Delivering continuity of midwifery care to Queensland women

For well women, evidence supports the use of specific, low-risk-focussed birth environments
(Davis, et al. 2011). Care provided in birth centres compared to conventional labour wards/
delivery suites increases normal birth rates, reduces obstetric interventions and women are
more satisfied with their experience (Gottvall, Waldenström, Tingstig, & Grunewald 2011;
Hodnett, et al. 2010).
It is important, however, not to confuse place of birth care with model of care.
It is entirely appropriate for continuity models to admit women regardless of risk status
and to provide intrapartum care in the environment suitable to the woman’s needs (refer
to Clinical Services Capability Framework and ACM Guidelines). This already occurs in rural
models such as Mareeba and Goondiwindi, where all women are accepted into the model
and the choice between birthing in the primary unit or the obstetric (secondary) unit is made
collaboratively.
Early presentation to hospital is associated with a 10–30 per cent increase in unnecessary
admissions increasing bed occupancy and costs (Ball 1996). It is also associated with
increased intrapartum intervention rates (Lauzon & Hodnett 2001). In continuity models,
intrapartum care usually starts with phone contact between the woman and her midwife (or
group practice partner on-call). The midwife’s familiarity with her client helps her to make
decisions about early labour care and when to travel to hospital. Early labour care may be
provided in the woman’s home. This may avoid early admission to hospital as an essential
aspect to improving outcomes.
Early labour care at home
Some MGPs, including the Gold Coast Birth Centre, Mater Mothers Hospital and Townsville
Birth Centre, provide for women to be visited in their home for early labour assessment
by their primary midwife. If the midwife’s clients are within a limited geographical area,
the midwife can schedule antenatal and postnatal home visits for other women around
early labour care of the woman. This provides for effective and supportive care, minimises
unnecessary hospital attendances for the woman and enables efficient use of the
midwife’s time.
Complex care in labour and birth
In situations of increasing complexity, the woman’s named midwife—her maternity care
coordinator—continues to provide primary care and continuity. Women may be transferred
to secondary care providers such as obstetricians, or tertiary care facilities. When practical
it is highly desirable that the midwife continue to provide midwifery care to the woman. This
maintains continuity of care, supports the woman’s plans and choices, is very reassuring
to the woman and improves maternal and neonatal morbidity and mortality (Homer, et al.
2008). Continuity in these situations also maintains midwives’ skills in complex care.
Midwifery continuity during and after transfer
When women need to transfer from Mareeba to Cairns they will be accompanied by their
MGP midwife, who may then provide ongoing primary midwifery intrapartum care during
obstetric-led care. In other rural settings women will have the midwife organise their transfer
but, dependent on workloads at the primary hospital, they may not provide ongoing care at
the transfer site.
Midwives in most birth centres (e.g. Gold Coast, Mackay and Royal Brisbane and Women’s
Hospital), continue to provide care to women following transfer to hospital birth suites.
Midwives in MGPs without designated birth centres, such as Mater Mothers and Logan
hospitals, also continue to provide care by the primary midwife should the woman’s care be
transferred to obstetric care.
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Delivering continuity of midwifery care to Queensland women