Guidance

Care continuity between midwifery and health visiting services: principles for practice

Published 31 July 2026

Applies to England

Executive summary

Continuity between midwifery and health visiting services helps ensure safe, high‑quality perinatal care. Breaks in continuity increase the risk of missed need, delayed support and avoidable harm. Families experiencing vulnerability or complex need are at particular risk.

This guidance sets out practical, practice‑focused principles to strengthen continuity between midwifery and health visiting services across pregnancy, birth and the postnatal period. It reflects current policy, evidence and learning, with a particular focus on:

• relational continuity
• shared professional oversight
• co-ordinated working at points of transition

The guidance aligns with national priorities for integrated, community‑based postnatal care, including:

• the healthy child programme delivery model
• NHS England’s postnatal improvement ambitions
• updated National Institute for Health and Care Excellence (NICE) guideline [NG194] Postnatal care

It supports proportionate universalism by emphasising a universal offer for all families, with earlier, additional or more intensive support provided according to assessed need.

The guidance does not prescribe a single model of delivery. It is intended to support local systems to review and strengthen pathways, professional practice and system enablers. Used effectively, it can:

• help services reduce fragmentation and improve safety
• improve families’ experiences
• prevent escalation of need
• contribute to reducing inequalities for women, babies and families across the perinatal period

Introduction

This guidance brings together and updates national principles on continuity between midwifery and health visiting services. It reflects current policy, evidence and learning, with a particular focus on improving continuity at important transition points across pregnancy, birth and the postnatal period. This guidance aligns with NHS England’s Improving postnatal care: a toolkit for integrated care boards, partners and providers, supporting its ambition for integrated, neighbourhood‑based postnatal care.

This publication sets out practical principles to strengthen continuity between maternity and health visiting services within the context of the healthy child programme. The healthy child programme is our national framework for improving the health and wellbeing of children and young people aged 0 to 19 (age 25 for care leavers or those living with special educational needs and disabilities) in England.

Continuity between midwifery and health visiting services is a core component of safe, high‑quality, personalised care for women, babies and families. It is particularly critical at transition points across pregnancy, birth and the early postnatal period. Fragmented care and poor communication increase the risk of missed need, delayed support and avoidable harm.

This guidance is informed by national policy, postnatal improvement work and lessons learned from recent maternal mortality reviews such as MBRRACE-UK’s ‘Saving Lives, Improving Mothers’ Care’ 2021 to 2023 report. Such reviews consistently emphasise the importance of continuity, relational care and co-ordinated support for women and families, particularly during the postnatal period.

It does not replace statutory contacts or clinical guidance. Instead, it concentrates on how services work together to support safe, co-ordinated and personalised care for all families, with additional or targeted approaches, such as earlier visits, joint reviews or enhanced follow‑up, where needs are greater.

National policy direction, including the 10 Year Health Plan for England: fit for the future, emphasises a shift from hospital‑based care to community, neighbourhood and digitally enabled models, with greater focus on prevention and tackling inequalities through proportionate, community-based approaches.

The postnatal period is an important opportunity to deliver this ambition, with midwifery and health visiting services playing a central role in ensuring continuity, early identification of need and co-ordinated support for families, helping to prevent need from escalating and widening inequalities.

This guidance is intended for:

• midwives, health visitors and service managers
• commissioners and system leaders
• professionals and partners working across maternity, primary care, public health nursing, early years and wider community services to support babies, children, young people and families

While national policy and improvement frameworks set expectations for integrated postnatal care, this guidance concentrates on how continuity is delivered in practice at the interface between midwifery and health visiting services, where the risks of fragmented care are greatest. It emphasises relational continuity, shared professional oversight and proportionate responses at important transition points.

What we mean by continuity

Continuity in this guidance is understood as relational and co-ordinated working over time, rather than solely the transfer of information or completion of handover processes.

Effective continuity includes the following principles.

Timely and proportionate information sharing and shared professional oversight

Midwives and health visitors share information early, accurately and in line with assessed need to support shared professional oversight across maternity and health visiting services. This:

• enables statutory antenatal and new birth health and development reviews to be timely, well informed and risk aware
• supports safe, co-ordinated transitions and follow‑up during the postnatal period

Clear responsibility and accountability at transition points

Continuity is strengthened when responsibility for care is explicit at significant transition points, including birth and discharge from maternity services.

