Research Article| Volume 33, ISSUE 5, e409-e419, September 2020

Download started.


Midwives’ views of changing to a Continuity of Midwifery Care (CMC) model in Scotland: A baseline survey

Published:November 25, 2019DOI:



      There is good evidence that Continuity of Midwifery Care (CMC) is associated with improved clinical outcomes, greater maternal satisfaction, and improved work experiences for midwives. Changes made to the organisation require careful implementation, with on-going evaluation to monitor progress.


      To develop a survey tool that incorporates several validated scales, which was used to collect baseline data prior to implementing a high-quality Continuity of Midwifery Care (CMC) model in Scotland (Hewitt et al., 2019). This tool gathered data about midwives’ personal and professional wellbeing prior to service reorganisation, with a longitudinal study intended to measure change in midwives’ reportage across time. This paper reports the baseline data-collection.


      An on-line survey was shared with practising midwives (n = 321) in Scotland via the NHS intranet, verbally, email, and paper. The survey elicited midwives views about Continuity of Midwifery Care (CMC); values and philosophies of care; attitudes towards their professional role; personal and professional demographics; quality of life and wellbeing. Psychometric attitudinal scales were scored and free text comments themed according to positive/negative opinions of the new Continuity of Midwifery Care (CMC) model to highlight key concerns to be addressed and identify change barriers or facilitators.


      The majority of midwives indicated support for philosophies underpinning Continuity of Midwifery Care (CMC), which includes physiological birth and providing autonomous midwifery care. Participants also indicated positive attitudes towards their current role and organisation, with some worrying about how the organisation was going to implement the changes required. Worries included, receiving an overburdening workload, being deskilled in certain areas of midwifery practice, and lack of support were litigation to arise.


      Midwives support the values and philosophies that underpin Continuity of Midwifery Care (CMC), yet worry about organisational change involved in evolving systems of care. Hence, management require to implement strategies to reduce fears. For example, delivering accurate and honest information, enabling midwives to plan, design and implement changes themselves, and providing emotional and material help.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Scottish Government
        The Best Start: A Five-year Forward Plan for Maternity and Neonatal Care in Scotland.
        • Renfrew M.J.
        • McFadden A.
        • Baston H.
        • et al.
        Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.
        Lancet. 2014; : 9-25
        • Department of Health (DH)
        Expert Maternity Group, Changing Childbirth Document.
        HMSO, London1993
        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife-led continuity models versus other models of care for childbearing women.
        Cochrane Database Syst. Rev. 2016; 4 (CD004667)
        • Homer C.
        • Leap N.
        • Edwards N.
        • Sandall J.
        Midwifery continuity of care in an area of high socio-economic disadvantage in London: a retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997–2009).
        Midwifery. 2017; 48: 1-10
        • Dixon L.
        • Guilliland K.
        • Pallant J.
        • Sidebotham M.
        • Fenwick J.
        • McAra-Couper J.
        • Gilkison A.
        The emotional wellbeing of New Zealand midwives: comparing responses for midwives in caseloading and shift work settings.
        N. Z. Coll. Midwives J. 2017; 53: 5-14
        • Menke J.
        • Fenwick J.
        • Gamble J.
        • Brittain H.
        • Creedy D.K.
        Midwives’ perceptions of organisational structures and processes influencing their ability to provide caseload care to socially disadvantaged and vulnerable women.
        Midwifery. 2014; 30: 1096-1103
        • Forster D.A.
        • McKay H.
        • Davey M.A.
        • Small R.
        • Cullinane F.
        • Newton M.
        • Powell R.
        • McLachlan H.L.
        Women’s views and experiences of publicly-funded homebirth programs in Victoria, australia: a cross-sectional survey.
        Women Birth. 2019; 32: 221-230
        • Hewitt L.
        • Priddis H.
        • Dahlen H.G.
        What attributes do Australian midwifery leaders identify as essential to effectively manage a Midwifery Group Practice?.
        Women Birth. 2019; 32: 168-177
        • Fernandez Turienzo C.
        • Roe Y.
        • Rayment-Jones H.
        • Kennedy A.
        • Forster D.
        • Homer C.S.E.
        • McLachlan H.
        • Sandell J.
        Implementation of midwifery continuity of care models for Indigenous women in Australia: perspectives and reflections for the United Kingdom.
        Midwifery. 2019; 69: 110-112
        • Cummins A.
        • Coddington R.
        • Fox D.
        • Symon A.
        Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care.
        Midwifery. 2019;
        • Dawson K.
        • McLachlan H.
        • Newton M.
        • Forster D.
        Implementing caseload midwifery: exploring the views of maternity managers in Australia: a national cross-sectional survey.
        Women Birth. 2016; 29: 214-222
        • Sidebotham M.
        • Fenwick J.
        • Rath S.
        • Gamble J.
        Midwives’ perceptions of their role within the context of maternity service reform: an Appreciative Inquiry.
        Women Birth. 2015; 28: 112-120
        • McCourt C.
        Organising safe and sustainable care in alongside midwifery units: findings from an organisational ethnographic study.
        Midwifery. 2018; 65: 26-34
      1. Care Quality Commission (CQC); 2019. Access at:

