The Moral Regime of Midwifery Continuity of Carer Implementation in England

Since 2016, the National Health Service (NHS) in England has been aiming to implement midwifery continuity of carer (MCoC), a model of maternity care in which the same midwife or small group of midwives provides antenatal, intrapartum and postnatal care for women, other birthing people and their babies. However, the implementation has faced significant difficulties. As part of a wider investigation into barriers to and facilitators of MCoC implementation, we carried out qualitative interviews with senior stakeholders involved in the implementation of MCoC at regional or national level in England. In this paper, we present an analysis of sociocultural values in the accounts of these stakeholders. We find these expert accounts of MCoC implementation are underpinned by a 'moral regime' which privileges certain norms and practices whilst deterring others. These accounts produce an idealised midwife-subject who is passionate and evangelical about MCoC as a form of care and seeks to persuade others to their cause, including through the use of evidence. We conclude with some thoughts about the range of possible consequences produced by this moral regime regarding the implementation of MCoC as a maternity policy in the English NHS, and the role of moral regimes in healthcare politics.