What is a caseload midwife?
To put it briefly, a rare and wonderful thing.
When I was pregnant with E I had the standard model of care for a low risk, first pregnancy. My antenatal appointments were with various midwives at my GP surgery. When I was in labour I was looked after by several shifts worth of midwives, none of whom I'd met before. On the postnatal ward there were another batch and when I got home yet more, rarely the same person more than once. This would probably have been fine if everything was straightforward, but as it wasn't I really hoped to have greater continuity of care second time around.
Thankfully I got REALLY lucky.
This time I had a caseload midwife. She visited me at home for my first appointment and for the last couple when getting to her was starting to be an effort. For medical reasons I saw her (or one of her small group of colleagues) every four weeks throughout my pregnancy and when M was born my midwife was the one who received her from the surgeons and made sure she was brought to me in a matter of moments. She arranged my gown so that my newborn could be placed skin to skin and shared our amazement as M immediately tried to wiggle up for a feed. Once I was home it was her or one of her team who visited me, as often as I felt the need, for more than four weeks. They checked on both my physical and emotional recovery and helped me with breastfeeding (not that M needed much help). It was wonderful.
As I said, I was really lucky. This kind of care is not common. To access it (at least in this area) you need to be booked with a hospital that has caseload teams and either registered with a specific GP practise or planning and eligible for a home birth (preferably both). I was near to a good hospital but didn't meet the other criteria. However, due to some complicated postnatal issues first time around I was referred to the case load team by two different doctors and after a bit of pleading they agreed to take me on.
Of course this time everything was straightforward, (to the point where I felt a bit of a fraud for taking up one of these precious spaces), but maybe the standard of care I received contributed to how much better I coped. I just so wish I'd had this option first time around.
Perhaps if I had, the midwife with me in labour would have known I needed honesty, not cheer-leading. Perhaps she could have broken it to me that my planned natural birth was increasingly unlikely and we could have made a calm decision to do the C-section sooner, while I was still in a fit state to think for myself.
Perhaps my recovery would have been easier without such a long labour before the surgery and my postnatal problems would have been picked up sooner by someone who knew me and could tell things weren't right.
Perhaps breastfeeding wouldn't have been such an almighty struggle if I'd had consistent advice and support.
Of course I can't know all that for sure, but I'm certain that my experience was far better all round this time and the caseload midwives certainly contributed to that.
I'd love to see this kind of service available to all mothers who want it. It seems deeply unfair that at the moment it's mostly reserved for those having home births, who are likely to be the most low risk cases and so often not those with the greatest need for support and continuity of care.The NCT (along with a few other charities) have recently launched a campaign for more caseload midwives: A Midwife For Me And My Baby. I have a couple of reservations about the campaign (see below) but I really hope they are heard and that it makes more pregnant women aware of the existence of caseload midwives, what they are and what a valuable service they can offer, however you plan to give birth.
Note on campaign: I whole heartedly support widening the availability of caseload midwifery. The campaign calls for more women to receive this kind of care during pregnancy and birth, I would like to see the postnatal period included as well. This would encourage breastfeeding by ensuring consistent advice is given and could help to pick up postnatal problems more quickly. I'm also concerned that the wording of the campaign manifesto is rather pro-natural birth. For example having a caesarean is put in the same list of bad outcomes as the death of the baby, post natal depression or PTSD. It's quite negative about obstetric units while at the same time praising "empowering" women to avoid interventions. I don't think it's helpful to load these issues onto the campaign and it distracts from the idea that caseload midwifery should be for everyone. It's perfectly possible for a women to look at all the evidence and make a rational, fear free, dare I say it "empowered" decision that she wants doctors around just in case, really doesn't like pain and wants an epidural ASAP, or that she'd rather be induced than go overdue etc. These women should be supported just as much as those who decide a natural or home birth is right for them.