Major new study assesses changes to midwifery models of care in England

Midwifery Continuity of Carer (MCoC) is a major policy initiative in NHS England, aimed at ensuring a woman’s care before, during and after birth is led by the same midwife, or a small team of midwives.

This represents a significant shift in usual approaches to care, which often meant that women saw different midwives through pregnancy, labour and early motherhood. This could lead to gaps in care that resulted in poorer outcomes and experiences for women and their babies.

The SIMCA project, led by the University of Plymouth with funding from the National Institute for Health and Care Research, will explore where implementation of MCoC is going well and where its implementation is creating challenges.

It also involves partners across the UK – including Cardiff University, University of Birmingham, the, Imperial College London, Imperial College Healthcare NHS Trust, leading pregnancy charity Tommy's, and The Mosaic Community Trust – and is the largest study yet conducted to assess the model’s implementation in such a large and complex system as NHS England.

Aled Jones, Professor of Patient Safety and Healthcare Quality and Head of the University of Plymouth’s School of Nursing and Midwifery, is the project’s chief investigator.

He said: “Midwives invariably deliver first-rate care for women and their babies. However, several reports into safety failures in England and internationally have demonstrated where that isn’t always the case. The Midwifery Continuity of Carer model offers an approach that may enhance the safety and quality of care for all women, in addition to improving job satisfaction for midwives. However, there are also significant uncertainties about its implementation. Better understanding of how implementation of MCoC works best and what factors influence implementation is imperative, and by the end of this study we plan to deliver that.”

It will focus on interviewing national and regional stakeholders involved in developing MCoC, and case studies of nine NHS trusts – in rural and urban areas with different socio-economic profiles – to better understand local, regional and national factors contributing to different rates of progress with McoC implementation.

The research will be used to inform future improvements within midwifery services, and will directly influence how current and future students and registered midwives implement and lead change in the NHS and internationally.

Kate Davies, Research, Policy and Information Director at Tommy’s is one of the PPI Leads on the project: “At Tommy’s, we believe everyone deserves the very safest and highest quality maternity care – and of course we want to see measures implemented in care that help deliver this. We’re delighted to be contributing to this project which will investigate the current model for Continuity of Carer so that there is a better understanding of what is working and what isn’t. We hear time and time again that Continuity of Carer means so much to women and birthing people and can help address inequity. We also know that for some midwives, when the right resources are there, this is their preferred way to deliver care. We’re excited to be part of a project that will find evidence to improve practice in this area.”