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Table 1 The local context for introduction of CMC*

From: Implementing continuity of midwife carer – just a friendly face? A realist evaluation

Potential FacilitatorsPotential Barriers
Macro (organisation):
High level support for new model. Clinical outcomes relatively good but rising intervention and decreasing ‘normal’ birth drive the need to change. Women generally satisfied with care but want more opportunities to build relationships with midwives.Shortage of resources, funds & community-based facilities. Current systems embedded in and developed for the fragmented model. Midwives leaving and fewer attracted in – leading to local and national shortages.
Meso (practice context)
Experience varies by location but good AN continuity within some community teams, while others recognise a need to improve. High stress and poor work experience may facilitate change, i.e. midwives will want to work differentlyLack of consistent access to physical spaces for clinical practice. Increasing work load, poor work-life balance and high stress among midwives – may constrain change i.e. midwives feel too stressed or burnt out to consider change. Poor relationships within and between professional groups.
Micro (midwife, relationship with women)
Some midwives welcome opportunities to build relationships and for holistic, woman centred practice. Some have had experiences of CMC. Limited opportunity for continuity & developing good relationships in current model but wanted by women and some midwives. Newly qualified midwives have positive experiences of CMC during undergraduate education.Most midwives want to stay in fragmented model. Many express concerns about safety of new model (e.g. not having right skills in right place), its impact on personal life or that it will not be properly resourced. Most midwives comfortable with rostered shifts and managing their work within these distinct periods. Many believe relationships with women are already good, or that women get too much choice or expect too much. Many do not believe new model to be very different to current care or to offer better continuity
  1. * Macro = actions & interactions at organisational & managerial levels and with midwives & MDT at other levels; Meso = actions and interactions within the CMC team, between CMC and non-CMC midwives and others in the MDT; Micro = actions and interactions between women and midwives and individual midwife attitudes & beliefs. Source: informal discussions, stakeholder interviews, baseline survey