BACKGROUND:
Midwifery continuity of carer (MCoC) is central to global maternity and perinatal care policy, offering improved outcomes for childbearing women, people, babies, and midwives. In England, MCoC implementation varies widely and sustainability remains challenging linked to local context, resourcing and management. Few evaluations have explored system-wide experiences across all staff groups and service-users to identify shared solutions.

OBJECTIVES:
To evaluate barriers, enablers, to establishing and sustaining MCoC across a whole geographical maternity system (4 hospital providers), capturing perspectives from midwives, students, managers, leaders, and service-users, and to provide practice-based solutions to shared opportunities and challenges.

METHODS:
A system-wide mixed-method evaluation was undertaken across a North-West England Local Maternity and Neonatal System (LMNS) during 2020–2021. Data were collected via an online survey (n=123; midwives, maternity support workers, students) and qualitative interviews (n=28; midwives, a service-user, stakeholder). Descriptive statistics summarised survey responses; thematic network analysis of qualitative data identified common themes.

RESULTS:
Findings generated one global theme—Making it work: Sustaining continuity of carer—with three organising themes: making a difference, making a start, and making it count. MCoC was valued for fostering relationships, improving outcomes, and enhancing professional satisfaction. Shared challenges included workload pressures, variable leadership support, and resource constraints. The study offers practice-based solutions, including strategies for leadership, team autonomy, collaborative working, and structured support to optimise collective opportunities and sustain MCoC.

CONCLUSIONS:
This system-wide evaluation offers original insights into shared experiences across all staff groups and service-users, providing actionable solutions to strengthen and sustain MCoC in diverse contexts. Findings are relevant to international efforts to implement and embed continuity of care models.

KEY MESSAGE:
Sustaining MCoC in practice demands context-sensitive strategies, investment in leadership and workforce wellbeing, and commitment to collaborative, flexible service delivery. Findings highlight the importance of investing in flexible, autonomous teams, staff wellbeing, and inclusive communication strategies to sustain MCoC across diverse maternity settings. Marginalized - minorities