Midwifery and health visiting services:

• plan handover arrangements, with clear accountability and agreed actions
• support shared oversight
• reduce the risk of gaps or duplication during the transition to community‑based postnatal care

A shared understanding of family context

Midwives and health visitors have a common understanding of a family’s strengths, circumstances, emerging needs and risks, which:

• reduces duplication and the need for families to repeat their histories
• enables proportionate responses as needs change across the postnatal period

Relational - rather than solely transactional - working

Continuity is underpinned by relational working (ongoing collaboration rather than one‑off exchanges), not just the completion of information transfer or handover processes. Where assessed need indicates, this:

• includes direct professional contact and discussion to maintain shared oversight
• supports joint problem‑solving
• enables timely, co-ordinated responses

Consistency for families

Families experience care as joined up and coherent, with consistent, evidence-based messages.

There is a clear understanding of how services work together to support them during the postnatal period and beyond.

A focus on equity and proportionate universalism

All families receive a universal offer, with targeted additional, earlier or more intensive support provided according to assessed need. Continuity between midwifery and health visiting services supports proportionate universalism by enabling flexible, co-ordinated responses that help prevent escalation of need and reduce inequalities.

These principles apply throughout the perinatal pathway, but are particularly important during the postnatal period when:

• responsibility for care transitions from maternity to community-based services
• the risk of fragmentation is greatest

Important transition points and information sharing

Effective continuity between midwifery and health visiting services depends on timely, proportionate and purposeful information sharing that supports shared professional oversight at important transition points across pregnancy, birth and the postnatal period.

While statutory contacts and minimum requirements are set out in the healthy child programme and NICE postnatal care guidance, this section concentrates on how information sharing supports safe, co-ordinated and personalised care, particularly where families experience vulnerability or complex need.

Principles for information sharing at transition points

At all stages of the pathway:

• information sharing should be lawful, proportionate and necessary, and aligned with local information-sharing arrangements
• families should understand what information is shared, why and with whom
• information sharing should support shared oversight, continuity and follow-up

Antenatal period

The antenatal period provides a critical opportunity to establish shared understanding and continuity between midwifery and health visiting before birth.

Midwifery services should:

• notify health visiting services early to support timely planning and engagement
• share relevant information in advance of the statutory antenatal health and development review, so that the contact is timely, well informed and risk aware

Where vulnerability or emerging risks are identified, services may need to share information earlier or more frequently to support shared oversight and co-ordinated planning.

All families should receive antenatal information, reinforced across services, about:

• the role of the health visiting service
• the statutory antenatal and new birth health and development reviews
• how midwifery and health visiting services work together
• the purpose and use of the personal child health record (PCHR - also known as the ‘Red Book’)

This is particularly important for first‑time parents and families new to England to support their engagement and informed participation in services.

Birth and discharge from maternity services

Birth and discharge from maternity services represent high-risk transition points within the postnatal pathway. Continuity at these points depends on planned, co-ordinated handover arrangements with clear accountability, rather than reliance on written transfer alone.

Timely information sharing should support shared professional oversight and include:

• maternal and infant health status
• any identified or emerging concerns
• safeguarding or vulnerability information
• changes in level of need (emerging, escalating or de‑escalating)
• agreed follow-up actions and responsibilities

Health visiting services should receive this information in sufficient time to support safe, personalised and co-ordinated delivery of the statutory new birth health and development review.

Where needs are complex or risks are evolving, direct professional communication should be used alongside written information to support shared understanding and co-ordinated follow-up during the postnatal period.

Early postnatal period

The early postnatal period is a time of increased vulnerability for women, babies and families that requires active continuity and shared oversight, not passive transfer of care. Lessons learned from maternal mortality reviews highlight heightened risk during this period, including risks related to mental health, safeguarding and physical health conditions such as cardiac disease, which may present or worsen after birth.

When responsibility for care transitions from maternity to community-based services, continuity is strengthened when:

• midwifery and health visiting services maintain appropriate communication during any period of overlapping involvement
• changes in need or risk are shared promptly
• families experience care as co-ordinated and responsive rather than fragmented

Where families disengage or decline contact, professional curiosity and co-ordinated discussion between services are essential to understand barriers, assess risk and agree appropriate follow-up.

Information sharing for families with complex needs

For some families, achieving safe and equitable postnatal care requires information sharing and professional co-ordination that is tailored to assessed need. This may include information sharing that is earlier, more frequent or more detailed, alongside closer professional discussion to support shared oversight across maternity and health visiting services.

How this applies in practice for families experiencing vulnerability or complex need is set out in the ‘Working with families experiencing vulnerability or complex need’ section below.

This approach supports proportionate universalism, ensuring all families receive a universal offer of care, with additional, earlier or more intensive support provided according to assessed need, in line with the Delivery of the healthy child programme guidance.

