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Co-creation of guiding principles and a practical framework for a midwifery continuity of carer model: a cooperative inquiry with midwives.

Pace, Charlotte Ashley


Charlotte Ashley Pace


Susan Crowther

Annie Lau


Current NHS policy recommends the transformation of maternity services in order to provide midwifery continuity of carer (MCoCer). This model is evidence-based best practice, and has been shown to improve outcomes and maternity experiences. Whilst the evidence suggests that this model of midwifery is also associated with positive practice for midwives, it poses professional and personal challenges. A systematic review of midwife experiences in providing continuity of carer was undertaken in order to foreground what is currently known about this domain. The findings of the review indicate that midwives working in continuity of carer models value the ability to manage their own working practices, and the ability to develop contextually and personally relevant strategies that help them to negotiate the potential challenges of MCoCer, and to sustain them in practice. The aim of this study was to engage midwives with a view to collaboratively creating a vision for a MCoCer model that is relevant to them. A cooperative inquiry (CI) based on midwives' contextual practical knowledge sought to bring about an understanding of how MCoCer could be implemented and sustained for a group of midwives. CI is a branch of action research methodology, which was chosen for its strengths in personal transformation and social emancipation. Eight midwives participated from a range of settings in NHS Grampian. The study explored their views on MCoCer, generating contextual knowledge and understanding from their perspectives, through phases of reflection and action. The informational outcomes of the CI were a shared philosophy of care that informed the team charter and a framework for MCoCer. The transformational outcomes included changes in perspectives, focus and autonomy of the CI midwives. The systematic review highlighted the importance of a person-centred model of practice - answering the needs of women and midwives - as key to the success and sustainability of MCoCer. Strategies that promote person-centred practice and sustain midwives in MCoCer were another key finding of the review. The CI equally identified that a supportive structure was necessary for work-life balance and that alignment of the organisation with a person-centred model was required to facilitate this. The team charter and framework were co-created to provide this contextually and personally relevant structure, helping to support the design and implementation of a sustainable model of MCoCer in NHS Grampian. The team charter and framework are both applicable and transferable to other midwives and regions, to support the sustainable implementation of MCoCer models elsewhere.


PACE, C.A. 2018. Co-creation of guiding principles and a practical framework for a midwifery continuity of carer model: a cooperative inquiry with midwives. Robert Gordon University [online], MRes thesis. Available from:

Thesis Type Thesis
Deposit Date Oct 10, 2019
Publicly Available Date Oct 10, 2019
Keywords Continuity of carer; Midwifery; Midwives
Public URL
Award Date Nov 30, 2018


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