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The logistics of this enterprising scheme, which was designed to improve communication and care in pregnancy, are reviewed The `Know Your Midwife' scheme was conducted at St George's Hospital, Tooting from April 1983 until August 1985 - it was a scheme designed to combat the very real complaint of pregnant women going through the usual GP/community midwife/hospital doctors / hospital doctors/hospital midwives `I never see the same face twice` syndrome. Four midwives (who happened to be hospital based) undertook the responsibility for caring for 250 women a year, they agreed to provide all antenatal care - referring women to a hospital doctor if any complication developed and having an agreement to refer all women to their consultant obstetrician at 36 weeks of pregnancy. One of the four would be with the woman throughout her labour and the four would provide the provide the bulk of postnatal care. The whole idea was that the women cared for in this way would get to know `their' four midwives and would have the security of knowing that at whatever stage of the childbirth continuum they were, they would have a care giver they knew with them. The `Know Your Midwives' started by inviting women to join their scheme by letter. With the letter they sent a photo of the four of them - with details about themselves underneath the photo - whether they were married, had children, liked sport, enjoyed music, where they lived, their interests - all this was designed as a way to help the women in their care get to know the midwives better, and it also seemed to put the relationship on a more even keel. If I know intimate details about you, such as whether you have ever had a termination that no-one else knows about, or whether you regularly get cystitis - it seems only fair that you should know something more about me, even if it is very nonthreatening information such as the names of my children and that I like going to the theatre. The four midwives worked a rota which mainly had two duties - the early shift when the midwife would be on duty from Sam, when the midwife would come to the postnatal ward and do postnatal nursings on the women from the scheme (usually about four women) and then she would go out into the community and do postnatal checks on women from the scheme who had gone home (she would see approximately four women), meanwhile the women on the ward would be looked after by the regular postnatal ward staff. The midwife on early shift would then come back to the hospital to run an antenatal clinic at which she would see five to six women at half hourly intervals. If she ever needed to refer a woman to a doctor, the clinic was in the hospital and she could just bleep whoever was on call. The midwife on an early shift came off duty whenever she had finished which was normally between 4 and 5 pm, but at weekends was more likely to be about 1.30 - 2 pm because no antenatal clinic was held at the weekends. The other duty the `Know Your Midwives' worked was an `On Call' shift which lasted from 7.45 am until 7.45 am the following day - a full 24 hours. The midwife on call would carry a bleep and she would be on call from her home - the `Know Your Midwives' were on call seven times every three weeks and they reckoned that for three of those periods they would not be called at all, but of course this was not guaranteed and some midwives seemed to be always called and others hardly ever. If the `Know Your Midwife' was not called by a woman in labour/with a query/wanting to change her antenatal appointment/worried about the baby, she would only come into the hospital from 4 - 7 pm when she would check and help the postnatal women from the scheme in the postnatal ward, she would also do any community evening visits that needed doing.
On a Wednesday was a duty which was worked on that day and no other - 1-9 pm, when the midwife would come in to do an antenatal clinic which ran from 1.15 - 9 pm and at which she would see 19 women with 20 minute appointments, with the `Know Your Midwife' working on an early shift who saw five to six women, between them they saw 25 antenatal women. The clinic on Wednesdays had a break in it from 4.30 - 6 pm when all the `Know Your Midwives' would gather, have a cup of tea, eat mountains of chocolates and discuss women they were concerned about, women they were due to deliver and what sort of labour and care they were hoping for, they also took this opportunity to exchange ideas, swap off duty (which they knew for about six months in advance) and get to know each other very well, this enabled a very supportive and cherishing atmosphere to develop. Each midwife kept a record of the amount of time she had worked, if she was on call but not called, she would write down three hours for that day if she went to the postnatal ward from 4 - 7 pm. If the midwife was called to someone at 8 am and worked through until 8 pm with only a half-hour break, she would write down 11.5 hours, at the end of the month all the hours were totalled and those midwives who had worked more than 150 hours in a 28 day period were repaid their time. In the sample of duty (Figure 1) the spaces marked X are when midwives are being paid time back. OC = On Call. E = Early Shift, a half = early shift which finishes early, D = Day Off, AL = Annual Leave. Alongside the operation of `Know Your Midwife' scheme a research project was set up to evaluate what happened to women looked after almost exclusively by midwives who they had been able to get to know. Women were looked after in labour by someone they knew and this was much appreciated. May 1986 |
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