Delivering continuity of midwifery care to Queensland women

Postnatal care
Each day, the midwife continued her diligent attention to all of us, making sure the baby
was drinking properly and I was recovering well. Her care was wonderful and holistic and
most of all genuinely caring. When the difficult times and tiredness came, as inevitably
they do even with the best of babies and births, the continuity of my home environment
and the care from my husband and the midwife was an enormous comfort.
(Review of Maternity Services in Queensland)
In most continuity models initial postnatal care is provided for a period of a few hours
(usually four to six) in hospital with the potential for longer hospital stays if clinically
required by mother or baby. After this time most postnatal care is provided in the woman’s
home. Some women may attend hospital, community facilities or clinics for particular needs.
Postnatal care in the home enables a midwife to assist the woman with the transition to
mothering in her own environment. Importantly this avoids the stress of travel early in the
postnatal period allowing vital family rest and stability. By working with the woman in her
own environment the midwife can assess and support the woman’s adaptation to parenting
within the woman’s context, environment and family.
Breastfeeding support is a key part of postnatal care and is greatly enhanced by continuity
of midwifery care. Women benefit from receiving advice from one midwife (instead of
contradictory advice from multiple caregivers) who can work through challenges with them.
Ongoing access to midwifery care by phone and home visiting enables early intervention in
breastfeeding crises when women are at risk of losing confidence and giving up. Queensland
Health strongly supports increased breastfeeding rates in the first six months (see www.
health.qld.gov.au/breastfeeding/).
As with antenatal care, postnatal care in the woman’s home helps the midwife to understand
the woman’s social circumstances.
Postnatal care is most effective if it continues for six weeks. There may be times late in the
postnatal period where the woman may prefer to come to the midwife. The midwife may also
provide postnatal care at a community base or clinic, possibly in conjunction with group
education. Both of these situations may provide an opportunity for the woman to start to
develop or extend social networks with women in the community.
Transition to child health care
Ideally midwives provide care to around six weeks after birth. Prior to the midwife concluding
her care with the woman, the woman is linked to community and child health services.
This ensures a seamless transition of care.
In circumstances where the woman and her baby would benefit from earlier integration to
child health services, child health practitioners may be involved in care with the midwife
during the antenatal period and/or immediate post-birth period to ensure continuity of care
is extended beyond six weeks. Continuity of care midwives are very well placed to work with
child health services as the partnership between the woman and the midwife can provide
the basis for a longer term relationship with child health services.
References
Australian College of Midwives. (ACM). (2008). National Midwifery Guidelines for
Consultation and Referral. 2nd Edition. Canberra: Australian College of Midwives.
Ball, J., Washbrooke,M. 1996. Birthrate Plus – A framework for workforce planning and
decision-making for midwifery services. Edinburgh: Elsevier.
Davis, D., Baddock, S., Pairman, S., Hunter, M., Benn, C., Wilson, D., Dixon, L. & Herbison,
P. (2011). Planned place of birth in New Zealand: Does it affect mode of birth and
intervention rates among low-risk women Birth. 38:2, pp111-119.
Fereday, J., Collins, C., Turnbull, D., Pincombe, J. & Oster, C. (2009). An evaluation of
Mdiwifery Group Practice Part II: Women’s satisfaction. Women and Birth. 22:11-16.
A guide to implementation
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