The continuity relationship makes caring for women with anxiety and depression easier, but it is also a heavy responsibility

Background: Perinatal depression and anxiety, experienced by about 20 % of women, are a risk factor for associated morbidities for mothers and babies, including risk of suicide and preterm birth. Traditionally this group of women have not been able to access midwifery continuity of care despite the known benefits. 

Aim: This study aims to explore the experiences of midwives providing continuity of care to women with perinatal mental health disorders and women's experiences of receiving care in a continuity of care model. 

Methods: We used a mixed methods design incorporating a qualitative exploratory study using a qualitative descriptive approach [1] to understand midwives experiences. We also explored the women's experience of receiving continuity of care and observed mothers interacting with their babies. The quantitative data was collected using the Parenting Interactions with Children Checklist of Observations (PICCOLO) [2], described in detail below, to measure these interactions. 

Results: Two overarching themes were generated: Continuity is protective, with subthemes Safe in their hands, Healing from previous trauma and Sustaining breastfeeding; and Having exceptional care deserves equitable access, with sub-themes Having your choices respected, Having a meaningful birth experience, Providing exceptional care requires support. 

Conclusion: This study adds to current literature that indicates midwifery continuity of care as emotionally protective, which is particularly important for women with perinatal mental health conditions and may have ongoing positive effects that foster wellbeing. Experienced as providing ‘exceptional’ care, our findings demonstrate an urgent need to increase access to such models, and ensuring midwives have equally ‘exceptional’ training, support and referral pathways, to ensure their sustainability.