Research Article|Articles in Press

“It’s no ordinary job”: Factors that influence learning and working for midwifery students placed in continuity models of care

Published:October 05, 2022DOI:



      Maternity policy and guidelines increasingly recommend or stipulate the increased provision of midwifery continuity of carer as a priority model of care. The scale up and sustainability of this model will require that student midwives are competent to provide continuity of carer at the point of qualification. Guidance relating to how to optimally prepare student midwives to work within continuity models is lacking.


      To explore perspectives and experiences of working within and learning from student placement within continuity models of care.


      An online mixed methods survey aimed at midwifery students and qualified midwives with experience of working within or providing education relating to continuity models. Quantitative results were analysed through descriptive statistics while free text responses were brought together in themes.


      Benefits and challenges to placement within continuity models were identified. These provide recommendations that will enhance learning from and skill development within continuity models of care.


      There is a need for continuity of mentorship and strong relationships between education and practice, and the provision of flexible curriculum content around this to enable students to prioritise appointments with women in their care. System level evaluation and support is needed to guide the optimal provision of continuity models, so that they are effective in improving outcomes and experiences. Foregrounding woman centred care as foundational to education and facilitating the critical deconstruction of dominant discourses that conflict with, and may prevent this form of practice, will promote the provision of care that is integral to these models.


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        • Allen J.
        • Kildea S.
        • Tracy M.B.
        • Hartz D.L.
        • Welsh A.W.
        • Tracy S.K.
        The impact of caseload midwifery, compared with standard care, on women’s perceptions of antenatal care quality: survey results from the [email protected] randomized controlled trial for women of any risk.
        Birth. 2019; 46: 439-449
        • Forster D.A.
        • McLachlan H.L.
        • Davey M.
        • Biro M.A.
        • Farrell T.
        • Gold L.
        • et al.
        Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial.
        BMC Pregnancy Childbirth. 2016; 16: 28
      1. C.S. Homer, N. Leap, N. Edwards, J. Sandall, Midwifery continuity of carer in an area of high socio-economic disadvantage in London: A retrospective analysis of Albany midwifery practice outcomes using routine data (1997–2009), 2017. Midwifery, 48, 2017 May, pp. 1–10. 〈〉.

        • 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. Heal. 2017; 11: 102-106
        • McLachlan H.
        • Forster D.
        • Davey M.
        • Farrell T.
        • Gold L.
        • Biro M.
        • et al.
        Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial.
        BJOG. 2012; 119: 1483-1492
        • 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
        • Dawson K.
        • Newton M.
        • Forster D.
        • McLachlan H.
        Exploring midwifery students׳ views and experiences of caseload midwifery: a cross-sectional survey conducted in Victoria, Australia.
        Midwifery. 2015; 31: e7-e15
        • Dixon L.
        • Guilliland K.
        • Pallant J.
        • Sidebotham M.
        • Fenwick J.
        • McAra-Couper J.
        • et al.
        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
        • 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. 2018; 31: 38-43
        • McInnes R.J.
        • Aitken-Arbuckle A.
        • Lake S.
        • Hollins Martin C.
        • MacArthur J.
        Implementing continuity of midwife carer – just a friendly face? A realist evaluation.
        BMC Health Serv. Res. 2020; 20
        • ace C.A.
        • Crowther S.
        • Lau A.
        Midwife experiences of providing continuity of carer: a qualitative systematic review.
        Women Birth. 2021; 35
      2. National Maternity Review. Better Births: Improving outcomes of maternity services in England – A Five Year Forward View for maternity care, 2016. 〈〉.

      3. Scottish Government. The best start: five-year plan for maternity and neonatal care, 2017. 〈〉.

      4. Australian Nursing & Midwifery Accreditation Council. Midwife Accreditation Standards, 2021. 〈〉.

      5. C.J. Hollins Martin, J. MacArthur, C.R. Martin, R.J. McInnes, Midwives’ views of changing to a Continuity of Midwifery Care (CMC) model in Scotland: A baseline survey. Women Birth. 2019 Nov, 33(5). 〈〉.

        • Newton M.
        • Faulks F.
        • Bailey C.
        • Davis J.
        • Vermeulen M.
        • Tremayne A.
        • et al.
        Continuity of care experiences: a national cross-sectional survey exploring the views and experiences of Australian students and academics.
        Women Birth. 2021;
        • Taylor B.
        • Cross-Sudworth F.
        • Goodwin L.
        • Kenyon S.
        • MacArthur C.
        Midwives’ perspectives of continuity based working in the UK: a cross-sectional survey.
        Midwifery. 2019; 75: 127-137
        • Cummins A.M.
        • Denney-Wilson E.
        • Homer C.S.E.
        The challenge of employing and managing new graduate midwives in midwifery group practices in hospitals.
        J. Nurs. Manag. 2016; 24: 614-623
        • Evans J.
        • Taylor J.
        • Browne J.
        • Ferguson S.
        • Atchan M.
        • Maher P.
        • et al.
        The future in their hands: Graduating student midwives’ plans, job satisfaction and the desire to work in midwifery continuity of care.
        Women Birth. 2020; 33: e59-e66
        • Gamble J.
        • Sidebotham M.
        • Gilkison A.
        • Davis D.
        • Sweet L.
        Acknowledging the primacy of continuity of care experiences in midwifery education.
        Women Birth. 2020; 33: 111-118
      6. Nursing and Midwifery Council, Realising professionalism: Standards for education and training. Part 3: Standards for pre-registration midwifery programmes, 2019. 〈〉.

