Delivering continuity of midwifery care to Queensland women

Primary midwife
Each woman receiving caseload midwifery care will have a “primary midwife” who provides
the majority of her midwifery care and is her maternity care coordinator. ‘Known midwife’
and ‘named midwife’ have the same meaning as ‘primary midwife’.
The woman will probably describe her primary midwife as ‘my midwife’.
Team midwifery
A model of maternity care in which a woman receives all of her midwifery care from a team
of midwives (six to eight midwives, sometimes more, sometimes less), but does not have a
nominated, known, primary midwife. Meeting a number of the team midwives antenatally
may provide some continuity for intrapartum care.
Team midwives usually work in shifts across the 24 hour day, and rotate across the
antenatal, intrapartum and postnatal stages of care for their group of women (Homer, et al.
2008). In effect, the whole team carries a case load collectively. In general, team midwives
do not work on-call and are not paid an annualised salary. There may be more than one
team operating within the same facility.
Examples of several midwifery models in Queensland are described in appendices 2.1 to 2.5.
Basic characteristics of a midwifery continuity of care model
The key characteristics outlined in Homer et al. (2008) are fundamentally based on womancentred
care:
• The main aim of the model is to provide the woman with access to a known midwife at all
times during pregnancy, labour and birth and the postnatal period.
• Antenatal care is provided in a range of venues: community, hospital, home.
• Midwives facilitate information sharing and antenatal support.
• There is planning, involving the whole family, around birth and postnatal care.
• The woman knows her midwife for birth care.
• Birth care is provided in whichever setting is appropriate for the individual needs and
wishes of the woman and depends on what is available locally.
• Postnatal and newborn care is provided in the community with much of it taking place in
the woman’s home.
• Where necessary, midwives will consult and refer to medical practitioners using their
clinical judgement and the ACM National Midwifery Guidelines for Consultation and
Referral (2008).
What is a midwifery continuity model
In midwifery continuity of care a woman has a ‘named’ or ‘primary’ midwife, typically working
with one or more backup midwives, providing care from early in pregnancy, throughout
pregnancy, labour and birth, to six weeks following birth. The primary midwife is the
woman’s coordinator of care, facilitating her access to more complex care and other carers
(often obstetricians) according to her needs.
It is important to consider continuity models from a woman’s perspective. Women want:
• to know who is responsible for their care
• to have most of their primary care provided by the same caregiver
• to have access to that caregiver when they consider it important.
Having intrapartum care from their known and trusted midwife is particularly highly valued.
Some other models broaden midwives’ clinical experience across the full scope of midwifery
practice. Team midwifery care, for example, is provided by a group of midwives who work
A guide to implementation
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