Why information sharing matters

At important transition points, effective information sharing helps to:

• support integrated postnatal care across maternity and community services
• enable earlier identification of emerging need and timely intervention, helping to prevent escalation
• strengthen safeguarding and risk management, including risks related to maternal mental health, physical health and social vulnerability
• improve experience for women and families by reducing fragmentation, duplication and the need to repeat histories
• underpin safe, co-ordinated postnatal care during periods of transition and increased vulnerability

These principles are central to continuity between midwifery and health visiting services, and are particularly important where needs are complex or evolving.

Continuity at birth, discharge and the postnatal period

Birth, discharge from maternity services and the postnatal period are critical transition points where continuity between midwifery and health visiting services has a direct effect on safety, experience and outcomes for women, babies and families.

Continuity at birth

Continuity around the time of birth is strengthened when:

• midwives share relevant information promptly with health visitors about maternal and infant health, family circumstances and identified risks
• teams communicate emerging concerns clearly, including where needs are escalating, de‑escalating or uncertain
• families understand how care will transition and who will be involved following birth and throughout their postnatal care

This supports health visiting services to prepare for timely, informed postnatal contact and reduces the risk of missed or delayed support.

Continuity at discharge from maternity services

Discharge from maternity services marks a significant transition in responsibility. This is often at a time when women and families may still be experiencing physical recovery, emotional adjustment and emerging needs.

Continuity at discharge is strengthened when there is:

• clear, timely and planned handover from midwifery to health visiting services
• explicit communication of maternal and infant health status, identified or emerging concerns, safeguarding or vulnerability information, and agreed follow-up actions
• clarity about professional responsibility and accountability for postnatal follow-up

Where needs are complex or risks are evolving, direct professional communication - alongside written information - supports shared understanding and co-ordinated planning during the postnatal period.

Continuity in the early postnatal period

The postnatal period requires active continuity of oversight and co-ordination, not passive transfer of care. Lessons learned from maternal mortality reviews highlight that risks related to mental health, physical health and safeguarding may emerge or worsen after discharge from maternity services.

Continuity in the postnatal period is strengthened when:

• the statutory new birth and development review is delivered as a face‑to‑face contact, usually in the family home by the named health visitor, enabling holistic assessment of maternal, infant and family health and wellbeing
• health visiting teams assess and re-assess family health needs to decide the appropriate level of support in line with the healthy child programme delivery model (universal, targeted or specialist support)
• midwifery and health visiting services maintain appropriate communication during any period of overlapping involvement
• changes in need or risk are shared promptly to support timely, proportionate responses

Where families disengage or decline contact, services should take a co-ordinated, trauma-informed and strengths-based approach, using professional curiosity to understand barriers, assess potential risk and agree appropriate follow-up. Further guidance is included below in the ‘Engagement, trust and professional curiosity’ part of the ‘Working with families experiencing vulnerability or complex need’ section.

What families should experience

When continuity between midwifery and health visiting services is effective at birth, discharge and in the postnatal period, families should experience care that:

• is culturally sensitive, trauma informed and strengths based
• supports dignity, trust and engagement

In practice, this means families should experience:

• clear understanding of who is involved in their care and how services work together
• consistent, evidence-based messages and advice
• reduced need to repeat their history or concerns
• timely, appropriate support that reflects their strengths, needs, circumstances and preferences

This contributes to safer care, improved experience and better outcomes across the postnatal pathway.

Working with families experiencing vulnerability or complex need

Continuity between midwifery and health visiting services is particularly important for families experiencing vulnerability or complex need. Fragmented care, delayed co-ordination or unclear accountability can increase the risk of missed need, non-escalation of concern and avoidable harm, particularly during the postnatal period.

For these families, continuity requires more than standard information transfer. It depends on earlier, richer and more relational working, alongside co-ordinated professional oversight, across maternity and community services.

Continuity in practice includes:

• earlier notification and information sharing during the antenatal period
• more frequent and detailed communication at birth, discharge and in the early postnatal period
• direct professional discussion between midwifery and health visiting services, rather than reliance on written handover alone
• planned, co-ordinated handover arrangements with clear accountability
• joint discussion, planning or visits where appropriate
• co-ordinated handover and follow-up arrangements, including with wider community or specialist services, in line with local pathways

These approaches:

• support shared professional oversight
• enable timely re-assessment of risk and need
• help ensure that support is proportionate, responsive and co-ordinated

Proportionate universalism in practice

All families receive a universal offer of care through maternity and health visiting services. For some families, achieving equitable outcomes requires earlier, additional or more intensive support that is delivered flexibly in response to assessed need.

