Delivering continuity of midwifery care to Queensland women

The challenge for rural units is recognised in this guide and resources are recommended
throughout which demonstrate how services can successfully make these changes. Staff
involved in the development of rural models are strongly recommended to study existing rural
midwifery continuity models. Goondiwindi and Beaudesert have published reports available
from the Nursing and Midwifery Office of Queensland (NMOQ) website.
International models
While midwifery continuity models are only available to a small proportion of Australian
women, they are standard care and well established in several other countries.
In New Zealand over 80 per cent of women have a named midwife responsible for their
primary maternity care. New Zealand women choose a Lead Maternity Carer (LMC), who can
be a midwife, GP or obstetrician (Guilliland, Tracy & Thorogood 2010). LMC midwives work as
caseload midwives providing continuity of care. They frequently work from community-based
private practices, often called “group practices”, in which several midwives work together.
These midwives provide antenatal and postnatal care mostly in the community and birth
care in urban hospitals, rural primary birthing units or at home, sometimes in remote and
inaccessible locations. “Core” midwives based in hospitals, usually working shifts, support
the primary midwives when women are admitted. Introduction of this model started in 1990
after reform of New Zealand’s health legislation allowed midwives access to maternity funding.
As well as delivering greater continuity of carer to New Zealand women, these reforms have
delivered cost savings through reducing interventions and resources and cost shifting more
expensive secondary services to primary and community services (Guilliland, et al. 2010).
The National Health Service (NHS), covering health services across the United Kingdom (UK),
provides community-based midwifery care to a high proportion of women. It is expected that
women can directly and easily access a midwife from early pregnancy for maternity care.
Services are expected to provide women with the support of a named midwife throughout
pregnancy and for women to be able to contact a midwife day or night at any stage in
pregnancy if they have concerns (Department of Health 2004).
The Netherlands is often used as an example of achievable primary community-based midwifery
care, as a significant proportion of births occur within the woman’s home under midwifery care.
Low risk women in the Netherlands have out of pocket charges for using hospital facilities;
however this charge expires if the woman has a medical condition (Hendrix, Evers, Basten,
Nijhuis & Severens 2009). Midwives have remained primary carers for the vast majority of Dutch
women and home birth is seen as a normal part of life (Mackay 1993).
In Canada, midwifery is a relatively newly recognised profession and midwifery is not regulated
in all provinces. However where the options for midwifery care exists many women are able to
access publicly-funded midwifery care including for birth in hospital, birth centre and at home
(O’Brien, et al. 2010). Canada is also the site for exemplary perinatal outcomes in extremely
remote locations with Inuit women birthing in midwifery care in their home communities in far
northern Canada (Van Wagner, Epoo, Nastapoka & Harney 2007).
Australia-wide moves to improve access to midwifery continuity
The consensus document Primary Maternity Services In Australia - A Framework For
Implementation (Australian Health Ministers’ Advisory Council (AHMAC) 2008) commits all
jurisdictions to offering women continuity of carer whenever possible and supports enabling
midwives to provide care across the continuum and applying the full scope of their skills.
Australia has seen steady progress toward increasing women’s access to midwifery continuity
models over the last 20 years. Birth centres and midwifery group practices are in place in all
states and territories and have been increasing in numbers. Demand for these models is also
increasing. Several states have models that include publicly funded homebirth.
The Commonwealth’s 2009 Maternity Services Review recommended improving women’s
access to choices in birth care and an expanded role for midwives (Department of Health and
Ageing 2009). In response to this review, the Commonwealth has created a range of Medicare
Benefits Schedule (MBS) items and Pharmaceutical Benefits Scheme (PBS) rebates, payable to
women using the services of private midwives notated as ‘eligible’ midwives by the Nursing and
Midwifery Board of Australia (NMBA). These developments are relevant to all maternity services
and are explained in greater detail in Section 13.
A guide to implementation
9