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A grounded theory study on midwifery managers' views and experiences of implementing and sustaining continuity of carer models within the UK maternity system.

Turner, Sarah; Crowther, Susan; Lau, Annie


Sarah Turner

Susan Crowther

Annie Lau


Background: Current UK health policy recommends the transition of maternity services towards provision of Midwifery Continuity of Carer (MCoCer) models. Quality of healthcare is correlated with the quality of leadership and management yet there is little evidence available to identify what is required from midwifery managers when implementing and sustaining MCoCer. Aim: To develop a theoretical framework that represents midwifery managers’ experiences of implementing and sustaining MCoCer models within the UK's National Health Service (NHS). Methods: Charmaz's grounded theory approach was used for this study. Five experienced UK based midwifery managers were interviewed to elicit views and understanding of the social processes underlying the implementation and sustaining of MCoCer. Interviews were transcribed and analysed and focus codes developed into theoretical codes resulting in an emergent core category. Findings: The theoretical framework illustrates the core category ‘Leading Meaningful Midwifery’. To manage MCoCer models midwifery managers require a trust and belief in woman centred philosophy of care. They need the skills to focus on non-hierarchical transformational leadership and the courage to assimilate alternative models of care into the NHS. Promoting and protecting the MCoCer model within current services is essential whilst forming a culture based on high quality, safe MCoCer. Discussion: MCoCer models that have sustained within the NHS have had supportive leadership from midwifery managers who have the necessary skills, attitudes, aptitudes and behaviours identified within the findings. Sustainable implementation of MCoCer is achieved through development of a values-based recruitment and retention policy within all areas of midwifery and encouraging midwives with previous experience in MCoCer or supportive philosophies towards it, to manage the model. Conclusion: Providing the appropriate support for MCoCer is time consuming and personally demanding for midwifery managers, however, implementing and sustaining MCoCer was shown by participants who valued MCoCer models to be rewarding, bringing meaning to their midwifery leadership.


TURNER, S., CROWTHER, S. and LAU, A. 2021. A grounded theory study on midwifery managers' views and experiences of implementing and sustaining continuity of carer models within the UK maternity system. Women and birth [online], In Press. Available from:

Journal Article Type Article
Acceptance Date Oct 23, 2021
Online Publication Date Nov 20, 2021
Deposit Date Nov 26, 2021
Publicly Available Date Nov 21, 2022
Journal Women and birth
Print ISSN 1871-5192
Electronic ISSN 1878-1799
Publisher Elsevier
Peer Reviewed Peer Reviewed
Keywords Midwifery management; Leadership; Meaningful midwifery; Continuity of carer; Grounded theory
Public URL
Additional Information In the file accompanying this record, the figures are provided separately at the end rather than integrated into the main text.


This file is under embargo until Nov 21, 2022 due to copyright reasons.

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