Problem: Continuity of carer models present positives and challenges for midwives working in them, and are difficult to sustain.
Background: Research shows midwifery continuity of carer improves perinatal outcomes and experiences, and is considered the optimal model of care.
Aim: To synthesise existing research on midwives' experiences of providing continuity of carer and generate further understanding of what sustains them in practice.
Methods: Protocol for the review was developed using PRISMA guidelines and registered with PROSPERO. 22 studies were included with original themes and findings extracted using JBI tools and synthesised using meta-ethnographic techniques. GRADE CERQual assessment of review findings showed high confidence.
Findings: Midwives identified working in continuity of carer models as both fulfilling and challenging. Professional autonomy and ability to develop meaningful relationships were the most commonly cited positives, while lack of work life balance and conflict with the wider maternity team were the main challenges. 15 studies identified strategies employed by midwives which sustained them in practice.
Discussion: Midwife experiences of providing continuity are impacted by personal and professional factors. Of paramount importance to sustainability of the model is the support of the wider organisation, and their alignment with principles of person-centred, relational care.
Conclusion: Relational models of care are desired by midwives, service users and are recommended in policy. Relational models of care must be responsive to midwives needs as well as birthing people, and therefore need to be designed and managed by those working in them and supported by the whole organisation to be sustainable.
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