Delivering continuity of midwifery care to Queensland women

Queensland women are being encouraged to explore their options for maternity care. The
Queensland Centre for Mothers & Babies (www.havingababy.org.au) has developed a range
of decision aids to encourage exploring the models of care available.
There is no need for facilities to examine whether local demand exists for midwifery
continuity models. Wherever midwifery continuity models are available they are very popular
with women. International evidence clearly demonstrates women’s preferences for continuity
and satisfaction with continuity models. Local experience also demonstrates that where
models exist, demand usually significantly exceeds capacity. Queensland maternity facilities
need to incorporate midwifery continuity of care models into their local, geographical and
workforce context.
Place of care
Overview
As women progress through pregnancy the midwife meets their continuity needs by working
in various environments, particularly the woman’s own home. This brings benefits to the
woman as well as to the midwife and the institution. Cost benefits of providing care in the
community rather than in hospitals or health centres are difficult to measure but there are
proven overall savings for the midwifery continuity of care model (Homer, et al. 2001; Toohill,
et al. 2011). Government policy supports the decentralisation of maternity services, so that
‘care is local or feels local’ (Queensland Health 2005).
For urban units the challenge is to reorient care provision from predominantly hospital-based
services to community-based services. The change in the way urban units provide care is
explained throughout this guide with considerations such as transport, equipment and
staffing.
Rural maternity services face a significant change to the entire way hospitals are staffed
and care is provided. The move to midwifery continuity of care models within rural units is
essential to sustainable service provision and is in alignment with consumer preference. The
challenge for rural units is understood and this guide provides these units with step by step
processes to reorient their entire service.
Antenatal care – including home, hospital clinics, community centres
I alternated between Karen and Meredyth, Karen was lovely and Meredyth was the
warmest, kindest person I had ever met. I got to know them both throughout the
pregnancy as did Michael and my children. They both prepared me well for all aspects of
the pregnancy, labour and birth.
(submission, Review of Maternity Services in Queensland)
Antenatal care can be provided in a range of settings. The most common settings for
midwives working in continuity of care models are the woman’s home or the hospital where
the midwife is based. However midwives are increasingly moving out into the community
to provide care in a range of other settings including shopping centres, community health
facilities, other practitioners’ clinical space (including medical practitioners), private clinic
locations and agencies such as young women’s services.
The benefit for the midwife in seeing a woman in her home is that it may provide an insight
into the woman’s home environment, her social support network and the other external
factors that may be impacting her pregnancy.
Labour and birth care
Labour and birth care may be provided in a hospital birth suite, a birth centre or potentially
in the woman’s home. At the time of writing this document Queensland had no publicly
funded home birth services, so this option will not be discussed in depth. Information on
publicly funded home birth models is available at www.nmh.uts.edu.au/cmcfh/research/
homebirth.html.
A guide to implementation
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