Delivering continuity of midwifery care to Queensland women

Caseload—rostered off-call
Midwives working within Queensland Health models often work in this way. Off-call time of
two days per week is rostered in accordance with the current industrial award. From within
the MGP back-up midwife/midwives provide care when their colleagues are rostered off-call.
Depending on these arrangements and the woman’s ability to meet the backup midwife/
midwives, continuity of carer is high.
Midwives working this way may have a consistent partner. Essentially the midwife is the
named midwife for their own caseload and the named backup for their partner’s caseload.
They get to know both groups of women well.
Time off can be organised regularly with set times each week where your partner midwife is
on-call for your women. For example midwives working in pairs may alternate weekends off
and have the same day off each week. This enables long-term planning and allows for days
‘work free’. It also allows for a flexible day off in the fortnight to avoid fatigue.
An alternative way of providing rostered off-call is to provide care for your own caseload and
have one or more colleagues within the MGP who are named as backup on a client by client
basis. This requires slightly more complex off-call rostering to ensure that off-call time does
not clash and that at least one of the known midwives is available for every woman.
Caseload—rostered on-call
This way of working means midwives have their own caseload for whom they are the
named or primary midwife, however they limit the time they are on-call. Typically the oncall
component is one or two nights per week. It also may vary depending on whether the
midwives are full or part-time and how many midwives are within the MGP.
This way of working limits women’s access to their primary midwife for intrapartum care to
one to two nights per week. The level of continuity of carer will be reduced. However this
model has evolved to reduce midwives’ on-call time, minimising disruption to their lives.
It is important to consider other stressors in this model:
• Midwives are on-call for large numbers of women (i.e. the whole of the MGP). The size of
the MGP will determine how many women the midwife is on-call for.
• Midwives are caring for women for whom they are not the named midwife. This minimises
the benefits of the midwifery partnership to the woman and the midwife.
• The additional stress for midwives being on-call for the whole MGP means that recovery
time after an evening/night on-call is more significant.
Team midwifery models—rostered shifts
The team midwifery model has not been discussed extensively throughout this guide.
The ‘enthusiasm for this model has waxed and waned over the past decade’ (Homer, et al.
2008). Resources for organisation of teams include Midwifery Teams and Caseloads (Flint
1993) which outlines a number of different roster systems. Homer et al. (2008) also describe
how rosters may work.
The significantly different factors of team models are that there is no named or primary
midwife to whom the woman can refer for her care and the midwives work in a roster system
across all areas. The care of the women in the team is usually shared across the whole team.
This means that no one person coordinates the care for individual women.
While teams may have been seen previously as a stepping stone to caseload care, some
team models have not been sustained. Enduring models include the Mackay Birth Centre. In
the majority of models the smaller the team, the higher the degree of continuity experienced
by women.
It is recognised that there may be other variations of team model. None of these models are
described in this guide.
A guide to implementation
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