Delivering continuity of midwifery care to Queensland women

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A mechanism to inform and engage the community is to develop an ‘options’ booklet outlining the model of midwifery continuity of care. However this must not be used to persuade a pre-determined direction of a service but a tool to ensure open and honest communication. Another is invitation to information sessions within the community. A further mechanism is for models to support consumer organisations in holding film nights or other social functions highlighting midwifery care. A well organised, supportive consumer organisation will be an asset in any cultural change process. If you appoint consumer representatives to steering committees, or if they are involved in clinical networks and other communication processes, they can help collaboration between caregivers and provide a better understanding of consumer perspectives. Culture of collaboration Traditionally the role of the midwife has been to provide care under the direction of a doctor. The midwife would seek advice and ultimately the responsibility for care would rest with the doctor. The move to midwifery continuity of care means that the midwife provides the care seeking clarification, advice or information to support her own decision making. The midwife may also get clarification, advice or information about the decisions made by the doctor in the woman’s care. Under this primary health model, the midwife is responsible for the primary care of the woman until care is transferred to a doctor. Views and beliefs within the maternity unit It is important to workshop or meet to discuss and outline the views and beliefs within your maternity unit. This provides an opportunity to transparently outline various stakeholder perspectives. It is important to develop a shared unit philosophy on continuity of midwifery care. Continued engagement to build and maintain collegiality, unity and ownership of the model is important. Ensuring medical engagement and/or co-operation Medical engagement and cooperation is often noted as a barrier for development of Midwifery Group Practice. Successful implementation of Midwifery Group Practice is only possible with collaboration in maternity care across the whole team. Collaborative maternity care has been the focus of federal maternity reforms and within this framework collaboration has increased importance in health care. Care is best provided by qualified health professionals who work collaboratively within a high quality, tiered health service, to ensure that women receive appropriate and timely care (Australian Health Ministers’ Advisory Council (AHMAC) 2008). Collaboration in maternity care requires defined roles and responsibilities. The National Health and Medical Research Council (2010) found that: Collaboration aims to maximise a woman’s continuity of carer by providing a clear description of roles and responsibilities to support the person who a woman nominates to coordinate her care (her ‘maternity care coordinator’). Staff engagement Some staff may not be knowledgeable of midwifery models and what these models mean for midwives and women. Some staff may view or treat MGP midwives differently to other staff or MGP staff may view themselves differently. Midwifery continuity of care models are a gold standard where they work with other models, not alone. 36 Delivering continuity of midwifery care to Queensland women
Bumps and blocks Well-meaning managers often suggest rotation through MGP for all staff as a mechanism for managing antagonism or elitism. While capacity-building and opportunities for relief are important, continuity of carer is a fundamental principle for midwifery models. Any strategy which limits the time midwives spend in the model potentially means that midwives are not staffing the model for a full pregnancy. This reduces the effectiveness of the model, the satisfaction of the staff and the skills that staff develop in continuity of care. A strategy for engaging and involving staff not working in the MGP is to ask for expressions of interest to fill any periods of leave which cannot be covered within the group. Having a specific rotational position which allows for a year in MGP will provide an opportunity for midwives wishing to develop skills in continuity of care to gain some experience. For example the Malabar MGP in Sydney (a program specifically for Aboriginal and Torres Strait Islander women) has a 12-month rotational position for an Aboriginal midwife. References Australian Health Ministers’ Advisory Council (AHMAC). (2008). Primary Maternity Services In Australia - A Framework For Implementation. Retrieved from www.ahmac.gov.au/ cms_documents/Primary%20Maternity%20Services%20in%20Australia.pdf Department of Health and Ageing. (2009) Report of the Maternity Services Review. February. ISBN: 1-74186-833-5. Online ISBN: 1-74186-834-3. www.health.gov.au/internet/main/ publishing.nsf/Content/msr-report Hendry, S. (2008). Understanding your context: preparing for change. In C. Homer, P. Brodie & N. Leap. (Eds.), Midwifery Continuity of Care. Sydney: Elsevier. Hirst, C. (2005). Rebirthing. Report of the review of maternity services in Queensland. Brisbane: Queensland Government. www.health.qld.gov.au/publications/corporate/ maternity_report2005/MaternityReview_FullDoc.pdf Homer C. (2006) Challenging Midwifery Care, Challenging Midwives and Challenging the System. Women and Birth. 