Delivering continuity of midwifery care to Queensland women

Section 10
Midwifery practice in continuity models
Introduction
Understanding midwifery practice in continuity models is essential
to all Queensland Health maternity services. This section gives an
overview and examples of midwives’ practice in continuity models. We
strongly recommend staff developing or working in midwifery continuity
models read “Midwifery Continuity of Care, A Practical Guide” by Homer,
Brodie and Leap (2008) for more comprehensive information.
Philosophy
Working in midwifery continuity of care practice may require a change in the way midwives
think, speak and provide care. The partnership between the woman and the midwife is
likely to be different from any other clinical roles the midwife has experienced. Women are
considered the expert in themselves and hold the ultimate power in decisions about their
birth and their care. Midwives in continuity of care models will be working in a different
context and therefore need support and guidance to make this transition.
The key principles in providing continuity of care have been identified by Sandall (1997) and
presented in Homer, Brodie and Leap (2008):
• an ability to develop meaningful relationships with women, meaning that midwives offer
continuity of carer, rather than being on-call for women they do not know
• occupational autonomy and flexibility so that midwives are in control of, organise and
prioritise their own work
• support at home and at work including midwives meeting frequently to discuss practice
issues, reflect on their work, share information and to ensure that they know when
individual midwives may need more support due to home issues.
Responsibility and autonomy
Midwives who provide continuity of care take a leading or coordinating role for individual
women’s maternity care. Compared to standard care, this gives the midwife greatly increased
responsibility for their practice and for the woman and her baby’s outcomes within the usual
scope of practice of the midwife.
Autonomy means self-determination, the ability to be self-governing. The concept of
autonomy in midwifery is used to provide understanding that midwifery is distinct from
nursing and medicine in that it has its own distinct body of knowledge. The midwife also has
her own individual knowledge making it possible to make decisions and determine actions
within the midwifery context ‘in her own right’ without reference to others (Pelvin 2010).
Evidence-based practice
Understanding and being able to apply evidence to decision making is critical. Units making
the transition to providing continuity of midwifery care may face opposition. Therefore it is
essential the midwives must be able to back up their decisions with evidence:
• Professional engagement is essential to remaining up to date with evidence and research
in maternity care.
• Skills in sourcing and analysing information about maternity care are an advantage, but
may well be the role of a few individuals within the group.
• Midwives’ attendance at professional midwifery seminars, workshops and conferences
will assist in seeking information to support their practice.
• Engaging with consumer organisations is another mechanism to source and reflect on
evidence.
A guide to implementation
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