        • Browne J.
        • Haora P.J.
        • Taylor J.
        • Davis D.L.
        “Continuity of care” experiences in midwifery education: perspectives from diverse stakeholders.
        Nurse Educ. Pract. 2014; 14: 573-578
      7. M. Sidebotham, J. Fenwick, Midwifery students’ experiences of working within a midwifery caseload model. Midwifery, 74, p. 21–8. 〈〉.

        • Carter A.G.
        • Wilkes E.
        • Gamble J.
        • Sidebotham M.
        • Gamble D.K.
        Midwifery students׳ experiences of an innovative clinical placement model embedded within midwifery continuity of care in Australia.
        Midwifery. 2015; (2019 Jul;74:21–8. 771)
        • Tickle N.
        • Sidebotham M.
        • Fenwick J.
        • Gamble J.
        Women’s experiences of having a Bachelor of Midwifery student provide continuity of care.
        Women Birth. 2016; 29: 245-251
        • ray J.
        • Leap N.
        • Sheehy A.
        • Homer C.S.E.
        Students’ perceptions of the follow-through experience in 3 year bachelor of midwifery programmes in Australia.
        Midwifery. 2013; 29: 400-406
        • Bradfield Z.
        • Kelly M.
        • Hauck Y.
        • Duggan R.
        Midwives “with woman” in the private obstetric model: Where divergent philosophies meet.
        Women Birth. 2019; 32: 157-167
        • Finlay S.
        • Sandall J.
        “Someone’s rooting for you”: continuity, advocacy and street-level bureaucracy in UK maternal healthcare.
        Soc. Sci. Med. 2009; 69: 1228-1235
        • Carter J.
        • Sidebotham M.
        • Dietsch E.
        Prepared and motivated to work in midwifery continuity of care? A descriptive analysis of midwifery students’ perspectives.
        Women Birth. 2021; 35
        • Moncrieff G.
        • MacVicar S.
        • Norris G.
        • Hollins Martin C.J.
        Optimising the continuity experiences of student midwives: an integrative review.
        Women Birth. 2020; 34
        • Baird K.
        • Hastie C.R.
        • Stanton P.
        • Gamble J.
        Learning to be a midwife: midwifery students’ experiences of an extended placement within a midwifery group practice.
        Women Birth. 2021;
        • Foster W.
        • Sweet L.
        • Graham K.
        Midwifery students experience of continuity of care: a mixed methods study.
        Midwifery. 2021; 98102966
        • McLachlan H.L.
        • Newton M.
        • Nightingale H.
        • Morrow J.
        • Kruger G.
        Exploring the “follow-through experience”: a statewide survey of midwifery students and academics conducted in Victoria, Australia.
        Midwifery. 2013; 29: 1064-1072
        • Rawnson S.
        A qualitative study exploring student midwives’ experiences of carrying a caseload as part of their midwifery education in England.
        Midwifery. 2011; 27: 786-792
        • ewton M.
        • Faulks F.
        • Bailey C.
        • Davis J.
        • Vermeulen M.
        • Tremayne A.
        • et al.
        Continuity of care experiences: a national cross-sectional survey exploring the views and experiences of Australian students and academics.
        Women Birth. 2021;
        • Sweet L.P.
        • Glover P.
        An exploration of the midwifery continuity of care program at one Australian University as a symbiotic clinical education model.
        Nurse Educ. Today. 2013; 33: 262-267
        • idebotham M.
        • Walters C.
        • Chipperfield J.
        • Gamble J.
        Midwifery participatory curriculum development: transformation through active partnership.
        Nurse Educ. Pract. 2017; 25: 5-13
        • Fahy K.
        What is woman-centred care and why does it matter.
        Women Birth. 2012; 25: 149-151
      8. World Health Organization. WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience, 2018. 〈〉.

        • Brady S.
        • Lee N.
        • Gibbons K.
        • Bogossian F.
        Woman-centred care: an integrative review of the empirical literature.
        Int. J. Nurs. Stud. 2019; 94: 107-119
      9. Towards a conceptualisation of woman centred care — a global review of professional standards. Women and Birth, 2021 Mar 4. 〈〉.

        • Cummins A.M.
        • Smith R.
        • Catling C.
        • Watts N.
        • Scarf V.
        • Fox D.
        • et al.
        Midwifery Graduate Attributes: a model for curriculum development and education.
        Midwifery. 2018; 61: 66-69
        • McAra-Couper J.
        • Gilkison A.
        • Crowther S.
        • Hunter M.
        • Hotchin C.
        • Gunn J.
        Partnership and reciprocity with women sustain Lead Maternity Carer midwives in practice.
        N. Z. Coll. Midwives J. 2014; : 49
        • Geraghty S.
        • Bromley A.
        • Bull A.
        • Dube M.
        • Turner C.
        Millennial midwifery: online connectivity in midwifery education.
        Nurse Educ. Pract. 2019;
        • Bass J.
        • Fenwick J.
        • Sidebotham M.
        Development of a Model of Holistic Reflection to facilitate transformative learning in student midwives.
        Women Birth. 2017; 30: 227-235
        • McKellar L.
        • Charlick S.
        • Warland J.
        • Birbeck D.
        Access, boundaries and confidence: the ABC of facilitating continuity of care experience in midwifery education.
        Women Birth. 2014; 27: e61-e66
        • Davis D.L.
        • Creedy D.K.
        • Bradfield Z.
        • Newnham E.
        • Atchan M.
        • Davie L.
        • et al.
        Development of the Woman-Centred Care Scale- Midwife Self Report (WCCS-MSR.
        BMC Pregnancy Childbirth. 2021; 21
      10. KE Howell, Critical Theory. In Howell KE, editor. An introduction to the philosophy of methodology. 2017. SAGE. 〈〉.