Delivering continuity of midwifery care to Queensland women

Bumps and blocks
The number of women per FTE midwife per year is determined by counting the number of
women who book, not the number of births. If births are counted instead of bookings, the
work caring for women who are transferred prior to birth or during labour, or who miscarry, is
not accounted for.
This is particularly important in rural models. Women with complexities will receive their
midwifery care (and often GP obstetric care) in the rural facility antenatally and postnatally,
but may birth at a referral hospital (with or without their caseload midwife). Thus rural
caseload midwives can be expected to provide midwifery care to a significantly higher
number of women than local birthing numbers.
Orientation and professional development
Local agreements should make provision for orientation of midwives entering the model
and ongoing professional development (covered in more detail in Section 9). All staff
working under Queensland Health nursing/midwifery awards have provision for professional
development leave and a professional development allowance.
Dependent upon previous experience, midwives may need a reduced workload in the first
weeks of working within a continuity model while they are supported by an experienced
colleague, identify their resources, adjust to processes and learn time management in the
new role. This may not be possible in some models, such as rural units providing care to the
whole local population. In some facilities, transfer to a new model will involve new or better
relationships within the broader community, including local leaders, community services
(health and non-health) and private health services. Orientation should also provide for
initiating and supporting the development of these relationships.
Access to professional development will vary according to location, with rural services
generally requiring additional relief periods due to the necessity to travel for educational
opportunities. The easiest way to help midwives access these professional development
opportunities is to allocate study leave either side of annual leave when the midwife’s
birthing caseload allocation would usually be reduced. In areas where support services
are in place to accept maternity clients in the absence of MGP midwives, it is beneficial for
the group or a subset of the group to attend annual education together. Given that social
support for midwives in these models is important, taking advantage of group opportunities
can assist and sustain team building.
The certified agreement includes provision in continuity models for a graduate midwife
position and this could be provided within a mentorship program. This is discussed in
Section 9 Professional Development.
Industrial matters – what works well
It is known that midwives working in MGP models experience satisfaction and sustainability
when midwives can build meaningful relationships with women, where they have
occupational autonomy and social support at work and at home (Fereday & Oster 2010;
Sandall 1997). Conversely Sandall (1998) found high burnout in team midwifery models.
Service reviews of Australian MGPs have found high satisfaction for midwives working in a
birth centre in a major hospital (Gold Coast) and tertiary centres without separate birthing
facilities (Mater Brisbane and Adelaide Women’s and Children’s Hospitals) (Collins, et al.
2010; Moore 2009; Toohill 2008). In the Adelaide Women’s and Children’s Hospital (Collins,
et al. 2010), 1000 of the 4000 birthing population were cared for within the MGP caseload
arrangement (Cornwell, Donnellan-Fernandez & Nixon 2008). More study on midwives’ work
satisfaction is needed, given current and predicted workforce recruitment and retention
concerns.
A guide to implementation
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