By Caroline Flint

Caroline Flint explains why mothers-to-be need to see the same midwives and consultants throughout their antenatal care. She describes how continuity is achieved in her own clinic

Last week I discussed ways of providing continuity of care by using the same medical attendants. I mentioned that women coming to consultant's clinics had the opportunity to ask to see their favourite doctor or midwife and that our midwives' clinic patients are allocated to a midwife. To facilitate continuity each midwife has a different coloured sticker which is stuck to the woman's notes.

When attending St George's midwives' clinic, mothers-to-be know who they are going to see and they can carry on the conversation where they left off on their last visit. Midwives enjoy getting to know their own patients and although we have not achieved mobility of staff throughout the unit, the antenatal clinic midwives often get messages from the labour ward or the postnatal ward `Jane Robinson is in labour, could Midwife Miranda pop up and see her please' or 'Phyllis James has had a little boy, could you tell Midwife Primo please'. So, Midwife Primo nips up to the labour ward to say hello and congratulations.

One of the most frightening aspects of labour for many women is that they will probably meet a total stranger when they enter the labour ward because, so far, most units do not operate a proper continuity scheme for maternity patients.

One way of overcoming this to some extent is for women to meet labour ward staff while they are still pregnant. At St George's, we encourage labour ward staff to come into the antenatal clinic to chat to women and introduce themselves. And when the labour ward staff are not busy they will do cardiotocographs on our pregnant women so giving them an opportunity to meet them.

In some units photographs of labour staff with names on, hang in the antenatal clinic so at least faces are recognizable.

Another feature of our clinic is the tours round the unit. At every clinic we organize a tour and many women go on the tour several times during a pregnancy. Usually our parentcraft sister takes pregnant women, their partners, their children and their friends for a tour of the labour ward to say hello to labour ward staff, to see the postnatal ward and specifically to talk to a woman who has had her baby that day so that they can see a very new baby and have an up-to-date account of labour. The tour gives women an opportunity to meet staff in the postnatal ward and the special care baby unit.

One way of achieving continuity in treatment is by using the nursing process in midwifery and in that way finding out how women feel about different aspects of their pregnancy.

At booking clinics we have a long interview with a midwife when each pregnant woman's obstetric and medical history is taken,' her family's medical history, any history of abnormalities or twins noted. Her last menstrual period, whether she smokes or drinks and what sort of food she eats - in fact all the usual questions but we also add several more questions so that we can get to know each woman as an individual. For example we ask:

• What would you like us to call you?
• Have you any brothers and sisters?

o What sort of births did your mother have? o How did she feed you all, breast or bottle? From these questions we can find out if there is any family history of disproportion or inadequate pelvis, but even more importantly, we can find out what this women's previous conditioning to birth has been. We can discover if she was the eldest of nine and in the house when her brothers and sisters were born or that her mother only had her and it was a very difficult forceps delivery.

• oAre both your parents well? o Do they live near you?

From these questions we can discover if the mother-to-be has experienced any recent bereavements.

• oWho will be able to help you when you come out of hospital with the baby?

This question will reveal how much family support the new mother believes she will receive.

We ask her about her job and whether she anticipates going back to work after the baby is born. We ask about her accommodation and whether she has enough room for a baby. All these questions give women an opportunity to think about some questions they had not thought about.

We also ask if the woman has been on the contraceptive pill and when she stopped. o Did she mean to become pregnant at this time?

• How did she feel about the pregnancy at first'?
• How did her partner react?

• Have you had anything to do with babies and little children before?

If the answer is no, an opportunity to handle a new baby while coming to the clinic can be helpful.

• Have you been in hospital before?
• How do you feel about coming here?
• Is there anything worrying you about being in hospital?

Specific requests can arise at this point and if written in the patient's notes will ensure continuity of treatment. For example, `Joan cannot bear blood tests, she agrees to have her booking bloods taken and her 36week blood test but she is not willing to have intermediate tests`.

• Is there anything else you would like me to write down about you?
• What about labour?
• Is there anything special you are hoping for? The nursing process could have been made for midwifery but I will explore this subject further next week.

December 22129 1982.