Embedding maternity support workers in a personalised midwifery project

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Sophie Eveleigh, Contract and Implementation Officer at Better Start Bradford, looks at how the organisation has improved midwifery support in parts of the city.

Sophie Eveleigh

In a time when recruiting and retaining midwives has proven to be difficult, embedding a Maternity Support Worker (MSW) within our Personalised Midwifery Project (PMP) has both enhanced and aided delivery, providing additional benefits to our families.

Recent policies for Continuity of Care in England, Scotland, and Wales (1,2,3) all consider the midwife as the central role of the continuous carer. Here we show that in the context of falling numbers of midwives (4), providing a cost-effective, non-clinical member of staff does not have to compromise this core ethos of continuity of care.

Better Births, published in 2016 by the NHS (5) to discuss improvements required in midwife-led care in England, spoke of implementing the midwife-led ‘continuity of carer’ (MCC) model. The model sits within the Maternity Transformation Programme, and is said to support safer, more streamlined maternity care, while fostering positive relationships between women and their midwives, resulting in better outcomes for mothers and their babies (6).

Project background

PMP is a partnership between Better Start Bradford, Reducing Inequalities in Communities (RIC), and Bradford Teaching Hospitals NHS Foundation Trust. The aim is to improve outcomes from maternity care in the Better Start Bradford and RIC areas. We extended the project area by including RIC postcodes in our inclusion criteria, allowing us to report separately on RIC participants.

PMP is an enhanced midwifery service ensuring pregnant women and their family receive ‘continuity of care.’ This means women can expect to see their own midwife for most appointments and for care before and after labour, with support from a small, friendly team. This type of care is safer, more personalised, and means that when women have their baby, they will usually be offered care by their own midwife, or a ‘buddy’ from the team who they have met before.

Appointments are arranged to suit the women, in their home, in family hubs, or in hospital. When women go into labour, the midwives will go to the hospital to look after them personally or will provide care for a home birth. Women who are eligible will be identified by the hospital data system which flags them up by postcodes, and they are then contacted by the team. Not all women can receive the continuity model because of capacity. Therefore, they are randomly allocated, allowing the cohort evaluation to be carried out.

The project aims to reduce health inequalities for babies and their mothers. We have built a small team of 3 full-time equivalent midwives, 1 team leader, 1 maternity support worker (MSW) and an administrator (ward clerk). This team is known as the ‘Clover Team,’ and they are under the community midwifery teams umbrella. The project was created using the midwife-led ‘continuity of carer’ model.

The MSW’s responsibilities include:

  • Arranging a pre-booking appointment/visit with mum to cover public health messaging and signposting.
  • Breastfeeding support and extra support during the post-natal period.
  • Plans and follow-ups, with an antenatal plus appointment at 22-weeks.
  • Running the Antenatal Plus Clinic, delivering public health messaging, and handing out appropriate resources.
  • Collecting equipment and ensuring all clinical venues are well stocked with items such as bed rolls to cover examination beds for each appointment, colostrum syringes etc.
  • Carrying out some admin tasks as needed.
  • Preparing booking, birth planning and newborn screening packs.
  • Day 3 and day 5 post-natal visits.
  • Allocation of women using randomisation to allow for the evaluation, but also giving all women an equal chance of being allocated to the team.

The model

  • Phase 1 of the project (October 2015 – February 2019) saw the MSW take on the pre-booking visits which we found improved access to care. This worked alongside all appointments with the named midwife and MSW able to stay longer at visits than during standard care visits.
  • Phase 2 (March 2019 – February 2020) continued with the MSW carrying out this work. The MSW prepared ahead of booked appointments, established relationships with mothers, and spread public health messaging on topics such as breastfeeding support.
  • In Phase 3 (March 2020 – present), the MSW is continuing the described in phase 1 and 2.

Findings

In phase 1 of the project, the women described high levels of satisfaction and greater trust with their named midwife compared to standard care. Midwives spoke of their job satisfaction, reduced stress, and increased role fulfilment. This was measured by interviewing midwives and mums and was echoed in phase 2 where midwives felt that upskilling the MSW had freed up their own time.

Evidence we received from practice showed that women receiving PMP were more likely to be referred to additional preventative support such as Better Start Bradford’s Baby Steps project, Bradford Doulas, or into the perinatal mental health support project.

From phase 2, the MSW carried out 172 post-natal plus contacts which were personalised to address relevant areas such as sleep, smoking, weight, and contraception. The MSW completed 231 other postnatal appointments.

Embedding an MSW into the service has allowed the project to function effectively with the existing staffing pressures facing midwifery, whilst still providing a personalised, patient centred service to the 438 women through the antenatal, postnatal, and intrapartum period.

Conclusion

PMP phase 1 improved access to care via pre-booked visits from an MSW. PMP phase 2 continued with MSW embedded in a model for preparedness ahead of the booking appointment, establishing of relationship and providing public health messaging. Research shows that families and midwives value the MSW in the team (7,8,9), and have reported the MSW role as critical to covering the workload. (7,8)

The MSW should not replace midwifery led care, However, they are crucial to supporting and complementing care received from a midwifery team during pregnancy and beyond. (10)

Quotes from service users:

“The bond and familiarity with my midwife is so important and means I do not have to explain my history over and over again.”
“She was really flexible as well because whenever I said, I can’t do this day and I can do this day, she’d move everything around for me.”
“It wasn’t just like a midwife it was like a ‘family member’ type of midwife."
"I remember when I had the baby and I was feeling a bit low in myself, she stayed a lot longer with me, just to sit with me and talk to me and that just made the day for me.”

References

1. NHS England (2020) Better Births Four Years On: A review of progress. https://www.england.nhs.uk/wp-content/uploads/2020/03/better-births-four-years-on-progress-report.pdf

2. Best Start (2017) https://www.gov.scot/publications/best-startfive-year-forward-plan-maternity-neonatal-carescotland-9781786527646

3. Maternity Care in Wales: a five year vision (2019) maternity-care-in-wales-a-five-year-vision-for-the-future-2019-2024.pdf (gov.wales)

4. NHS England (2023) NHS Workforce Statistics. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/february-2023

5. Better Births (2016) national-maternity-review-report.pdf (england.nhs.uk)

6. NHS. Continuity of carer. https://www.england.nhs.uk/publication/implementing-better-births-continuity-of-carer/Date accessed 16/08/2022

7. Griffin, R. (2019) ‘Maximising the contribution of maternity support workers (MSWs) in North West London’, British Journal of Healthcare Assistants, 13(11), pp. 549–551. Available at: https://doi.org/10.12968/bjha.2019.13.11.549.

8. Lindsay, P. (2018) ‘The role of the maternity support worker as part of the maternity care team’, British Journal of Healthcare Assistants, 12(11), pp. 540–545. Available at: https://doi.org/10.12968/bjha.2018.12.11.540.

9. Dunkley-Bent J. The importance of continuity of carer in maternity services. 2018. https:// www.england.nhs.uk/blog/the-importance-of-continuity-of-carer-in-maternity-services/

10. NHS Improvement. Safe, sustainable and productive staffing. An improvement resource for maternity services. 2018. safe-staffing-maternity.pdf (england.nhs.uk)

A research poster showcasing this work was shown at the Annual Unicef Baby Friendly Initiative conference in Harrogate 22-23 November 2023.

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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