Continuity of carer: what matters to women? A review of the evidence

Objectives: to consider how 'continuity of carer' has been defined in the l iterature and to review the literature on what aspects of continuity matter to women, Design: structured literature review. Setting: the first objective was addressed within the context of a review o f the organisation of midwifery services in the UK; for the second objectiv e a wider literature was drawn on. Measurements and findings: data were systematically extracted from the iden tified 'core' studies on the methods used for assessing continuity of carer and on women's satisfaction with periods of care. Continuity of carer was found to be defined in these studies as fewer caregivers, either overall or during pregnancy, or as a known caregiver in labour, Little attention was paid to other possible interpretations of continuity of carer. The literatu re on what is important to women was found to have used four distinct metho ds and findings were consistent within methods. Studies comparing women who had and had not had a known carer in labour found no significant differenc es in satisfaction; those using rankings or ratings found that a known intr apartum carer was a relatively low priority and most of those using open-en ded questions found that few women mentioned continuity. In contrast, all s tudies which asked postnatal women whether a known intrapartum carer was im portant reported that those who had experienced it said 'yes: while those w ho had not, generally thought it unimportant, Key conclusions: there has been an emphasis in existing literature on conti nuity of carer but little attempt to assess continuity or quality of core. Limited definitions of continuity of carer have been used, There is no evid ence that women who were cared for in labour by a midwife that they had alr eady met were more satisfied than those who were not, Other aspects of woma n-centred care were likely to be more important, Women wanted consistent ca re from caregivers that they trust, but most did not value continuity of ca rer for its own sake. Implications for practice: limited definitions of continuity of carer seem to be becoming ends in themselves. This has particularly been the case with defining continuity as 'having a known carer in labour'. The available evi dence does not justify prioritising this definition of continuity - rather the reverse, This is important for both women and midwives since it opens u p other possibilities for organising services that put less strain on midwi ves' lives and may be equally satisfying for both women and midwives. (C) 2 000 Harcourt Publishers Ltd.