144 Chapter 6 Table 3: CMOCs underpinning the two themes Role ambiguity and conflict, and Personal and professional boundaries (Continued) CMO 7 Shared Philosophy Midwives often come from diverse backgrounds and may hold varying philosophies and practices regarding maternity care. (C) To implement MLCC, it is essential to bring together midwives who share a common philosophy and approach to care. (MRc) Mutual understanding, trust, and a sense of shared purpose are fostered by aligning the team around a shared philosophy. This alignment helps to reduce misunderstanding and conflict, and ensure that all midwives are working towards the same goals and standards of care. (MRp) As a result, a cohesive and collaborative team culture emerges, leading to the successful implementation and sustainability of MLCC within the team. (O) 36 39 40 49 54 55 64 65 68-70 73 74 C, contexts; CMOCs, context-mechanism-outcome configurations; MLCC, midwife-led continuity of care; MRc, mechanism resource; MRp, mechanism response. Personal and professional boundaries The MLCC model may introduce challenges to achieving a healthy work-life balance. Midwives working in MLCC are enabled to take on expanded roles and responsibilities within interdisciplinary teams, which may be experienced as increased work demands. Balancing the demands of MLCC with personal well-being and family responsibilities requires a supportive working environment and clear expectations about workload management. The ability to provide MLCC is strongly influenced by the personal lives of midwives. The more roles an individual has, the higher the likelihood of experiencing stress in an MLCC model.31 The influence of experienced flexibility is described in CMO6, Table 3. One of the most challenging aspects of MLCC is the extensive on-call duties, which have a significant impact on midwives’ personal lives.34 38 41 43 44 49-51 55 57 63 73 “A key barrier to the rapid implementation of a continuity of carer model is that many staff have become accustomed to working in a non-continuity model, and have built their non-work arrangements around this. This is not an easy matter to untangle.” 75(Page 2) It is, therefore, essential to maintain an appropriate caseload size. Caseload sizes vary according to the level of continuity provided and the risk status of the clients.33 34 67 72 75 76 For full continuity of care throughout the whole childbirth continuum, an average caseload size of 35-40 per fulltime midwife seems typical.16 41 50 65 67 68 73 76 77 A caseload that is too high reduces time with women, the ability to manage oncall work effectively, and the quality of care. The size of the midwifery team is also important: a team that is too large loses continuity, while a team that is too small lacks sufficient back-up. To avoid high turnover or dropout within the team, it is important to create a cohesive team with a shared philosophy. A shared philosophy fosters a supportive working environment, which is essential for the sustainability of the MLCC model, as described in Table 3, CMO7. Although not clearly stated in the
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