Marylou Carr - Continuity of Carer Midwife

What does your job involve?

Continuity of Carer (CoC) is a unique and rewarding role, embodying the best of midwifery. It involves providing care for women and their families throughout the pregnancy and birth experience, this covers:

Antenatal Care:
As part of my role, I provide antenatal care in community clinics within our caseload. Families can easily contact their named midwife through phone calls, texts, and emails, fostering a strong relationship built on trust and familiarity. One of the key advantages of working at UCLH is access to a well-resourced institution with world-renowned professionals. However, it can be large and challenging to navigate. Having a CoC midwife allows women and their families to have a dedicated liaison and advocate who can guide them through the system while delivering personalised care.

Intrapartum Care:
I also provide intrapartum care, staffing the birth centre during 12-hour call shifts. While not all women in my caseload choose the birth centre or remain there throughout their labour, ideally we try to attend their births, whether at the birth centre or on the labour ward if a transfer occurs. Additionally, I support families opting for home births, ensuring continuity of care across settings.

Postnatal Care:
Postnatal care is provided both through home visits and community clinics after the family leaves UCLH or following a home birth. Visits vary depending on the family's needs, offering another opportunity to maintain continuity of care and support.

What does a typical day look like?

There is no "typical" day in this role due to its variety. However, here’s a glimpse of my week:

• Clinic Day: I have one day per week that is dedicated to clinics at the Amwell Group Practice, a fixed point in my schedule.
• Visits: On other days, I may conduct community visits to assess mothers and babies, provide breastfeeding support, weigh newborns, and perform newborn blood spot tests. These visits also include emotional and physical assessments of mothers, identifying additional support, needs, and creating follow-up plans.
• Specialised Clinics: I may run baby-only clinics, performing Newborn Infant Physical Exams (NIPE), which are required within 72 hours of birth.
• Antenatal Classes: Some mornings are spent facilitating antenatal Zoom classes, followed by afternoon clinics at Great Ormond Street Hospital (GOSH) for women whose children require specialised care.
• Booking Visits: I conduct comprehensive first antenatal visits for women in the community, which are essential to establishing care plans.
• Birth Centre Shifts: On birth centre shifts, I care for low-risk women during labour, birth, and postpartum, ensuring holistic care through all stages.

Each day requires flexibility, teamwork, and adapting to the needs of the community and the team.

What are the main challenges in your role?

One of the key challenges is acting as a liaison within a large institution and advocating for women and their families. Navigating complex systems while ensuring families feel supported requires resilience, flexibility, and a passion for problem-solving. Additionally, the diverse roles within CoC midwifery demand adaptability and a willingness to embrace change, which can be both rewarding and demanding.

What do you most enjoy about your role?

I thrive on the challenges that come with this role. Building meaningful relationships with families and supporting them through life-changing experiences is deeply fulfilling. I also value the multidisciplinary nature of my work, collaborating with a skilled and supportive team to deliver exceptional care.

How did you become a Continuity of Carer midwife?

I trained as a midwife in the USA, where my professional experience aligned closely with the CoC model. When I joined UCLH, I worked across various maternity departments, but the CoC team felt both familiar and rewarding. It allowed me to build on my experience of providing holistic care in community clinics and birth centres.

What skills do you need for your role?

Curiosity, compassion, and engagement are essential for a CoC midwife. You need to adapt to changes in care, embrace challenges, and thrive in a dynamic environment. Strong communication, organisation, and advocacy skills are also critical.

What are your career ambitions?

With a long and diverse career as a midwife, I aspire to continue strengthening the profession and improving care for women and families.

What advice would you give to someone thinking about a career as a Continuity of Carer midwife?

• See your team as a resource—you don’t need to know everything but must be willing to ask for support.
• Be proactive and organise your time effectively.
• View yourself as an advocate for the families you care for.
• Stay updated on your skills and knowledge to provide the best care possible.