I Bird’s scientific contributions

Background The majority of maternity care is provided in the community, yet there is little information regarding the workload, stress level and performance of the community midwife (CMW).Method Survey of 278 CMWs serving six large maternity units with a total annual birth rate of ca. 35 000. Anonymous, semistructured questionnaires were used to obtain both quantitative and qualitative data.Results213 questionnaires were returned (response rate 77%). The average caseload of respondents was 154. High or very high stress levels were reported by 118 respondents (57%). They also tended to have long working days, with an additional 5 h worked per week. 97 (47%) were dissatisfied with support received from their own Trust. Many expressed difficulty in performing well, achieving only a suboptimal level of service for the women they were caring for: only 63 (31%) felt able to prepare women appropriately for birth and 113 (54%) thought that they were able to give sufficient support to breastfeeding mothers.ConclusionCMWs appear to work under substantially high caseloads, which in this survey was more than 50% above the recommended level.1 This was associated with long working weeks, high stress levels and a feeling of insufficient support from the employing Trust. There was a wide perception by CMWs that the level of care they provided was suboptimal as a result. Quality maternity care requires better attention to appropriate workforce levels and support for midwives working in the community.

Background Good community based maternity care requires clear care pathways and confidence in their application. The authors wanted to investigate how well community midwives (CMWs) considered themselves able to deal with a set of problems.Method Survey of 278 CMWs serving six large maternity units with above average levels of deprivation. Anonymised semistructured questionnaire included questions about 12 areas of care. Results were expressed as the proportion of CMWs who reported that they were unaware or unsure of a care pathway, and those who were not confident or unsure about that particular area of care.Results213 questionnaires were returned (response rate 77%). There was wide variation in presence of care pathways and confidence levels for different tasks, with better results for smoking, drugs & alcohol and mental health issues, and poor rates for issues such as poverty, housing, migrants & asylum seekers and women with physical and learning difficulties (table).Unaware or unsure of a care pathway (%)Not confident or unsure in providing care (%)Smoking cessation22.83.4Drug/alcohol misuse17.527.8Obesity46.550.0Poverty89.057.0Inadequate housing90.867.1Non-English speaking migrants68.528.3Asylum seekers84.974.0Mental health problems12.718.0Teenagers25.911.1Child protection issues5.313.0Domestic abuse23.233.1Physical or learning difficulties77.276.Conclusion There is an urgent need for standardised care pathways and better training to cover all areas of need, including those characteristic of deprived areas, to allow CMWs to deliver an equitable maternity service.