Delivering continuity of midwifery care to Queensland women

Section 5
Cultural change—shared vision: shared culture
Moving from traditional models to midwifery continuity
Why change
Moving from conventional maternity care to a Midwifery Group
Practice requires new processes, procedures and clinical skills
as outlined in earlier sections. However models are unlikely
to be successful without significant cultural change within
maternity services. Different roles, especially for midwives, and
different relationships between caregivers: midwifery, medical
and management; require a different organisational culture. Staff,
especially at the leadership level, need to be sensitive to cultural
issues and diligent about pursuing the required changes.
Women and families receiving care also have adaptations to make. An obvious
benefit is having a known caregiver responsible for primary care and coordination of care.
However for some, there may be challenges in adapting to a framework of informed choice.
Queensland Health’s website on change management may be viewed at: http://qheps.
health.qld.gov.au/cpic/content/pflowsup_changemngt.htm. This should be referred to by all
facilities undertaking projects with culture change elements.
Traditional maternity care
In conventional care, medical doctors take a lead role in providing antenatal care, with
women seeing midwives and sometimes specialist obstetricians periodically at hospital-run
antenatal clinics.
In labour a different group of midwives and doctors will provide hands-on intrapartum care.
After birth, while in hospital, yet another group of midwives will provide postnatal care.
This occurs within a shift work model. On discharge from hospital, some postnatal care may
be provided by a further group of hospital midwives or by child health nurses and/or GPs.
Details vary across health services.
The traditional, or ‘medical model’ has been considered normal practice since the early 20 th
Century. However it has significant limitations, particularly from the woman’s perspective.
Care is significantly fragmented, with women frequently seeing 25 or more caregivers
(Homer 2006). Consistent care is difficult for women to access when responsibility for care is
distributed among so many caregivers.
Moving to continuity models
A growing body of evidence shows improving the woman’s experience and developing a
partnership with a continuous carer is linked to improved health outcomes (Sandall, et al.
2009). For the greatest benefit to be achieved, research demonstrates the woman should
receive care in labour and birth from a known midwife (See Appendices 1.02 and 1.03).
This level of continuity requires not only organisational change but a change in thinking and
orientation for practitioners and managers who have been working in traditional models.
There will be major benefits to women, community, staff and health service provision into
the future, through the reorientation of care delivery to that of woman-centred continuity of
midwifery care models.
Delivering care within new models requires a process of cultural change and carries
significant challenges on the path to major benefits for staff and the community.
A guide to implementation
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