Balancing the Joys and Challenges of the Continuity of Care Model: A Study Exploring the Perspective of Midwives and Their Family Members

Abstract

Background: In Aotearoa New Zealand, women receive continuity of maternity care (COC) from a lead maternity carer (LMC), most of whom are midwives. Providing COC requires midwives to have periods of being on call. These periods can include multiple days on call, involving unpredictable hours, which may affect not just midwives’ wellbeing but also their family life. More research is needed to understand how providing continuity of care affects the midwives, their family life and their social life.

Aim: To explore the effects of working as a community-based midwifery LMC on the wellbeing of midwives and family lives.

Method: We undertook qualitative research involving face-to-face and/or online interviews with midwives and their family member/s. Purposive sampling was used to recruit the 47 midwives (32 current LMCs, 15 former LMCs), alongside 51 family members who agreed to be involved in the study. An interview guide was used with prompts to support consistency. NVivo software supported a template analysis of the data from which three main themes were identified.

Findings: The LMC midwives described their work as intrinsically rewarding due to the building of valued relationships. However, challenges involved periods of being constantly on call, the unpredictability of call outs and potentially long working hours. these issues also affected family members. The midwives described a lack of operational support which often resulted in having to organise and pay for time off call, leading to financial vulnerability.

Conclusion: This study has identified a number of challenges to the current LMC midwifery model. A reasonable balance which ensures regular time off call yet still maintains the provision of continuity of care may be the key to supporting sustainability in the role and retention of the current workforce.