From this September, One to One Midwives, an NHS commissioned service, will be providing additional maternity care options for women in North East Essex.

Following successful pilot schemes in several other regions, One to One midwives will work alongside NHS healthcare teams, including obstetricians and health visitors, to offer women a free, personalised service within their own community.

Essex Baby speaks to Joanne Parkington, founder and clinical director of One to One, to find out how this service could benefit women and their families in Essex.

This may be the first time some member of our community have heard of One to One Midwives. In a few sentences, could you sum up your ethos and what you aim to offer expectant mums?

One to One Midwives provide a community based midwifery service with continuity and choice at the heart of everything we do.  When a woman first accesses One to One she is allocated a named midwife who will be the lead caregiver throughout her pregnancy, birth (if she chooses a homebirth) and for 6 weeks of postnatal care.  The One to One midwife will be available over 24 hours a day, 7 days a week and when she is on holiday her ‘buddy’ will be available instead.  Care takes place in the women’s homes at times to suit their needs and the vast majority of visits take place in the evening or at weekends to ensure that partners are also active participants in the care.  There are no limits to the number of visits and the woman and midwife will agree how often the visits should take place to meet the individual needs of the family, not just based around routine or traditional care models.

Experiences of NHS maternity care in Essex varies greatly between women. Some report excellent continuity, with the same community midwife caring for them before, during and after their baby’s birth. Other say they saw a different midwife at every visit. Does your service guarantee an allocated midwife?

Once a midwife is allocated she will become the primary caregiver and will only handover care if she goes on holiday.  Care may be shared with a ‘buddy’ for this reason but the woman should only ever see a maximum of 2 midwives throughout her antenatal and postnatal care.  Our latest audit showed that women received 92% of their care from their named midwife and for those women who chose a homebirth 78% were attended by their named midwife.

Does your service include full antenatal screening? What happens if complications arise?

One to One provides all the screening that every woman is entitled to should she choose.  These include scans and blood tests as well as newborn screening after the birth.  If complications arise, One to One will refer to an appropriate specialist, which may include an obstetrician etc.  This will be with the full consent of the woman and if necessary care will then be ‘shared’ should the continued support be required from the wider multi-disciplinary team.

Which areas in Essex will your service cover, and how will it be rolled out?

Currently One to One will commence our service in North East Essex from the beginning of September.  We have just recruited 4 more midwives who will start with us from October onwards so we will roll out the service dependant on the number of women who access our care and where they live.  If women wish to book with us from outside of North East Essex we will liaise with the commissioners in their areas to ensure that we can accept women into our care and will recruit more midwives if the demand in these areas increases.

Will all expectant mothers in these areas be able to access your maternity services? Is there a set criteria that must be met?

One to One can accept any woman into our care – there are no restrictions.  If a woman requires additional support we will work with the appropriate professionals to ensure that women have access to the wider multi-disciplinary team and receive seamless, integrated care.

Will you also be running parent education classes or support groups in Essex where expectant mums can meet other women/couple who are at a similar stage in their pregnancy?

One to One provide parent education and in the future, we will be providing free hypnobirthing courses to all women who book with us.  We also encourage social groups, particularly for breastfeeding support after the baby is born, but we aim to facilitate coffee mornings for any woman to ensure that there is a strong network and support system for them.

Do One to One Midwives offer any alternative or complimentary therapies, such as hypnobirthing or reflexology?

The majority of our midwives receive hypnobirthing training and we support and facilitate additional training for those midwives who wish to use it in complementary therapies.  In the North West region we have midwives trained in reflexology and aromatherapy and they provide regular clinics for all One to One women.  We also partner with existing organisations to ensure that women have access to these in their areas, for example for aquanatal and pregnancy yoga.

Approximately, how many women do you expect will benefit from this service in Essex over the next year/five years?

One to One are a choice option for women in the area.  This will depend on how many women want to access this service but we would hope that we are available for any woman in the area who would choose this model of care for many years to come.

Do your midwives attend hospital births? Are NHS midwives supportive of their practise?

One to One midwives do not have access to the hospital as the lead caregiver but a One to One midwife may attend a hospital birth as a support/advocate for the woman.  One to One midwives have been ‘NHS’ midwives and they have all trained in the NHS.  Most midwives will support this model of care as it is seen as ‘true’ midwifery but caseloading is not a career choice for every midwife and sometimes there can be cultural differences that can be challenging to overcome.

With all the fantastic rewards offered by your model of care, what sort of safeguards are in place to prevent midwives from becoming over-loaded? Is there a limit to how many cases each midwife will be assigned at any given time?

Each One to One midwife cares for a caseload of 40 women at any one time.  This can be challenging but each midwife is in control of her own working day and flexibility and is often the key to ensuring that midwives do not become burnt out.  All the midwives are supported by a close team and there is a robust organisational structure to ensure that wider support is also available should the midwife need to access it.  Midwives also receive 10 weeks annual leave a year and they have ‘protected time’ off each week that is agreed with their ‘buddy’. 

Concerns have frequently been raised in the media about the privatisation of the public services, how does your team feel about working outside the NHS?

One to One are not ‘privatisation’ of the NHS at all.  The definition of privatisation does not apply to the NHS – it is more suitable to say that contracts are out sourced by the NHS to the independent sector.  One to One are given the opportunity, through a short term fixed period contract, to provide services under the NHS.  One to One are also a ‘choice’ option – we are not guaranteed any women. Women only come to us, and will stay with us, if we provide them with the service that they want.  We do not have the ‘guaranteed’ workload that other NHS providers have – so we have to be good or women will go elsewhere!

 The One to One midwives and the rest of the team, have either trained in the NHS or worked in the NHS.  I think it is very telling that the employees have also ‘chosen’ to work for an organisation that meets their needs and is a choice for them also!  One to One offer benefits within their employment such as flexibility of working and control over your working life, the ethos of the organisation will also impact on whether someone wants to work for us or not – at the moment I am delighted with the workforce.  One to One has a strong, dedicated and committed workforce and a recent staff survey demonstrated that nearly 90% of the workforce love coming to work!

 For more information about One to One midwives visit: http://www.onetoonemidwives.org/