The data from the studies was extracted verbatim into the JBI format (Appendix C) Table 5 presents the descriptive characteristics and Table 6 the methodological approaches of the seventeen studies selected for the review.
Four countries are represented across the studies UK (n=3), Australia (n=7), Denmark (n=1) and New Zealand (n=6). Gilkison et al. 2015; McAra-Couper et al. 2014 and Hunter et al. 2010 report on different aspects of the same study and were all included for their individual contribution to the review aim. It was surprising that no studies emerged from the Netherlands as continuity of carer is the predominant model of maternity care. The definition of continuity, provision type and women cared for (Table 5), was a significant characteristic which related directly to the findings of each study. The relevance of these definitions in relation to the findings are identified in the Discussion
Table 5: Summary of descriptive characteristics of the included studies
STUDY NO. STUDY DATE AIM SETTING CONTINUITY PROVISION PARTICIPANTS
1 BROWNE ET AL. 2014 Continuity experiences of student midwives
Australia All risk student Caseloading (30 women over 3 years)
15 final year students, 14 RM mentors of graduating students,6 maternity managers
2 COX AND SMYTHE 2011 Experiences of three LMC midwives leaving practice
New Zealand All risk Caseloading 3 LMC midwives with 5-11 years experience who left practice 6months-3 years before interviews 3 CUMMINS ET AL. 2015 Experience of newly qualified midwives in
continuity models
Australia Various models (MGP, caseloading, integrated) mixed settings, risk not clear
13 NQ midwives (2ACT, 8NWS, 3 South Australia) working in CoCer models
4 DONALD ET AL. 2012 Investigating work-life balance of caseloading midwives to develop solutions to improve
New Zealand All risk Caseloading 16 LMC midwives (including lead researcher)
5 EDMONDSON AND
WALKER
2014 Experience of midwives providing caseload care and how they maintain work-life balance
Australia Low risk Caseloading (40 women) 7 midwives ages 40-60 with 3 years or less in CoCer models
6 ENGEL 2003 Experiences of LMC midwives caseloading New Zealand All risk Caseloading 5 midwives from MGPs 7 FEREDAY AND
OSTER
2010 Exploring how midwives achieved work- life balance in a continuity of carer model
Australia Low risk Caseloading (40 women) 17 midwives 3months-2 years experience in CoCer MGP 8 GILKISON ET AL. 2015 What sustains on-call, caseloading Lead
Maternity Carer (LMC) midwives in New Zealand
New Zealand All risk Caseloading 11 LMC midwives 12-20 years experience in practice
9 GRAY ET AL. 2013 Explore the follow-through experience from a student midwife perspective, to identify learning and identify personal impact
Australia Student Caseloading, 10-30 women, mixed settings, risk unclear
28 students (11 1st year, 9 2nd year,
4 3rd year and 4 graduates
10 HUNTER ET AL. 2016 What sustains LMC midwives in midwifery practice over time
New Zealand All risk Caseloading 11 LMC midwives 12-20 years’ experience in practice 11 JEPSEN ET AL. 2016 Advance knowledge about the working
and living conditions of midwives in caseload midwifery and how this model of care is embedded in a standard maternity unit
Denmark All risk Caseloading (typically pairs, 1 week on call, 1 week off 60 women per year
12 caseloading midwives in observational study +1 for semi- structured interviews
12 MCARA-COUPER ET AL.
2014 To understand what sustains on call case- loading LMC midwives who have practised as LMCs for at least eight years
New Zealand All risk Caseloading 11 LMC midwives 12-20 years’ experience in practice
13 MCCOURT AND STEVENS
2006 An ethnographic study of the experiences of midwives in a caseload midwifery practice (setting up and sustaining)
UK All risk Caseloading 40 women/year in MGP buddy pairs in a team of 6
36 caseload midwives
14 MOORE 2009 Experiences of midwives commencing a new MGP
Australia Low risk caseloading within MGP of 7 midwives
7 midwives in MGP
15 NEWTON ET AL. 2016 to explore caseload and standard care midwives’ experiences of midwifery work in two new caseload models in Victoria
Australia Caseloading- risk status unclear but likely to be low risk from included quotes
14 midwives aged 30-50 years with 1-15 years’ experience initially, 1 midwife on Mat leave at 2 years 16 RAWNSON 2011 Experiences of caseloading for students
and how this has impacted their learning to becoming a midwife
UK Student caseloading 1-18 women during final 18 months of course. Risk status unknown as caseload selected by students
8 final year students aged 23-50 from 5 NHS Trusts
17 SANDALL 1997 To examine the impact of changing childbirth on midwives’ work and personal lives across 3 sites providing continuity on a continuum
UK All risk caseloading, MGP of 6 caseloading and traditional midwifery care.
