Sustaining continuity of carer in practice: a service evaluation of a local maternity system in Northwest England

Where midwifery is integrated fully into health systems, evidence demonstrates that relational, midwifery-led continuity of carer (MCoC) improves biopsychosocial outcomes for birthing women, people and babies. MCoC is where one or a small team of midwives are the lead carer throughout the childbearing continuum regardless of place of birth, pre-existing or emerging risk factors; working with multidisciplinary professionals if required. In England, wide-scale system changes and implementation were underway to scale up MCoC. However, this was halted due to multiple complexities following the pandemic and ongoing staffing issues. Our mixed method study carried out in 2021 was an external research evaluation across a region of four NHS sites who were at different stages of MCoC implementation. Here we report qualitative insights capturing the successes and challenges in four different contexts to help guide the reintroduction of MCoC services. Recruitment was conducted via stakeholder events and social media; included 123 survey participants (68 providing qualitative data) and 28 interview participants. Thematic analysis was carried out with a global thematic network approach to interpret the data. One global theme of 'Making it Work: Sustaining MCoC' was developed comprising of four organising themes - 'making a difference', 'making a start', 'making it count', and 'making it fit'. Collectively, these findings highlight what works well for staff, families, and the service, alongside MCoC challenges and how to overcome them. These findings offer practical insights to support successful implementation - 'making it work: future transformations' - critical to the ongoing sustainability of a service wide transformation.