Delivering continuity of midwifery care to Queensland women

Culture of birth—current issues
Intervention
Recent years have seen dramatic increases in the rate of birth intervention. For example,
in Queensland the caesarean section rate increased from 21.4 per cent in 1993 to 31.3
per cent in 2007 (Queensland Maternal and Perinatal Quality Council 2010) and increased
further to 34 per cent in 2008 (Queensland Health 2009). This has significant short and longterm
health consequences for women and babies.
Increasing intervention rates have highlighted the two opposing belief systems around birth:
the perspective that focuses on the risks inherent in birth and the perspective that sees birth
as a normal part of a woman’s life cycle. These differences are recognised in several of the
government documents informing maternity reform (Department of Health and Ageing 2009;
Hirst 2005; National Health and Medical Research Council 2010).
There are facilities that have a culture of collaboration which enables the perspective of both
frameworks to be addressed. MGPs can function effectively alongside obstetric units with a
low level of inter-professional conflict, providing women’s primary care needs effectively and
ensuring timely access to medical intervention when needed. Collaboration in maternity care
is discussed in greater depth in Section 11.
Adapting to changes in the midwifery profession
The midwifery profession is now acknowledged as a distinct profession separate to nursing.
The Australian Health Practitioners Regulation Agency (AHPRA) records midwives and nurses
in separate registers. Increasing numbers of midwives are graduating from direct entry
programs, without nursing skills or nursing registration.
New clinical governance processes need to be developed to accommodate and support
evolving clinical practices and work arrangements. Services which continue to pursue
traditional nursing management and governance strategies will struggle to support new
models and retain staff with a midwifery professional identity.
Midwives’ view of themselves
Midwives often work in models where the person deemed responsible for all clinical
decision making is a doctor. Midwives may be unaccustomed to a role where they need to
make decisions for which they are responsible and accountable. Some midwives flourish in
systems which require increased autonomy and accountability while others are reluctant to
take this step. A structured approach to midwifery professional capacity building (covered
in Section 9) is essential to ensure midwives have the skills and confidence to make the
transition to providing care across the full scope of midwifery practice.
Steps in changing culture
Engagement with the profession
The foundation for achieving effective cultural change is engagement with experts in
the model you are seeking to establish. This will be with midwifery leaders, midwives
experienced in continuity of care and consumers. The Nursing and Midwifery Office
Queensland (NMOQ) and the Australian College of Midwives Queensland Branch (ACMQ)
are key contacts. Engaging external expertise in establishing, working in and sustaining
midwifery continuity of care will be invaluable in dealing with barriers and is an essential
step in supporting cultural change.
Engaging medical colleagues
It is essential to engage a range of medical practitioners in understanding and developing the
midwifery continuity of care model. Medical staff are likely to understand and accept a new
model of midwifery practice, if they understand how it works and are engaged and consulted
early in the development process. The workforce and capacity issues in maternity care affect
all professions and most doctors involved in obstetric care can see the benefits of a stronger
primary care system and improved continuity of care (Masel 2009). There is also increasing
recognition of consumer preference for this model, the health benefits for women and the cost
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Delivering continuity of midwifery care to Queensland women