48 midwives 7/7 MGP, 22/28 team continuity, 19/23 traditional community practice
Table 6: Summary of methodological characteristics of included studies
STUDY METHODOLOGY SAMPLING METHODS DATA COLLECTION DATA ANALYSIS
BROWNE ET AL. Qualitative descriptive Recruitment strategy not explicit Focus Groups (1 student, 3 MWs/managers) and Interviews. Not clear if
structured/unstructured
Descriptive thematic analysis by independent researcher and confirmation of final themes with reference group
COX AND SMYTHE
Qualitative interpretative informed by
phenomenology
Purposive sampling (conscious sampling by researcher)
Unstructured in-depth interviews Constant comparison method- Manual identification and grouping of themes
CUMMINS ET AL.
Qualitative descriptive Purposive sampling strategy of NQ midwives followed by snowball sampling
Semi-structured interviews face-to- face, telephone or skype
Thematic analysis using NVIVO software to code into groups and identify themes
DONALD ET AL. Cooperative Inquiry (Action Research)
Open invitation through NZ College of Midwives Journal
Focus groups audio recorded with consent
Recordings transcribed verbatim and manually grouped by researcher
EDMONDSON AND WALKER
Grounded Theory Purposive sampling through invitation to midwives working at a birth centre
Individual semi-structured face to face interviews lasting 30 minutes
Individual recordings transcribed verbatim and checked with midwife. Constant comparative methods used to identify and group themes
ENGEL Qualitative narrative Recruitment strategy not clear Recorded narrative of the participants experiences
The framework approach to analysis used. 5 step analytical process to preserve original accounts and observations of the people studied.
FEREDAY AND OSTER
Qualitative interpretive Purposeful sampling of midwives working in the MGP invited
In depth semi-structured interviews lasting 45-60 minutes
Data driven thematic analysis of verbatim transcripts in 3 stages. NVivo software used to define and group themes which were member checked with participants in stage 3. GILKISON ET AL. Qualitative descriptive Purposive sampling through
networks available to the midwives followed by snowball sampling
Face to face interviews, unclear if structured or semi-structured
Thematic and content analysis used to group data from the verbatim transcripts
GRAY ET AL. Qualitative descriptive Random sampling from a purposive group of 65 students
Structures survey (not included in review) and semi-structured telephone interviews
Inductive thematic analysis of verbatim transcriptions by independent service
HUNTER ET AL. Qualitative descriptive Purposive sampling through networks available to the midwives followed by snowball sampling
Face to face interviews, unclear if structured or semi-structured
Thematic and content analysis used to group data from the verbatim transcripts
JEPSEN ET AL. Qualitative ethnography Purposive sampling of caseload midwives working at a location in Denmark
Observation of practice and individual semi-structured interviews
5 step thematic analysis following the thinking of Van Manen (2014)
MCARA-COUPER ET AL.
Qualitative
phenomenology- inspired by ethnography
Purposive sampling through networks available to the midwives followed by snowball sampling
Face to face interviews, unclear if structured or semi-structured
Thematic and content analysis used to group data from the verbatim transcripts
MCCOURT AND STEVENS
Qualitative ethnographic Midwives who joined the caseload pilot scheme were all involved
In depth unstructured and focus groups
Verbatim transcriptions were analysed using grounded theory techniques to identify themes. Constant comparison techniques employed
MOORE Hermeneutic Phenomenology
Purposeful sampling of midwives in specific MGP
Semi-structured interviews Verbatim transcriptions analysed using Gadamers theoretical model
NEWTON ET AL. Qualitative descriptive Purposive sampling of midwives in a caseload model
In depth semi-structured
interviews at 6 months and 2 years or at time of resignation
Thematic analysis of verbatim transcripts using Normalisation Process Theory
RAWNSON Grounded theory Purposive sampling of final year midwifery students from 5 NHS Trusts
In depth semi-structured interviews
Verbatim transcripts checked by student midwife. Line-by- line analysis and open coding to group codes and produce themes
SANDALL Qualitative descriptive Recruitment strategy not clear Semi-structured individual interviews
Verbatim transcriptions analysed using computerised qualitative data analysis package