|
|
Continuity of care has been the ruling passion of Caroline's professional life and this section bears witness to her ceaseless promotion of the concept over a period of fifteen years. The earliest article was written in 1979, shortly after Caroline had qualified as a midwife (having interrupted her training for 12 years whilst bearing and caring for her three children). She had immediately gone to work as a community midwife and had promised herself that she would work to change the face of maternity care within a decade. These articles trace Caroline's thinking regarding continuity of care as it developed over the years. In 1979 she outlined a hospital-based scheme in which three midwives would provide care for 468 women per year throughout the antenatal and intranatal periods! (`A continuing labour of love'). This scheme was based on antenatal consultations lasting fifteen minutes and labour care averaging eight hours; unsurprisingly both calculations were revised thereafter. The scheme is presented in intricate detail, as are those which followed, and it is obvious that many, many hours of Caroline's life have been spent laboriously working out off-duty and holiday rosters and on-call and antenatal clinic schedules, with the idea that ready-devised packages were more likely to appeal to the sceptics amongst her professional colleagues. The fact that Nursing Mirror made `A continuing labour of love' its cover article nonetheless suggests that continuity of care was an idea likely to touch a chord with many midwives. In late 1981, shortly after getting the job of antenatal clinic sister at St George's Hospital in Tooting, Caroline wrote a series of four articles for Nursing Mirror in which she suggested a variety of ways in which continuity of care could be realized. Though still hospital-based, these schemes did carry continuity through the postnatal stay in hospital, and a more realistic woman to midwife ratio of 50-60: 1 per year. In addition to citing an improved experience of care for women, Caroline now also proposed that continuity of care would provide midwives with greater job satisfaction and also prove beneficial in financial terms, as well as possibly in terms of perinatal outcome. At that time Caroline still saw her scheme as forming only a small service alongside conventional care within a maternity unit `because it is too complicated and because high risk patients need more care by doctors' (`Emma, Joan, Liz and A.N. Other'), a view she was to abandon by the time she helped reorganize care in Westminster and Kensington seven years later (`Riverside Midwife Teams'). She even gave half-hearted approval to the idea of teams of 15-16 hospital-based midwives formed around a consultant (`Small is intimate'), a model of care that was to give her the screaming ab-dabs by 1987 (`In search of continuity of care'). Meanwhile Caroline had taken on the job of antenatal clinic sister at a large London teaching hospital. Whilst still waiting to persuade someone to let her pilot a continuity of care scheme and to give her the necessary financial backing, she set about trying to improve conventional antenatal care and to introduce more continuity into the system. A series of nine articles describing her many and various ideas appeared in Nursing Mirror during the winter of 1982/ 83 (`Where have we gone wrong?'...`Encouraging feedback'). Public disgruntlement at maternity care has been picked up and projected by the media, and several thousand people had even gathered to demonstrate against one consultant's policies outside the Royal Free Hospital earlier in 1982. The fact that many of the ideas that Caroline put forward-taking histories in women's homes, birth-plans, midwives' clinics-were `radical' goes to show the extent to which public disquiet was justified. The introduction of even a modicum of continuity into women's maternity care was not going to be easy. In 1983, the effort Caroline had expended in developing a research proposal and applying for permission and funds to carry out a randomized controlled trial investigating continuity of care from a team of four midwives paid off. South West Thames Regional Health Authority and the Wellington Foundation awarded her the largest research grant ever made to a midwife in the UK. A number of articles outline and report on this original `Know Your Midwife' (KYM) scheme, as it was named. Four midwives (though six midwives were actually involved over the two years of the trial) successfully gave care to 250 women a year from 1983-1985. The KYM scheme was a watershed in midwifery and in Caroline's own life. It achieved what it set out to do in terms of the parameters of the study but all had not been plain-sailing. The report which appeared in Nursing Times in 1985 titled `Labour of love' bears witness to some of the problems encountered by Caroline and her colleagues. Amongst these were disagreements with midwifery managers over the visiting of clients at home in early labour. This was eventually forbidden much to Caroline's despair. Another source of despondency was the suspension from practice of one of the team midwives over the unavoidable death of a baby. Somehow Nursing Times was persuaded to erase this midwife form the cover photograph on the edition in which `Labour of love' appeared, leaving Caroline in tears of frustration, sadness and anger. Furthermore, despite the positive findings of the KYM report, very few continuity of care schemes were developed in the years immediately following. In 1987, Caroline was publicly lamenting this fact (`How the midwife's role needs to change'). She herself, somewhat at a loose-end professionally, had gone into independent practice and undertaken the Advanced Diploma of Midwifery once the project had been completed. She was also, at this time, describing herself in the bits of biographical blurb accompanying her various articles as an independent midwife `looking for a post in the Health Service where she can set up teams of midwives so that all women will know their midwives throughout the pregnancy and the postnatal period'. Riverside Health Authority took her on as a midwifery consultant shortly afterwards and with her help established what is probably, at the time of writing, the most fully developed system of team midwifery within the National Health Service. In 1991 Caroline was appointed as one of two midwife advisors to the House of Commons Health Committee meeting under the chairmanship of Nicholas Winterton MY to investigate the maternity services. The Winterton Committee's report of 1992 and, to a lesser extent, that of The Expert Maternity Group in 1993 represent the apotheosis of much of Caroline's long held vision for maternity care. Nonetheless, her the time of the most recent article in the section (`Hailing a new philosophy'), she had come to see continuity in terms of midwifery caseloads whereby each midwife would care for 35 or 36 women a year and work in a partnership with one other midwife with a similar caseload. During the years she spent at home caring for her children, Caroline had been a regular contributor to her parish magazine. It meant that by the time she relaunched herself into midwifery, she had developed the skill and zest for the written word which have been so essential to her vowed aim of radically changing midwifery. Her original time-scale of ten years may have been too optimistic but Caroline has made a vital impact on the profession she is so passionate about, and her willingness to put pen to paper (or fingers to keyboard) has been crucial in this. In no area is this more apparent than in continuity of care.
|
|