Our new midwifery standards have drawn on the framework for quality maternal and newborn care from the Lancet series on Midwifery (2014).

In the standards, promoting and providing continuity of care and carer is explicitly part of safe and effective care for women and their newborn babies. The midwife is responsible for creating an environment that is safe, respectful, kind, nurturing, and empowering, ensuring that the woman’s experience of care during her whole maternity journey is seamless.


Hayley had a baby boy (Joel) three years ago - a forceps birth on the delivery suite. This time she would like to give birth in the new midwife led unit (MLU) as she’s heard good things about how they really listen to your views and preferences from her friends. She’s interested in having a water birth.

You are one of the midwives in the MLU which has been open for a year and is staffed by a team of who work in community and in the MLU. This is a new scheme, developed in collaboration with the local Maternity Voices Partnership and is working well.

You explain that you will be Hayley’s midwife throughout her pregnancy and afterwards when she and her new baby are at home. You have a first year student midwife Dani, with you today who is on her first placement. You introduce Dani to Hayley and ask if Dani may observe her first MLU ‘booking visit’. Hayley agrees and says she had a lovely student midwife with her during her last birth.

You complete Hayley’s booking in the MLU and arrange her next scan appointment. You show her and Chris, her partner round the MLU and give details of how to contact you and the MLU team should she have any questions or concerns.

Putting the proficiencies into practice

The Standards of proficiency for registered midwives list the knowledge, skills and behaviours that every midwife must have by the end of their programme.

The standards are set out in six sections called 'domains'. These domains inter-relate and build on each other, and shouldn't be seen separately 

Domain 2

Domain 2 is specifically about continuity of care and carer and how it links to safe and effective midwifery care: 

Domain 2.1

Demonstrate knowledge and understanding of the health and social care system and of different settings for midwifery and maternity care, and the impact of these on women, newborn infants, partners and families

How you demonstrated this:

You demonstrate your proficiency by recognising the potential benefits of midwifery led care for Hayley and ensuring she has the opportunity to understand how the MLU operates and how midwifery led care will support her.

You also demonstrate the linked skills from Domain 6, particularly 6.8 as you have:

  • Discussed with Hayley and Chris their options for the place of birth
  • You've supported Hayley's decision
  • You will regularly review this with Hayley and colleagues as her pregnancy progresses.

While you are caring for Haley, you are also demonstrating the values within the Code by:

  • Treating Hayley as an individual
  • Upholding her dignity
  • Listening and responding to her preferences and concerns.

By doing the above, you're making sure that her physical, social and psychological needs are assessed and responded to.

You're also respecting Hayley's right to privacy by carring out her booking visit in the designated room in the MLU. She will go home with her own confidential, hand-held records that you have both worked through during her 'booking' appointment as well as her details being held on the secure IT system, ensuring confidentiality.

Domain 2.2

Demonstrate knowledge and understanding of different ways of organising midwifery and maternity care, and the potential positive and negative impact of these on safety and effectiveness, and on women, their newborn infants, partners and families

How you demonstrated this:

You have given Hayley the opportunity to discuss the range of options of where to give birth based on her needs, views and preferences. In line with the Code, you are acting in Hayley’s best interests having listened to her concerns and knowing the most recent evidence about continuity of care and carer.

The work that you did in collaboration to develop the MLU demonstrates that as described in Enabling professionalism, you are incorporating up-to-date evidence in daily practice, are sharing and disseminating evidence-informed practice and working innovatively.

Domain 2.4

Demonstrate the ability to work in and across a range of health and social care settings and with other health and social care staff to promote continuity of care and carer.

How you demonstrated this: 

By working in the MLU you will have daily interaction with a range of other healthcare professionals that work and support women and families within the maternity context.

When arranging Hayley's scan, you're demonstrating the linked skills from Domain 6.9 of identifying, contacting, and communicating effectively with colleagues from your health and social care settings, ensuring continuity of care.

You're communicating clearly as in the Code. You have transferred authority to the ultrasonographer as one registered professional to another to perform the ultrasound scan as in our Delegation and accountability which is supplementary information to the NMC code.

Domain 2.5

Demonstrate the ability to provide continuity of midwifery carer across the whole continuum of care and in diverse settings for women and newborn infants with and without complications and additional care needs.

How you demonstrated this: 

You were part of the team that worked with the local Maternity Voices Partnership to increase the diversity of settings in your maternity service.

You demonstrate the ability to provide continuity of care and carer as Hayley progresses through her pregnancy as part of the team and liaising with other colleagues in the event of their input being needed to her care for example the ultra-sonographer carrying out the next scan.

You've shown that as in Domain 6.11, you identify resources relevant to the needs of Hayley and her baby, in this case an ultrasound scan, and support and enable her to access these as needed.

Domain 2.11

Demonstrate the ability to be the coordinator of care within the wider interdisciplinary and multiagency teams, arranging a seamless transfer of care when midwifery care is complete.

How you demonstrated this: 

Throughout Hayley’s maternity journey co-ordination of care will continue within the team. This is to ensure her mental, physical, psychological, social and spiritual care needs are met within your midwifery team and from the interdisciplinary and multiagency teams.

You are also demonstrating the responsibility outlined in Domain 4: The midwife has specific responsibility for continuity and co-ordination of care, providing ongoing midwifery care as part of the interdisciplinary team, and acting as an advocate for women and newborn infants to ensure that they are always the focus of care.

When you transfer Hayley’s care to community care, you will be demonstrating Domain 6.12. Which is to arrange for effective transfer of care for the woman and newborn infant, as needed, and when midwifery care is complete.

Domain 2.21

Demonstrate an understanding of the need for an ongoing focus on the promotion of public health and well-being of women and newborn infants, their partners and families across all settings.

How you demonstrated this: 

Hayley might share a number of concerns about the forthcoming birth as she is keen to avoid a forceps delivery this time.

You will be able to support her in several ways during her pregnancy to plan for this birth. This support could include working together on movement and exercise, doing a birth plan, attending hypnobirthing sessions locally and consideration of using the birthing pool to help during labour and birth.

You're also demonstrating that you're following Domain 6.10. This domain is to consistently plan, implement, and evaluate care that considers the needs of women and newborn infants together. You can also demonstrate Domain 6.13, which is to inform and update interdisciplinary (so far with Hayley, this is the ultrasonagrapher) and multiagency colleagues about changes in care needs and care planning, and update records accordingly.

Statements with more information

The Code

The values and principles set out in the Code can be applied in a range of different practice settings, but they are not negotiable or discretionary. All standards apply within your professional scope of practice.

The Code was produced collaboratively and is structured around four themes - prioritise people, practise effectively, preserve safety and promote professionalism and trust.


Professionalism can mean different things to different people but all midwives practice in line with the Code, and reflect on their practice as part of revalidation.


As registered professionals midwives are accountable for all aspects of their practice, including accountability for what they choose to delegate, and agreement, or not, to undertake activities which are delegated to them.

Test your understanding

  1. Consider the importance of exploring place of birth with women and their partners. What aspects of maternity service delivery do you need to share with women in your local area?

  2. Consider how you reassure women that their decisions are supported in your practice?

  3. What role do the multidisciplinary and multiagency team play to support you practice and the women in your care?


You may wish to use this scenario and your reading as part of your continuing professional development (CPD) for your revalidation.