Delivering continuity of midwifery care to Queensland women

Bumps and blocks
A key element for success is that staff involved in the change process understand midwifery
continuity of care models and woman-centred care. The pitfalls of trying to establish a model
where there may be resistance to change and the temptation to circumvent a Midwifery
Group Practice in favour of other models may be avoided by some study of midwifery
continuity of care models. We have referred extensively to the work of Homer, Brodie and
Leap (2008), which is essential reading for staff setting up new models. Chapters 1 and 2
recommend some background reading. Those with further interest may review further works
suggested in the research section.
Vision
Having a clear vision for your service is vital. Staff involved in the transition of services must
have belief and conviction in the model. McCourt and Page (1996) outline the following
preconditions to successful organisational change:
• a genuine will to succeed
• vision for the model
• central values of the model
• sharing broadly from grass roots to executive.
The vision needs to address key aspects of the model:
• size of the model (is it the whole service or a proportion of the service to meet targets
established by Queensland Health)
• arrangements or organisation of provision of care (model of care)
• places/settings care is to be provided
• who the service relates to (e.g. specific needs groups, all risk, low risk)
• how the model interrelates to existing staff or co-exists with conventional models and
other services.
Leadership
The most critical aspect in implementation of midwifery models of care is leadership.
Without leaders who understand and embrace the key elements of midwifery continuity
of care, midwifery models will not succeed. Leadership also requires effective succession
planning to ensure that all levels of a service maintain and develop the vision of the model.
Historically services have operated within what may have been regarded as a
multidisciplinary team approach, but this has been largely within a hierarchal arrangement
which often fails to use the skills of the midwives effectively. Generally senior nurses and
medical practitioners have been responsible for decision making in a top-down approach.
Undertaking a leadership role in developing a new midwifery continuity service is different
from leading a traditional maternity service. Facilitating and leading change requires an
ability to be innovative and to negotiate the existing system, networks and philosophical
barriers. The leader’s role includes communicating the vision for the model, protecting the
philosophy of woman-centred care and supporting and making understood the autonomous
role of the midwife. Leaders require the energy to change both the direction of a service and
the placement of midwives within nursing structures and medical models.
Homer, Brodie and Leap in their book Midwifery Continuity of Care (2008) provide additional
perspectives for managers on page 11 and in Chapter 8. In this Guide, Section 5 Cultural
Change and Section 9 Professional Capacity Building have additional information for leaders.
The British NHS Midwifery Leadership Competency Model describes a set of key
competencies for midwifery leaders and is available from:
www.rcm.org.uk/EasysiteWeb/getresource.axdAssetID=9950&type
A guide to implementation
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