Relaxed and realistic During pregnancy

Relaxed and realistic During pregnancy
Women experiencing continuity of care are more relaxed, they know their medical attendants as friends, they are not embarrassed or reticent in bringing up personal fears or worries, they feel more confident, and their expectations for labour can be discussed and noted - with realistic prospects that these can be carried out at the time.

I believe continuity of care could be the most decisive factor in the future reduction of the perinatal mortality rate, and probably the most influential factor in enhancing the quality of the experience of giving birth for both the expectant parents and their child.
How can we achieve continuity of care in the hospital setting? Can it be done? I believe it can - but that it needs a radical rethink in our use of midwife hours, and that it needs very special midwives to start the scheme. I also think that initially, and perhaps subsequently, not all patients could be included in it.

Involvement
Here is my plan for a pilot scheme achieving continuity of care throughout the antenatal period and during labour and delivery, by a team of three midwives. Between them, they can give antenatal care to and deliver 468 patients a year, and following delivery they can visit their patients in the postnatal wards.

The midwives will be working flexitime, coming in to their patients when they are needed but having definite off-duty days and on-call days so that they can plan their lives in advance.
This pilot scheme is for continuity of care during the antenatal period and delivery, but obviously the ideal would be to carry the concept through into postnatal care too. I would welcome suggestions and comments on how this could be achieved.
Emma becomes the first continuity midwife. She has been employed specifically to inaugurate the scheme and thus she needs to be someone who is settled in her private life (she will need to be involved in the scheme for at least two years to see any results), she needs to be on the telephone and she needs a car for which she is paid at the standard user rate.
Emma will be employed for 40 hours a week or 80 hours a fortnight. She will control her own off-duty and may find it helpful to have a clock-on, clock-off card or a card she fills in with the times she comes on or goes off duty.

Let us imagine that Emma starts working in the antenatal clinic in March. In the first month, she books 36 patients who are 12 weeks pregnant (nine a week) and explains to them about the continuity scheme. The continuity patients are allotted 15 minutes for every antenatal visit and Emma does all their care except that on their visits at 16 weeks, 32 weeks and at term, the patients also see the consultant obstetrician. Emma takes histories, weighs the patients, tests urine, takes blood pressures, tests for oedema and palpates the women's abdomens.