to this family for involving me in their pregnancy and birth, and I’m even more thankful that they wanted me to share their story with you. It is definitely an experience I will hold close to my heart, purely because of the relationship we formed across all of those appointments and visits. I can only hope that they felt the benefits of continuity too, because to me, it is something so rewarding and delightful which should be experienced by as many people as possible.

Reading to recommend

I’ll pop a list of documents about continuity and caseloading below, should you want to know any more information!

Better Births website:

http://betterbirths.rcm.org.uk

Royal College of Midwives article:

https://www.rcm.org.uk/news-views-and-analysis/news/‘caseloading-means-less-intervention

Implementing Better Births:

https://www.england.nhs.uk/wp-content/uploads/2017/12/implementing-better-births.pdf

Experiences of student midwives:

https://www.midwiferyjournal.com/article/S0266-6138(10)00118-X/abstract

NICE Guidance:

https://www.nice.org.uk/guidance/cg138/chapter/1-Guidance#continuity-of-care-and-relationships.

Report by Jane Sandall on improving maternity care:

https://www.rcm.org.uk/sites/default/files/Continuity%20of%20Care%20A5%20Web.pdf.

 

Imogen x