ABSTRACT
This chapter considers the research evidence underpinning the introduction of case load held models. Continuity of carer is a complex intervention which makes evaluation more difficult. The active ingredients may be the setting for community visits, the personal relationships, frequency of appointments, personnel involved or access to services. The Cochrane review of midwife led continuity models is the most cited source of evidence about outcomes. This systematic review extracted data from 15 randomised controlled trials across four countries, involving over 17,000 mothers and babies. McLachlan found that the epidural rate was significantly lower in women in the case load group than those having standard care. The reduction in epidural rate may impact on the type of birth experienced by women in a case load held team. Few studies have investigated longer term outcomes related to continuity of carer and outcomes relating to the postnatal care.
