Delivering continuity of midwifery care to Queensland women

• Find a few sources of evidence (e.g. Cochrane database) that you can regularly review to
support decisions.
• When faced with a decision about care where you are uncertain, seek support and
guidance from a mentor or another midwife.
• If challenged on an area where you are not certain or face opposition, seek a supportive
forum in which to revisit the decision, engage other clinicians and seek a range of
information sources about the decision.
Most midwives on initial discussion indicate that they take full responsibility for midwifery
care to the full scope of practice. Yet at times statistical analysis of transfer rates, reasons
for transfer and outcomes indicate that midwives may lack confidence across the scope
and respond with high rates of transfer. It is important that this risk is recognised by
midwives and that they are supported by an appropriate mentor in developing their skills in
communication and collaboration, and with an understanding of consultation and referral
processes and guidelines.
Bumps and blocks
Midwives may feel unable to ‘stand on their own two feet’. They may find it difficult to
make and own decisions when providing care. This may be exacerbated because the
views and philosophy of the managers and medical staff within the unit do not support
continuity of midwifery care. Smooth working of the models relies on the acceptance of the
midwife as an equal member of the multidisciplinary team. The NHMRC National Guidance
on Collaborative Maternity Care (2010) has been endorsed by Queensland Health and
is the appropriate basis for collaboration within the unit. Engagement with consumer
groups, midwifery professional organisations and NMOQ is also helpful in building a
culture of respect and collaboration. It is critical that each midwife has a clear professional
development plan and is supported by experienced continuity of care midwives through
mentoring plans or programs.
Relationships within the MGP
A range of relationships determine the way the midwife practices in the MGP:
• the partnership between the woman and her primary midwife
• the relationship between the midwife and the other midwives within the MGP who provide
back up support
• the relationships between all the MGP midwives
• the relationships MGP midwives have with people outside the model, including core
midwifery staff and obstetricians (covered in Section 6 Governance and Section 11
Collaboration).
Partnership between the woman and her primary midwife
The fundamental partnership in continuity of care models is between the midwife and
the woman. In providing continuity of care midwives are developing a partnership with a
woman that provides a different level of care to working in fragmented models of care. The
partnership between a woman and her midwife is described by Pairman (Pairman & McAra-
Couper 2010) as a ‘professional friendship’.
In standard maternity care the relationship between a midwife and a woman is bound by
many nursing conventions, as the ‘boundary’ between the professional or ‘expert’ and the
woman receiving care is clear. In models where the midwife provides care for the woman
throughout pregnancy, the life-transforming experience of labour and birth and to six week
post birth, sometimes over a number of years and through a number of pregnancies, the
relationship is very different.
Those who view midwifery as a sub-speciality of nursing may be challenged by elements
of the professional friendship that is a partnership. The Midwives Guide to Professional
Boundaries (ANMC 2010) recognises that the context in which the care is provided has a
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Delivering continuity of midwifery care to Queensland women