Caseholding as a Student Midwife

This blog has been adapted from an article written for the Student Nursing Times.

April 2020.

I have just come to the end of a Caseholding placement on my Midwifery degree. This has involved working under indirect supervision to care for a small casehold of women where I have provided antenatal and postnatal care at home, and intrapartum care at their chosen place of birth. It’s the culmination of a lot of hard work for myself and my 1709 colleagues. We have been looking forward to this opportunity since applying to study and over the past year our placements have all been geared towards this. Over the autumn and winter I was signed off to provide care under indirect/minimal supervision for low-risk women; which has enabled me to work with a small number of women very closely during this uncertain time, supported by Supervisors who have overseen all that I have done.

Caseholding Midwifery care is a bit of a buzz phrase at the moment, although women have no doubt sought out ongoing care from other women from before we began documenting it, the professional notion of Continuity of Carer was only formalised as a concept relatively recently. Many midwives see it as the ultimate goal of the profession, and others who are more comfortable with the modern application of maternity care see it as unachievable and unrealistic.

However, women themselves report very high levels of satisfaction with this model of care, and it is associated with better maternal and neonatal outcomes. Considered the ‘gold standard’ of midwifery care, and also the most highly requested service by women themselves, continuity of carer involves midwifery care provided to a woman by a named midwife – antenatally, during labour and birth and postnatally. This facilitates relationship building and also enables midwives to become tuned-in to the women they care for – picking up early signs of the need for specialist involvement. One midwife I worked with told me she could recognise the babies she cared for by the sounds of their fetal heart tones, and if this is an achievable skill just imagine how powerful it would be to have that midwife with you during labour and birth, when heart tones are often used to assess fetal wellbeing. Although anecdotal, this example always stuck with me as a reminder of the importance of relationship building between midwife and mother.

What the opportunity of Caseholding has meant for me is that I have walked alongside women during the global health crisis (Covid) and during the many changes we are witnessing today. I have seen anxiety when women worry they will have to birth without a birth partner and they have experienced concern when their midwifery contacts have been reduced to essential visits only with phone consultations replacing many face-to-face visits. However, I’ve also seen the beginnings of realisation that many of the interventions that medical maternity care offers, for example fetal heart tone screening, are not as valuable as maternal instinct and dedicated midwifery care, for example using fetal movements as an indication of baby wellbeing. If this health crisis can place a tiny bit of the power of pregnancy and birth back into the hands of women, at least that is cause for celebration.

I have shed more than a few tears this week as I have said goodbye to the women I have cared for and their beautiful new babies, as well as the midwives who have supported me throughout twenty weeks of placement over two years. I hope that the care that I have offered has been valuable and worthwhile as I have gained so much from being a professional companion to these women. I feel as if I am finishing when I have only just begun.

We don’t yet know what the future holds. On the usual degree programme we would have a university block followed by twelve weeks in placement as per NMC education policy. However, many universities are facilitating the national voluntary call-up of students (nursing and midwifery) in their final six months to supported but non-supernumerary NHS positions. It is unclear how the University I attend intends to proceed, and many of us worry that we will need to defer or delay finishing.

It is uncertain times for a student midwife, as well as the women she cares for!