Delivering continuity of midwifery care to Queensland women

5. Cultural change—building a supportive cultural environment
Implementing midwifery models involves significant cultural changes within services and
with partner services, largely relating to the very different practice and more autonomous
working arrangements of midwives in continuity models. Medical staff need to be engaged to
understand the model and how collaboration will work.
6. Clinical governance
As midwife models are relatively new in Australia, they have specific clinical governance
requirements including a specific set of Key Performance Indicators (KPIs). Processes for risk
management, monitoring and review and clinical audit should be included.
Processes for consumer participation and informed choice should be built into models from
the outset. Use of Queensland’s Maternity and Neonatal Clinical Guidelines are recommended.
7. Costing and revenue for caseload models
Midwifery continuity models (inclusive of one-to-one labour care and home visiting) show cost
savings when compared with standard care. However, a project investment will usually be
required to establish the model. Analysis of Australian models shows that savings are mainly
due to reduced antenatal and neonatal admissions and reduced medical interventions.
8. Industrial issues
Midwives working in caseload models in Queensland Health services are covered by special
provisions within the Award. They do not work shifts, they organise their work time according
to the needs of their women and as negotiated within their MGP and with their line manager.
Each model requires the negotiation of a detailed Local Agreement, developed by a working
party with appropriate representation from management staff, midwifery staff and the
Queensland Nurses Union (QNU).
9. Professional development and capacity building
Midwives moving into a continuity model of care have particular professional development
needs, largely relating to the requirements to work across the full scope of practice. A range
of resources is available to support midwives preparing for work in continuity models,
including the Australian College of Midwives Midwifery Practice Review.
10. Midwifery practice in continuity models
Midwives working in these models must take a high degree of responsibility for the care of
their clients and for their work arrangements. This requires a different philosophy and skill
set. Relationships with women are close, continuous (sometimes for more than one baby),
responsive to women’s needs and very effective in supporting women’s ability to birth and
mother.
Working arrangements are flexible and involve negotiation amongst midwives in the MGP
and in practice partnerships to cover women’s care needs. Care can be provided in a range of
settings, including women’s homes, community-based clinics and in hospitals.
Midwives working in midwifery models should be active in developing and refining their
model of care and planning long-term and day-to-day working arrangements. When well
supported by management, this results in sustainable, reliable service.
11. Collaborative maternity care
Midwifery continuity models involve a high level of collaboration amongst practitioners,
improving quality of care and workplace experience. Communication pathways, clinical
guidelines and protocols and multidisciplinary education and review processes enable
collaborative practice. Many models will depend on collaboration with practitioners from
other facilities when care requires escalation.
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Delivering continuity of midwifery care to Queensland women