One-to-one midwifery practice part 4: sustaining the model

Abstract

This article, the last in a series of four looking at the implementation of a case load (CL) midwifery scheme, examines issues around the sustainability of the model. It is based on a data collection period of 46 months, from the inception of the scheme following Changing Childbirth (Department of Health, 1993). The CL scheme now operates as part of the mainstream local service, and has recently been extended across the local community service. This article focuses mainly on problems and an analysis of the motivations of midwives who left, as the previous article looked at the meaning of CL midwifery and discussed the considerable rewards and satisfaction the midwives’ experienced. Here we discuss the main factors in midwives’ decisions to leave and how far these might be linked to the context of their work, the features of a pilot scheme or more enduring features of working with a personal CL.