19: 79-83. Masel, S. (2009). Birth Partners - The rebirth of maternity services. Australian Rural Doctor. March, 6-11. National Health and Medical Research Council. (NHMRC). (2010). National Guidance on Collaborative Maternity Care. NHMRC, Canberra. Accessed 27 July 2011 www.nhmrc.gov.au/guidelines/publications/cp124 Pairman, S. & McAra-Couper, J. (2010). Theoretical frameworks for midwifery practice. In S. Pairman, S. Tracy, C. Thorogood, J. Pincombe (Eds.). Midwifery preparation for practice. 2nd Edition (pp.331). Australia: Elsevier. Queensland Health. (2009). Health Statistics Centre Perinatal Statistics 2008. www.health.qld.gov.au/hic/peri2008/perinatal08.asp Queensland Maternal and Perinatal Quality Council. (2010). Review of Pregnancies, Births and Newborns in Queensland 1988 to 2007. Accessed 19 March www.health.qld.gov.au/maternity/docs/qmpqc2010_88-07data7.pdf Sandall, J. (1998). Occupational burnout in midwives: new ways of working and the relationship between organisational factors and psychological health and well being. Risk, Decision & Policy. 3 (3):213-232. Sandall, J., Hatem, M., Devane, D., Soltani, H. & Gates, S. (2009). Discussions of findings from a Cochrane review of midwife-led versus other models of care for childbearing women: continuity, normality and safety. [doi: 10.1016/j.midw.2008.12.002]. Midwifery. 25(1), 8-13. A guide to implementation 37
Page 1 and 2: Nursing and Midwifery Office, Queen
Page 3: Nursing and Midwifery Office, Queen
Page 6 and 7: Section 9 Professional development
Page 8 and 9: 4 Delivering continuity of midwifer
Page 10 and 11: 5. Cultural change—building a sup
Page 12 and 13: Section 1 Why provide continuity of
Page 14 and 15: These reforms can be seen as part o
Page 16 and 17: The emotional and social benefits w
Page 18 and 19: Section 2 Midwifery continuity mode
Page 20 and 21: shifts, but also rotate across ante
Page 22 and 23: For well women, evidence supports t
Page 24 and 25: Gottvall, K., Waldenstrom, U., Ting
Page 26 and 27: • The project officer develops se
Page 28 and 29: - on-call arrangements - relief - (
Page 30 and 31: Section 4 Key elements to successfu
Page 32 and 33: Key issues for leaders in midwifery
Page 34 and 35: At the Gold Coast Hospital Birth Ce
Page 36 and 37: Goondiwindi A review of Goondiwindi
Page 38 and 39: Culture of birth—current issues I
Page 42 and 43: Section 6 Clinical governance Eleme
Page 44 and 45: Consumer participation and informed
Page 46 and 47: Clinical practice guidelines To ens
Page 48 and 49: Award levels for midwives Often mid
Page 50 and 51: Balance of service demand and resou
Page 52 and 53: Considerations when implementing ca
Page 54 and 55: Section 8 Industrial issues The ann
Page 56 and 57: Example: A new MGP model is impleme
Page 58 and 59: References Collins, C., Fereday, J.
Page 60 and 61: Each midwife working in Queensland
Page 62 and 63: Midwives working in continuity of c
Page 64 and 65: Skills for managers Managers suppor
Page 66 and 67: • Midwifery Practice Review (MPR)
Page 68 and 69: • Find a few sources of evidence
Page 70 and 71: Interactions within the whole MGP T
Page 72 and 73: Measurement of continuity provided
Page 74 and 75: • clearly outline what constitute
Page 76 and 77: At 1 pm I receive a call from K, sh
Page 78 and 79: Section 11 Collaborative maternity
Page 80 and 81: Example Mary presents to Miles Hosp
Page 82 and 83: Collaboration with GPs A range of m
Page 84 and 85: How to sustain your model The abili
Page 86 and 87: References Homer, C. Brodie, P. & L
Page 88 and 89: MBS rebates are available for a ran
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Hybrid private and public models Wo
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operationalised the universal postn
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Glossary This glossary includes all
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Team midwifery: A model of maternit
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94 Department of Health and Ageing.
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Queensland Health. (2008b). Queensl
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Acknowledgments Queensland Health w
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Delivering continuity of midwifery care to Queensland women

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