Delivering continuity of midwifery care to Queensland women

profound impact on the relationship between the midwife and woman. This partnership
changes the way midwives provide day to day care. With the focus on woman-centred care
the midwife provides care in consideration of the needs of the woman more than the needs
of the institution, and also at times more than the midwife’s own needs. Strategies around
maximising continuity while balancing the midwife’s needs are presented below.
Bumps and blocks
Due to the close partnership midwives in caseload models form with women in their care,
they usually come to know the needs and wants of women and are better able to support
them. In mainstream models it is more difficult to advocate for a person you have only just
met. Midwives working in continuity of care models may therefore appear or be labelled as
more outspoken when in fact they are fulfilling their professional role ensuring women are
understood and provided with informed choice.
Some staff (midwives, obstetricians, managers) may find this level of partnership
challenging. It may pose a particular challenge where the continuity of care midwife provides
care for a woman who chooses care contrary to existing policy. A clear understanding of
the woman’s right to make informed choices is necessary for all staff. ‘Informed choice’
situations should be used to enable review of policy and to develop shared understanding
of the needs and rights of women with unconventional preferences or needs.
Working together
A key element of MGP is the way in which midwives work together to provide care.
Arrangements between midwives to provide backup care for each other’s women are crucial
to the sustainability of continuity models. A common mechanism to achieving this is by
midwives working in a practice partnership of two or three midwives. These midwives meet
each other’s women antenatally and go on-call for each other to allow time off-call or rest at
times of increased activity.
Some MGPs do not divide their caseload midwives into partnerships of two or three,
preferring to have a backup midwife from the MGP named for each individual woman. The
benefits of this are working flexibly with a range of colleagues, spreading on-call and off-call
time over a number of midwives and women being able have both midwives of their choice.
The benefits of a consistent partner are being able to schedule time off opposite each other,
getting to know a set group of women both as a primary and back up midwife and getting to
know intimately the way another midwife works.
When setting up the MGP, trust between partner midwives is essential. Having a similar
philosophy is a good starting point. Partnerships where both midwives are at the same life
stage (e.g. small children) work well for some, but equally partnership where midwives are
at different stages of life (e.g. one with small children, one with grown children) sometimes
allows more flexibility.
There are a range of decisions to be made between the partners:
• how to organise on- and off-call time
• when, where and how often each midwife meets her partner’s primary care clients
• how informal and formal communication within the pair will occur
• what information you are providing women and how women communicate with their
midwife and back up midwife
• organisation of leave and professional development.
The needs of midwives working this way are paramount and if difficulties arise between
colleagues it is important for those supporting the caseload to quickly recognise and support
ways of resolving the situation.
A guide to implementation
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