Project 20: Midwives' insight into continuity of care models for women with social risk factors: what works, for whom, in what circumstances, and how.
Hannah Rayment-Jones, Sergio A Silverio, James Harris and 2 others
PMID 32066030WHAT IT FOUND
Midwives working in continuity models for women with social risk factors described using flexible appointments and repeated contact to build trust.
This trust encouraged women to disclose hidden issues like domestic abuse and substance use later in pregnancy, allowing for tailored care and advocacy.
Key findings
01Trust built through repeated contact and flexible appointment times enabled women to disclose sensitive information, such as domestic abuse and homelessness, later in pregnancy than at booking.
02Midwives advocated for women by explaining the supportive role of social care services, which helped counteract fears of surveillance and engagement with child protection systems.
03Community-based midwives reported better integration with local support services compared to hospital-based teams, who faced barriers due to large catchment areas and reduced community resources.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study relies on midwives' perceptions and self-reported insights rather than objective patient outcomes or data. Participants knew they were being evaluated, which may have influenced their responses to demonstrate the service's success. The study was urban-based only, limiting applicability to rural or remote settings. Small sample size of 11 midwives from two specific models in London. No patient data or clinical outcomes were measured; the findings are theoretical mechanisms for further evaluation.
Declared interests
The research was supported by the National Institute for Health Research (NIHR) Doctoral Research Fellowship and other NIHR collaborations. The authors declared no competing interests.
The easy way to misread this
Do not interpret these themes as evidence that continuity of care models improve clinical outcomes for women with social risk factors. The study reports midwives' perceptions of mechanisms and does not measure patient health or social outcomes.