        • McInnes R.J.
        • Hollins Martin C.J.
        • McArthur J.
        Midwifery continuity of carer: developing a realist evaluation framework to evaluate the implementation of strategic change in Scotland.
        Midwifery. 2018; 66: 103-110
        • Royal College of Midwives
        Why Midwives Leave.
        (October. Access:)2016
        • Friedman H.S.
        • Liang M.
        • Banks J.L.
        Measuring the cost–effectiveness of midwife-led versus physician-led intrapartum teams in developing countries.
        Womens Health. 2015; 11: 553-564
        • Hatem M.
        • Sandall J.
        • Devane D.
        • Soltani H.
        • Gates S.
        Midwife-led versus other models of care forchildbearing women.
        Cochrane Database Syst. Rev. 2008; (CD004667)
        • WHO
        Midwife-led Versus Other Models of Care for Childbearing Women.
        • Pawson R.
        • Tilley N.
        Realistic Evaluation.
        SAGE, London1997
        • NHS Scotland
        The Warwick-Edinburgh Mental Well-being Scale (WEMWBS).
        2006 (Available at: [Accessed 26 April 2018])
        • Stamm B.H.
        ProQoL: Compassion Satisfaction and Compassion Fatigue, Burnout, Secondary Traumatic Stress.
        2009 (Available at: [Accessed 26 April 2018])
        • Reime B.
        • Klein M.
        • Kelly A.
        • Duxbury N.
        • Saxell L.
        • Liston R.
        • et al.
        Do maternity care provider groups have different attitudes towards birth?.
        BJOG. 2004; 111: 1388-1393
        • Matthews A.
        • Scott P.A.
        • Gallagher P.
        The development and psychometric evaluation of the Perceptions of Empowerment in Midwifery Scale.
        Midwifery. 2009; 25: 327-335
        • Turnbull D.
        • Reid M.
        • McGinley M.
        • Sheilds N.R.
        Changes in midwives’ attitudes to their professional role following the implementation of the midwifery development unit.
        Midwifery. 1995; 11: 110-119
        • Thomas J.
        • Paranjothy S.
        National Sentinel Caesarean Section Audit Report.
        Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit, 2001
        • Fenwick J.
        • Sidebotham M.
        • Gamble J.
        • Creedy D.K.
        The emotional and professional wellbeing of Australian midwives: a comparison between those providing continuity of midwifery care and those not providing continuity.
        Women Birth. 2017; 31: 38-43
        • Banovcinova L.
        • Baskova M.
        Sources of work-related stress and their effect on burnout in midwifery.
        Procedia Soc. Behav. Sci. 2014; 132: 248-254
        • Harris F.
        • Teijlingen E.
        • Hundley V.
        • Farmer J.
        • Bryers H.
        • Caldow J.
        • Ireland J.
        • Kiger A.
        • Tucker J.
        The buck stops here: midwives and maternity care in rural Scotland.
        Midwifery. 2011; 27: 301-307
        • Alexander C.R.
        • Bogossian F.
        Midwives and clinical investigation: a review of the literature.
        Women Birth. 2018; 31: 442-452
        • Yilmaz D.
        • Kılıçoğlu G.
        Resistance to change and ways of reducing resistance in educational organizations.
        Eur. J. Res. Educ. 2013; 1: 14-21
        • NHS Service Delivery and Organisation
        Managing Change in the NHS. NHS R&D Programme.
