Evaluation of the enhanced midwifery continuity of carer model (EMCoC)

Please see the link to the full Evaluation of enhanced midwifery continuity of carer report here.

An infographic of the findings can be found here, and a summary of the findings here

Background

Pregnancy and birth experiences for women from deprived socioeconomic backgrounds and minority ethnic groups are 50% more likely to result in poor outcomes, with five-fold difference in maternal mortality rates for women from Black ethnic backgrounds.

Midwifery Continuity of Carer (MCoC) aims to provide personalised and safe care to women and their families via provision of the same midwife, supported by a small team of midwives, throughout pregnancy, birth and the post-partum period.

The enhanced model of MCoC aims to provide extra support to women and their families in the most deprived areas of England, in order to reach the target of providing continuity of care for 75% of women from Black, Asian and minority ethnic and women from the most deprived groups by March 2024.

What we are doing

Our aim is to undertake a rapid formative evaluation of enhanced MCoC implementation. We will generate rapid insights into the format of care delivery and the experiences of those delivering and receiving enhanced MCoC to assess its early impacts.

We will conduct a multi-site, multiple methodologies study, conducting interviews with staff, stakeholders and service users who are delivering or in receipt of the enhanced MCoC model, across nine case study sites.

Our research questions include:

1. What are enhanced MCoC service delivery models and how have these been developed in response to service model guidance and related policies, existing MCoC services, high-priority issues and specific local needs?
2. What are the barriers and facilitators to the implementation of enhanced MCoC models of care from a staff perspective and can fidelity to the model envisaged be maintained?
3. What are staff views on the acceptability of the enhanced elements of MCoC models and their experience of these, including how staff interface with other health and social care teams?

What evidence is there that delivery of enhanced MCoC is resulting in purposeful improvement to care delivery or leading to unintended consequences, including any early benefits or risk as judged by staff?

The protocol for this evaluation can be found here.

What we found

1. Use of Funds: Most teams used the funding to hire Maternity Support Workers, who supported with antenatal and post-natal appointments, mental health and wellbeing, and signposting families to non-NHS services such as baby basic charities and financial support. 
2. Implementation Challenges: Many teams were unable to start the service during the pilot period due to delays in the Trusts receiving the funding, as well as ongoing staff shortages and difficulties in recruiting the support staff. 
3. Staff and service user acceptability: Midwives reported improved care quality and more time to support the women work due to the extra member of staff. Women using the service reported they appreciated the personalised approach and felt well-supported. The programme also effectively supported vulnerable groups (e.g. young parents, non-English speakers, those with mental health needs). 

The pilot showed positive outcomes, especially in care quality and support for disadvantaged women. However, issues with implementation limited its full potential. Further research is needed to evaluate long-term health impacts.