New resources supporting care handover between midwives and health visitors
By Clare Livingstone, Professional Policy Advisor, RCM & Alison Morton, Executive Director, Institute of Health Visiting on 26 May 2021 Maternity Safety Maternity Services Wellbeing Of Women England NHS NHS Staff
Having demonstrated a significant improvement in outcomes for women and babies, providing continuity of carer along the whole ‘maternity journey’ has become a key tenet of modern midwifery policy. Additional resources are needed to implement the model, as outlined in the RCM’s Midwifery Continuity of Carer (MCoC) Position Statement and we are calling on Government to ringfence sufficient investment to ensure the safety of services.
The principles of continuity, however, are well understood by both midwives and health visitors. The care of women should flow seamlessly through the antenatal, intrapartum and postnatal continuum – with their needs being effectively met by known and trusted professionals, offering appropriate interventions, communication and support throughout. This is why we support and welcome new guidance from Public Health England on care continuity between midwifery and health visiting, published this month.
Taking the analogy of a ‘journey’ for pregnancy and birth for a moment, let’s imagine it’s like boarding a train. You store your luggage away safely, familiarise yourself with your surroundings, greet the passenger sitting next to you and settle into your window seat. We all trust we know where we are going.
Suddenly the train stops. You get off, forgetting a scarf or a hat. When is the right connecting service to your destination? Carrying your luggage through the rush hour crowds, you arrive at a new platform and climb aboard another train. Where is the buffet car? How does the toilet work? These passengers are not so friendly. The guard wants to check your tickets again. Feeling uncomfortable yet? Tired? Anxious?
This is clearly a trivial example to illustrate how mothers and babies may experience disrupted care at the hands of maternity services, but the point is a serious one. Current systems in the UK often leave women at 10 days after the birth needing to leave the maternity train and find their way onto a brand new service.
Women confide in and trust their midwives and health visitors. These professionals hold valuable knowledge about them, which shapes their care and the pathway they take. If a woman begins her pregnancy as a smoker, support will be offered to help her to quit. She may have experienced postnatal depression after her last baby and be receiving cognitive behavioural therapy (CBT) or other support through the ‘Improving access to psychological therapies’ scheme (IAPT) in England or through her GP or mental health teams elsewhere in the UK. She could be living in overcrowded housing, about to be offered alternative accommodation in an unfamiliar area. These needs don’t go away at 10 days after the birth, so we cannot afford to derail any of this woman’s support.
How does this translate into seamless care by midwives and health visitors?
Let’s return to the journey. Wouldn’t it be better to join up these trains, to take women and their babies right the way through, from early pregnancy to when their children reach school age? Imagine if it were possible for the same professionals to be involved with a family’s care and if they are not, that the communication cord runs right down the line. Personal information must be safely held, without having to be unpacked again and again, then nothing gets lost along the way and everyone knows their direction of travel.
The RCM is very keen to see the principles of MCoC further utilised, to bridge the transition women make between midwifery and health visiting, after their baby is born. There are so many opportunities to get this right – midwives providing care out of community hubs, health visitors’ antenatal contacts, digital record keeping, to name but a few. It is a vitally important part of a woman’s maternity journey, so come along and jump on board!
The RCM also has a news story on the guidance at https://www.rcm.org.uk/news-views/news/2021/may/midwife-and-health-visitor-care-continuity-takes-a-step-forward/.