By Caroline Flint

What have our children's education, going to the dentist and booking a dozen driving lessons got to do with midwifery practice? Caroline Flint reveals all, in a salutary lesson on continuity of care

Education is our most precious gift to our children - yet it is the aspect of parenting that has caused me more anguish and agony than any other. Like most caring parents we looked around at all the different schools available to our children - we chose the ones we thought would best fit the needs of the particular child. We encouraged each piece of work, we exclaimed over each piece of homework, we encouraged and assisted (when we were able to understand). We went to every parents' evening and tried to support every school activity, every sale, every outing, every fund-raising event. In fact we behaved like all the other parents who are reading this piece, as most caring parents behave when faced with the enormous responsibility of educating the adults of the future.

We hung on to every word the teacher said about our little darling. If she said `He's a nice boy', we were in ecstasies. If it was: `She's very uncooperative', we felt like all time failures. And then there's the influences they have - `Miss says you shouldn't send me to school with a cold; Sir says that Spurs will win the cup; Miss says could you please make sure I have a new gym skirt for after half term'. Oh, the agony of it all. I'm so glad that they are now too old for school.

Let us look at an another aspect of education. Just imagine that when your child comes home from school, she says: `We had a teacher called Miss Roberts today, she taught us about the fire of London' week.' The child replies: `Yes, but that was Mr Jones, Miss Roberts didn't know we had done it already. We've done France three times this term with different teachers'. Just imagine your child having a different teacher each day - having a series of supply teachers, never the same one twice. How would you feel? Would you complain? Would you try to improve the situation?

That's an extreme example. Imagine instead, going to the dentist with toothache and having a series of treatments. You were treated by Miss Jones, a very pleasant Australian woman who discussed what she was going to do. For your second treatment you find that you are to be treated by Mr Smith, an elderly and rather abrupt man, who hardly speaks to you. For your final treatment it may well be Mr Singh who tells you that instead of this being your last treatment, you have to come back again.

Imagine booking 12 driving lessons and ending up with a different instructor each week - each emphasizing different aspects of driving. If you complain to the manager of the driving school he says you are being difficult and that everyone else manages with a different instructor each time. You ring another driving school and ask them about their instructors - yes, they have 12 and you are likely to have each one if you have 12 lessons, but don't worry they all work to the same policy, they all try to say the same things.

I hope these examples are ringing bells. I am , of course, trying to give an example of what it is like for most women having a baby in 1986 in most maternity units. Research into the Know Your Midwife scheme on providing continuous care by one midwife showed that many women in the control group coming for 14 visits to the antenatal clinic saw 12 different care-givers and some saw 14. They never saw the same person twice. When they went into labour, they met more care givers, and all this at a time of heightened awareness, heightened sensitivity, when they were feeling vulnerable and fearful. Is it right'? Is it inhumane? Or just inexcusable?

I was sitting in an antenatal class one Monday evening and one of the prospective fathers said something. When I had answered, he said very perceptively: `Of course, we wouldn't need to ask you half these questions if we knew which midwife was going to be with us during labour.`

How right he was. If he and his partner knew which midwife was going to be with them during labour they could discuss directly with the midwife how she felt about the aspects of labour they are most concerned about; what she feels about episiotomies, sytometrine and epidurals; if she will deliver the baby onto it's mother's tummy and leave the cord until it has stopped pulsating, if she is happy to leave the membranes unruptured unless there is some strong reason for rupturing them.

How hard it is for parents when you never see the same person twice, when you hear a midwife saying: `I don't like to think of these intense relationships with parents. I like to think I work in a team, which includes obstetricians, physiotherapists, health visitors, nursery nurses, auxiliaries, domestics and students. We all say the same, we all work to the same policy."

Remember the 12 different driving instructors, and imagine what this team would be like for the woman on the receiving end. In the Know Your Midwife research we found that 43 per cent of women in the control group had 3-4 different midwives with them in labour and these were different from those they had met antenatally.

One observation made in a study of pregnant women was: `She would like, if possible, to have someone around during labour who had given her some antenatal care." Isn't it time we recognized the inadequacies of our fragmented system and made sure that women have continuity of personnel during the childbirth continuum?

Micklethwaite, L., Beard, R., Shaw, K. (1978). `Expectations of a pregnant woman in relation to her treatment.' British Medical Journal; 2: p.188.

May 14, 1986