Continuity of Midwifery Care in Complexity

Abstract

Continuity of midwifery care has demonstrated some beneficial outcomes for mothers and their babies with no evidence of poorer outcomes. Much of the evidence to support this claim is sourced from research conducted with women described as ‘low risk’. The model of midwifery in New Zealand, which is based on continuity of midwifery carer, has the potential for midwives to continue care even when significant risk has been identified. This care would be provided in collaboration with and support from medical personnel and hospital-based midwives. There is no research that has specifically examined the outcomes for women with complex needs, also called ‘high risk’, who have been provided continuity of midwifery carer. Given the increased incidence of morbidity in the childbearing population it is important to examine this issue in some depth. This small piece of research begins this, by looking at how women with complex needs and who have had continuity of midwifery care have experienced this care. The aim of this research therefore is to provide a comprehensive description of how women with complexities experience continuity of midwifery care across the maternity episode. A qualitative descriptive study was conducted in one part of New Zealand. Three women, all with varying types of complexity were interviewed. The interviews were transcribed, and the transcripts were analysed thematically. There were four themes: the relationship was everything; knowing what was happening was important; power was managed and balanced; and extra care was needed. The three women had the same needs and experiences of continuity as did low risk women described in the literature. However, another aspect, not previously reported, was that the women thought that the midwives spent a lot more time with them than they otherwise would have needed to. They were grateful for this.