Systems of midwifery care in use in Scotland

A survey was undertaken to identify the different systems of midwifery care in use in hospital and community settings in Scotland. The 53 units which responded provided 90% of the maternity care in Scotland. Of the 53 units, the 28 integrated units undertook 83% of Scottish births and were more likely than the non-integrated units to have implemented systems designed to reduce fragmentation of care. Nearly a fifth of units had five different systems of care in operation. More than half the units had at least one of the following systems of care in operation or under planning: individualised care plans; 'patient allocation'; DOMINO schemes; nursing/midwifery process or model; and team midwifery. The most frequently used system was planning individualised care (88% of the units). 'Patient allocation', nursing/midwifery process or model and the DOMINO scheme were in over 60% of the units. The least used system was team midwifery, which was in operation in 21% of the units and being planned for a further 30%. The use of the different systems in combination within a number of units demonstrates that approaches to the objective of continuity of care are complex. There is a need for further research into continuity of care as this is a commonly cited advantage of all five systems of care.