Delivering continuity of midwifery care to Queensland women

Midwives working in continuity of care will need a range of skills that promote physiological
birth and may not be in daily use in traditional care. These include using a variety of nonpharmacological
methods of pain relief in labour including water immersion and water birth,
and management of physiological third stage.
Mareeba
Mareeba has a population of approximately 8 000 and is 64km from the closest obstetric
maternity service in Cairns, North Queensland. In 2005, Mareeba Maternity Unit set up a
midwifery model when local medical availability was declining. The hospital has a Midwifery
Group Practice with six caseload midwives. In addition, core midwives are rostered to the
combined maternity-paediatric unit and provide in-hospital care to maternity clients.
Local GP obstetricians perform elective LSCS at Mareeba, but there is no formal on-call GP
obstetric service. Intrapartum obstetric backup is provided remotely from Cairns Integrated
Women’s Health Unit with most women who develop complications being transferred to
Cairns Base Hospital. In addition to full continuity of care for pregnancy, labour and birth
and postnatal to six weeks in the community, the MGP midwives provide pre-conception,
pregnancy counselling, order pathology and ultrasound tests, and undertake well women
checks including pap smears (S. Eales, personal communication, March 11, 2011).
Communication, leadership and research
Communication is a fundamental skill for any clinician, essential for safe practice and
effective collaboration. It is important that midwives reflect and critically review their skills in
communication with a mentor, trusted colleague and/or previous client. The communication
skills of the midwives working in midwifery continuity of care models need to be excellent.
Midwives will be assessing their communication skills as part of their professional
development assessment and may include upgrading these skills in their professional
development plan.
Midwives’ communication with each other needs to be transparent, respectful and extensive
in nature, particularly at the outset of the implementation of the model. Midwives meeting
frequently will develop an understanding of accepted group boundaries and will identify any
specific needs of individuals within the group. They will also develop a range of strategies
to support each other and knowledge of the skills each individual midwife has around
communication.
Bumps and blocks
The language we use as maternity care clinicians has a big influence on the care we provide
and on the experiences of women and their families. How do women feel about being
referred to as ‘patients’ or ‘ladies’, or being ‘delivered’ or ‘managed’ When performing
invasive procedures, are we asking for consent in a way which recognises that the woman
has a choice What language can we model for colleagues, and use to help the woman feel
in control, instead of feeling intimidated by a powerful institution and its staff (Blyth 2005).
It is important that language and communication does not reinforce ‘opposite thinking’
(e.g. good versus bad, health versus illness, safety versus risk) (Leap & Pairman 2010).
Midwives and managers working within continuity of care need to be acutely sensitive of
the effect of words, the power relationships as experienced by women, and to use language
which helps women to maximise their sense of power.
Some midwives working in midwifery continuity of care models will find themselves in
a leadership role, either within the model, within the wider health service or in their
profession. They may also be required to provide additional levels of political advocacy and
lobbying in development and maintenance of the model. Midwives may be supported by
specific leadership training or supported by midwifery leaders.
Critical analysis and application of evidence to practice is a further skill for midwives in
continuity of care models.
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Delivering continuity of midwifery care to Queensland women