Community midwifery care and social care pathways

Fiona Cross-Sudworth, Mandy Williams, Jason Gardosi

Research output: Contribution to journalArticlepeer-review


Background: Social issues are an important aspect of maternity care. In 2008, Birmingham Health and Wellbeing Partnership commissioned the West Midlands Perinatal Institute to conduct a regional confidential enquiry into perinatal deaths. As the majority of pregnancy care takes place in the community, a questionnaire accompanied the enquiry in order to give background information concerning workload as well as perceived confidence and competence of community midwives (CMWs) in giving care.

Aim: To investigate how well CMWs considered themselves able to deal with social issues and care.

Method: A retrospective total population semi-structured postal questionnaire about community midwifery was developed, incorporating workload and provision of care, as well as specific questions about social issues and confidence in making referrals or providing care. All community midwives (n=278) working in six large inner city maternity hospitals in the West Midlands between 2008 and 2009 were sent a questionnaire. As part of a confidential enquiry into perinatal deaths in the West Midlands, ethical approval was not deemed to be necessary.

Findings: A total of 213 (77%) of the questionnaires were returned. The majority of the respondents were experienced midwives; 153 (72%) had been qualified for over 10 years, although 71 (33%) had been working within community for less than five years. There was wide variation in knowledge of social care pathways, and in the confidence and compliance of their use. Pathways where CMWs had the highest knowledge were child protection, mental health issues, drugs and alcohol, smoking and teenage pregnancy. All of these areas had high rates of referrals. There was, however, a lack of knowledge of social care pathways for women with physical and learning difficulties, new migrants and asylum-seekers, and those claiming benefit and with housing issues. These areas had low referral rates, and referrals were not consistent with available care pathways.

Conclusion: There appeared to be a large disparity in social care offered by CMWs across the trusts surveyed. Many CMWs considered that they were not able to appropriately manage women with specific social needs, most notably new migrants or asylum-seekers and women with learning or physical disabilities. The study highlights the need for clear, standardised social care pathways, as well as training and ongoing support to improve quality and equity of care both within and across trusts. This may also increase CMWs’ confidence and competence to appropriately identify and support vulnerable women.
Original languageEnglish
Pages (from-to)15-21
JournalEvidence Based Midwifery
Issue number1
Publication statusPublished - 13 Mar 2015


  • community midwife
  • confidence
  • social care pathway
  • vulnerable women
  • referrals
  • community miudwives' perceptions
  • evidence-based midwifery


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