Process lessons from evaluating a combined continuity of carer and home birth scheme

Introduction Continuity of midwifery carer improves outcomes, but there is significant variation in how such schemes are implemented and evaluated cross‐culturally. The Angus home birth scheme in Scotland incorporates continuity of carer throughout pregnancy, labor, birth, and the postnatal period....

Full description

Saved in:
Bibliographic Details
Published in:Birth (Berkeley, Calif.) Calif.), 2020-12, Vol.47 (4), p.389-396
Main Authors: Symon, Andrew, Shinwell, Shona, Craig, Justine
Format: Article
Language:English
Subjects:
Birth rate
Caregivers
caseload midwifery
Childbirth & labor
Continuity of care
continuity of carer
Deprivation
home birth
Home births
maternal choice
Midwifery
Midwives
record keeping
socioeconomic inequality
Teams
Women
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction Continuity of midwifery carer improves outcomes, but there is significant variation in how such schemes are implemented and evaluated cross‐culturally. The Angus home birth scheme in Scotland incorporates continuity of carer throughout pregnancy, labor, birth, and the postnatal period. Methods Manual maternity case note review to evaluate the 80% continuity of carer and 3% planned home birth rate targets. Results Of 1466 women booking for maternity care, 69 joined the scheme. Forty‐four had a planned home birth (3% overall), of whom seven were originally deemed ineligible. Of the 44, eight (18%) also achieved 80% continuity of carer with the primary midwife; by including a home birth team colleague, the continuity rate rose to 73%. Women whose care achieved home birth and continuity targets had lower deprivation scores. Eligibility issues, women's changing circumstances, and data recording lapses were complicating issues. Conclusions Targets must be both feasible and meaningful and should be complemented by assessing a broad range of outcomes while viewing the scheme holistically. By expanding eligibility criteria, the home birth rate target was met; including input from a home birth team colleague in the calculation meant the continuity target was nearly met. With dedicated and competent staff, adequate resource and political support, and when considered in the round, the scheme's viability within local services was confirmed. Other generalizable learning points included the need to standardize definitions and data recording methods. Comparability across schemes helps grow the evidence base so that the links between processes and outcomes can be identified.
ISSN:0730-7659
1523-536X
DOI:10.1111/birt.12514