Delivering continuity of midwifery care to Queensland women

shifts, but also rotate across antenatal, intrapartum and postnatal stages of care. This
builds midwives’ skills and may deliver increased continuity of care, but generally delivers
a low level of continuity of carer to women and may also contribute to fragmentation of care
(McCourt, Stevens, Sandall, & Brodie 2006).
Midwifery group practice
A Midwifery Group Practice (MGP) is the organisational unit of caseload midwives. The MGP
is organised to maximise continuity of carer for individual women, while supporting and
sustaining midwives in their work. An MGP may be large or small and there may be more
than one MGP in a service with a large number of caseload midwives. The key to effective
delivery of care by an MGP is to ensure partnership and backup arrangements within the
MGP provide care to each woman from only two or three midwives.
There are a range of ways to organise midwives’ work in an MGP, which are described in
Section 9.
A key function of an MGP is to provide backup for each caseload midwife and ensure she
has adequate rest and time off-call. This is commonly achieved by midwives working in
partnerhip pairs (or occasionally groups of three). The ‘pair’ may be consistent or may
only work together on a case by case basis. Partnership pairs or threes negotiate backup
arrangements for each other’s women.
Small MGP models may include only two to four midwives. Each midwife will be the named
midwife for a number of women. They will also have another group of women for whom they
are the back-up midwife. In small MGPs the woman’s access to a known care provider for
intrapartum care is relatively straightforward, as the pool of possible caregivers is small.
In larger MGPs (≥4), women’s access to continuity of carer, particularly for intrapartum care,
must be tightly monitored. Broadly distributed backup arrangements (e.g. whole group
providing back up) in large MGP’s will tend to provide only a small proportion of women with
care from their named midwife in labour and birth.
Who receives midwifery continuity of care
Continuity of carer is beneficial to all health care consumers. It has been shown to improve
outcomes and consumer satisfaction across areas of health care and across degrees of
complexity of care (Fereday, et al. 2009; Toohill 2008; Turnbull, et al. 2009).
Midwifery continuity of care has traditionally been embedded in ‘low risk’ models. However
there is no evidence to support excluding women from midwifery continuity models because
of their risk status or the complexity of their needs (Sandall, Hatem, Devane, Soltani, &
Gates 2009). For example, women receiving intensive obstetric care benefit from a primary
midwife coordinating their care, facilitating their access to obstetric care and providing their
primary care needs during antenatal, intrapartum and postnatal periods. An example occurs
in Adelaide at the Women’s and Children’s Hospital where a maternal and fetal medicine
midwife coordinates care in collaboration with the MGP midwives (Homer, et al. 2008).
Some midwifery continuity models in Queensland provide care to all women in a defined
geographical area, including those with complex pregnancy or health needs. These models
mainly occur in rural areas (e.g. Goondiwindi and Mareeba) but they could also function
effectively in urban areas.
Other continuity models focus on women with specific needs, such as socially
disadvantaged and vulnerable women and do not exclude women due to risk status (e.g.
Logan MGP). Birth centres tend to have low-risk-focussed exclusion criteria (e.g. Toowoomba
Birth Centre, Gold Coast Birth Centre), with some models (e.g. Gold Coast Birth Centre)
retaining women within the continuity of carer model, supported by collaborative obstetric
care, if complications develop after a set gestational period.
Regardless of the target client group all models will use the Australian College of Midwives’
(ACM) National Midwifery Guidelines for Consultation and Referral (2008) and maintain a
culture of collaborative care.
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Delivering continuity of midwifery care to Queensland women