        2001 (. [Accessed 16 April 2019])
        • Baker D.B.
        • Benjamin Jr., Ludy T.
        The affirmation of the scientists-practitioner: a look back at boulder.
        Am. Psychol. 2000; 55: 241-247
        • Pinder C.C.
        Work Motivation in Organizational Behavior.
        2nd ed. Psychology Press, New York2008
        • Deckers L.
        Motivation: Biological, Psychological and Environmental.
        3rd ed. Pearson, Boston (MA)2010: 2-3
        • Mitchell T.R.
        • Daniels D.
        Motivation (chapter 10).
        in: Borman D.R. Ilgen R.J. Klimoski R.J. Handbook of Psychology (vol. 12): Industrial Organizational Psychology. Wiley, New York2003: 225-254
        • Vinchur A.J.
        • Koppes L.L.
        A historical survey of research and practice in industrial and organizational psychology.
        in: Zedeck S. APA Handbook of Industrial and Organizational Psychology. American Psychological Association, Washington DC2010
        • Griffin M.A.
        • Clarke S.
        Stress and well-being at work.
        in: Zedeck S. APA Handbook of Industrial and Organizational Psychology. American Psychological Association, Washington (DC)2010
        • Spector P.E.
        • Fox S.
        The stressor-emotion model of counterproductive work behavior.
        in: Fox S. Spector P.E. Counterproductive Workplace Behavior: Investigations of Actors and Targets. American Psychological Association, Washington DC2005: 151-174
        • Clarke S.
        Safety leadership: a meta-analytic review of transformational and transactional leadership styles as antecedents of safety behaviours.
        J. Occup. Organ. Psychol. 2014; 86: 22-49
        • Dollard M.
        • Bakker A.
        Psychosocial safety climate as a precursor to conducive work environments, psychological health problems, and employee engagement.
        J. Occup. Organ. Psychol. 2010; 83: 579-599
        • Jepsen I.
        • Juul S.
        • Foureur M.
        • Sørensen E.E.
        • Nøhr E.A.
        Is caseload midwifery a healthy work-form: a survey of burnout among midwives in Denmark.
        Sex. Reprod. Healthc. 2017; 11: 102-106
        • Newton M.S.
        • McLachlan H.L.
        • Forster D.A.
        • Willis K.F.
        Understanding the’ work’ of caseload midwives: a mixed-methods exploration of two caseload midwifery models in Victoria, Australia.
        Women Birth. 2016; 29: 223-233
        • Pallant J.F.
        • Dixon L.
        • Sidebotham M.
        • Fenwick J.
        Further validation of the perceptions of empowerment in midwifery scale.
        Midwifery. 2015; 31: 941-945
        • Jex S.M.
        • Britt T.W.
        Organizational Psychology.
        Wiley, Hoboken (NJ)2008
        • Haines V.Y.
        • Taggar S.
        Antecedents of team reward attitude.
        Group Dyn. Theory Res. Pract. 2006; 10: 194-205
        • Schultz D.P.
        • Sydney E.
        Psychology and Work Today: An Introduction to Industrial and Organizational Psychology.
        10th ed. Prentice Hall, Upper Saddle River (NJ)2010
        • Gray J.
        • Taylor J.
        • Newton M.
        Embedding continuity of care experiences: an innovation in midwifery education.
        Midwifery. 2016; 33: 40-42
        • Burchell M.
        • Robin J.
        The Great Workplace.
        The Great Workplace Institute, New York, New York2011