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Major overhaul for maternity care

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Primary midwives will be introduced Primary midwives will be introduced to provide women with continuity of care throughout their pregnancy and delivery

Maternity services in Scotland are set to drastically change so every women has a primary midwife throughout her journey of care and receives more care in the community.

The Best Start: A Five year Forward Plan for Maternity and Neonatal Care in Scotland presents recommendations for alterations to the midwifery workforce, the aim of which is to improve care for mothers and babies.

The most significant change will be the introduction of continuity of carer, meaning mothers will have their care led by the same midwife antenatally and across the birthing period.

The introduction of this role was put forward in response to a strong evidence base suggesting that women would prefer to have one midwife oversee their care. This was considered important by women so they could build relationships with their midwife.

The report acknowledges that introducing a primary midwife ‘challenges traditional approaches to NHS maternity care provision’ and so will require a substantial shift to achieve this model of care.

The existing midwifery and obstetric workforce will be reconfigured, the report says, in a way that will support the continuity of carer concept for all women.

‘Reconfiguration will be worked through by managers and staff in different localities,’ says Mary Renfrew, professor of mother and infant health at the University of Dundee and a member of the report’s review board.

‘An implementation plan will be forthcoming soon, to incorporate consultation and work with Health Boards, staff, advocacy groups, and others,’ she adds.

Community hubs
The report also recommends that most maternity care is carried out in the community through the introduction of community hubs. ‘We felt there was strong evidence, for the majority of care in straight forward healthy pregnancies,

to try and shift the focus of care from hospital consultant-led units into community hubs and midwife-led units,’ explains Mary Ross-Davie, director for Scotland at the Royal College of Midwives (RCM).

The community hubs will allow families to build up relationships with staff and to access a range of advice on breastfeeding, minimising the separation of mother and child and encouraging father and child bonding.

It is also recommended that each GP practice has a link GP to each midwifery team in order to provide a liasion point at the GP practice and the health visiting team.

The practicalities of this will also be determined by discussion and consultation in local areas, says Professor Renfrew.

The details of how a ‘revolutionary’ plan such as this is implemented will be all-important in achieving the best outcomes for mothers and babies.


1. Scottish Government. The Best Start: A Five year Forward Plan for Maternity and Neonatal Care in Scotland. 2017.

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