Continuity between midwifery and health visiting services supports proportionate universalism when:

• assessment and re-assessment of family health needs inform the level and intensity of support
• families move flexibly between universal, targeted and specialist support, in line with the healthy child programme delivery model
• services communicate escalation or de‑escalation of support clearly to each other
• families experience continuity and coherence, rather than repeated referral or retelling

This approach helps ensure that support is matched to need, not determined by service boundaries or timing of discharge.

Co-ordinated working around families

For families experiencing vulnerability or complex need, continuity may require:

• antenatal health visiting involvement
• planned, co-ordinated handover at birth and discharge
• joint discussion or planning between midwifery and health visiting services
• timely involvement of wider community or specialist services, in line with local pathways

These approaches should:

• be planned and proportionate, with clarity about roles, responsibilities and follow‑up
• prioritise safety, equity and experience

Engagement, trust and professional curiosity

Families experiencing vulnerability may disengage from services, decline contact or have inconsistent engagement. In these circumstances, continuity supports safer care when:

• professional curiosity is applied to understand underlying barriers, risks or changing circumstances
• services communicate and co-ordinate responses, rather than working in isolation
• strengths, protective factors and family voice are actively recognised
• support is flexible, respectful and responsive to individual circumstances

A relational, trauma‑informed and strengths‑based approach supports engagement and trust, particularly at points of transition. It also contributes to safer, more equitable postnatal care.

Taken together, these approaches support safer, more co-ordinated postnatal care for families experiencing vulnerability or complex need. This helps to:

• prevent escalation
• strengthen safeguarding
• reduce inequalities

Enabling continuity through community and neighbourhood models

Effective continuity between midwifery and health visiting services is shaped by individual practice. The systems, structures and conditions in which services operate also influence effective continuity.

National policy direction emphasises a shift towards integrated, community‑based and neighbourhood models of postnatal care, with greater focus on prevention, equity and co-ordination across organisational boundaries.

Community and neighbourhood‑based working

Continuity is strengthened where midwifery and health visiting services are embedded within place‑based and neighbourhood health models that:

• support regular professional contact and shared problem‑solving
• enable co-ordination around families rather than service boundaries
• improve access and continuity for families, particularly those experiencing disadvantage

This may include neighbourhood health teams, community venues or other locally agreed models that:

• bring professionals together around babies, children, young people and families
• support integrated postnatal care

Digital and information infrastructure

Comprehensive digital and information infrastructure is an important enabler of continuity and integrated postnatal care. Effective systems support:

• timely, accurate and proportionate information sharing
• visibility of risk, vulnerability and agreed plans
• shared professional oversight across maternity and community services
• reduction of duplication and administrative burden

Leadership, culture and workforce support

Continuity is more likely to be delivered consistently where:

• leaders across maternity and health visiting services prioritise continuity as a quality and safety issue in local planning and oversight
• roles, responsibilities and thresholds are clearly understood
• staff are supported to use professional judgement, curiosity and relational approaches
• time is protected for co-ordination, communication and joint working

A culture that values collaboration, learning and shared accountability supports safer and more responsive postnatal care.

Training and shared learning

Joint training and workforce development can strengthen continuity by:

• building shared understanding of professional roles and contributions
• supporting consistent evidence-based messages to families
• increasing confidence in identifying and responding to vulnerability and risk
• reinforcing trauma‑informed, culturally sensitive and strengths‑based practice

Opportunities for shared learning should reflect local priorities, and population need and postnatal improvement ambitions.

Commissioning and assurance

Commissioners and system leaders enable continuity when they:

• articulate clear expectations for continuity, information sharing and collaboration
• commission services in ways that support proportionate universalism
• align maternity, health visiting and early years pathways
• use existing healthy child programme and postnatal performance frameworks to monitor quality, safety and equity

Continuity should be understood as a core component of quality and safety - not an optional addition - particularly during the postnatal period and at significant transition points.

Using this guidance locally

This guidance is intended to support shared understanding and continuous improvement. It does not prescribe a single model of delivery. Local systems should use it flexibly, reflecting population need, service configuration and available resources.

Local systems can use this guidance to:

• support the design, review and improvement of local maternity-to-health visiting pathways
• inform supervision, reflective practice and joint working across services
• guide quality improvement, service development and postnatal improvement activity
• strengthen commissioning, assurance and governance arrangements

Effective continuity between midwifery and health visiting services relies on ongoing collaboration, learning and adaptation. Local approaches should be reviewed regularly, and informed by data, professional insight and feedback from women and families.

Continuity is a core component of quality and safety, particularly at points of transition across pregnancy, birth and the postnatal period.