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What do you do, Rachel?

Rachel Smith is a midwifery practice leader in the Lambeth Early Action Partnership (LEAP) Caseload Team.

Colourful question marks drawn by a child

""May 2023

How long have you been a midwife and what’s your career journey been? 

I qualified as a midwife in 2017 and started my career as a rotational midwife within Bart’s Health NHS Trust. I was fortunate enough to land my dream job as a LEAP (Lambeth Early Action Partnership) caseload midwife at Guy’s and St Thomas’ in October 2018 and I have been in that job ever since. 

I’m now the midwifery practice leader of the LEAP caseload team. Having started in the team in 2018, I took on my current role in February 2022, covering a colleague’s maternity leave. 

What is the Lambeth Early Action Partnership (LEAP)?

LEAP is a national lottery funded project which aims to improve outcomes for young children living in 4 particular pockets of Lambeth. These pockets were chosen based on evidence that these areas suffered with the greatest levels of deprivation compared to the rest of the borough. 

LEAP is made up of over 20 services and these fall into 4 categories of: communication and language development, diet and nutrition, social and emotional development and midwifery. All the services work together towards the shared goal of improving children’s outcomes. 

How do midwives in your team work? 

Our team of midwives equate to six full time roles and across the team we aim to care for up to 200 women per year. We provide continuity through pregnancy, birth, and the postnatal period and aim to build high levels of trust with our clients, by providing them with a named midwife who works within a small team.

The way we organise ourselves across the team to provide this care to our clients is important. We each do 10 on calls in a 4-week period and this is a combination of on calls during the day, and at night. When we’re not on call, we have protected 9-5 days where we run our clinics or complete home visits. On these protected days, we can organise our diary however suits us best.

How do you help develop midwives in your team? 

Our team is small so we meet regularly as a group to discuss our caseloads, share ideas and reflect on experiences. Our relationships as both colleagues and friends are strong. By meeting regularly we create a supportive and safe space to unload or explore difficult clinical situations. The team also know that I’m always available if they wish to speak privately, or they can just call me if they have a question. As a team, we are constantly sharing our learning with each other and this helps all of us to develop as practitioners. 

On an individual basis, I aim to use each midwife’s performance development review to explore, encourage and support them to take up any learning or development opportunities that they have interest in. 

What support do midwives in your team provide before and after birth?

The main thing we provide is continuity. Each client has a named midwife and gets the opportunity to meet the other midwives, so they are familiar with the whole team. We stress that no question is a silly question and we make it easy for clients to contact us.

We also see our clients frequently and this allows us to both monitor them closely and quickly identify potential issues as well as forming trusting relationships.

I find that by forming these relationships, our clients are more likely to disclose issues to us. We can then refer them for any specialist or additional support they may need. We co-ordinate care, often between a number of different services outside of health to ensure a network of support is in place and effective.

Why is this support so important?

Firstly, research shows that continuity of care is what families want. And secondly, our support and care significantly reduce some adverse clinical outcomes. We are therefore improving care for our clients from both an emotional and physical perspective. Our service is targeted at those who are sadly most at risk of health inequalities with the aim of providing equity within maternity care for people of Black or Brown ethnicity or people who are socio-economically disadvantaged. Through continuity of care we are able to improve equity to these groups, which is fundamentally important.

What is special about LEAP?

As a midwifery team, we have well established referral pathways to services both in and outside of LEAP. LEAP provides additional specialist support for a variety of needs that may not otherwise be fully met. For example: a parent and infant relationship service, Baby steps (antenatal classes for all that live within LEAP areas), Community Action and Nutrition (CAN) - nutritional support for pregnant women with a BMI of 25 or more, and breastfeeding peer support. Through LEAP, we are able to offer a complete holistic package of care and support to every family within our area.

Why is it so important to address health inequalities around maternity care?

Everyone should be entitled to kind, caring, gold standard maternity care, no matter what your background is.

The evidence shows us that women of Black of Asian ethnicity have a greater chance of a poorer health outcome and I’m passionate about changing this. I believe that our continuity of care team, with support from our maternity colleagues and LEAP partners, is making a small but significant impact on helping reduce these health inequalities at least on a local basis. As a small team, we are trying to do our bit towards the bigger picture of health equity for all.

What do you most love about your job?

It is a privilege to form such strong bonds with a diverse group of women, and support them through every part of their journey into motherhood. I’ve had several women come back and have another baby with the team. It’s amazing to feel like their ‘family midwife’ who provides continuity for more than one pregnancy. I also LOVE my amazing team of midwives who get me through every day still smiling – I couldn’t do it without them all.

For more information watch:

What it’s like to be a LEAP midwife

LEAP midwives- women’s experiences

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