Delivering continuity of midwifery care to Queensland women

Measurement of continuity provided—Key Performance Indicators
The establishment of targets for continuity of care means that services must diligently
monitor the way midwives are organising their work to determine the impact on the woman’s
ability to have her named or primary midwife for intrapartum care. KPIs will include a
measure of continuity and facilities may change their whole maternity service to a way of
working that provides some element of continuity of care to ensure they meet the target.
Alternatively they may change a small amount of the service to a caseload model that
provides a high level of continuity of carer to meet the target.
Bumps and blocks
Benefits for the woman and satisfaction for the midwives may be reduced where the size of
the MGP disguises ways of working that do not promote continuity.
It is clear that providing a lot of back up, in addition to your own workload, will increase
fatigue levels. It is not possible for midwives to predict how many hours they will work each
week, as this depends on the needs of the women for whom they are providing care.
Organisation of day-to-day care
Work–life balance
Midwives moving to continuity practice need to adapt to a significantly increased level of
autonomy and responsibility. Their midwifery practice is no longer constrained to clearly
demarcated shifts, outside of which they carry no responsibility for care. Their midwifery
practice is mixed into their life and spread throughout their time.
This change in midwives’ practice also brings a dramatic change to the work of their
managers. Managers have less direct control and much of the work they oversee is out of
sight. Midwives and their managers need to be very conscious of how each midwife’s needs
as a mother (or father), woman (or man) and person are balanced with their responsibilities
as a professional.
The day-to-day care for women in continuity of care is mostly described in stories rather than
provided as tools which enable midwives to plan and provide care in an organised way. This
may be due to the variety of ways of providing care.
These resources are strongly recommended:
• Pairman, S., Tracy, S., Thorogood, C. & Pincombe, J. (2010). Midwifery preparation for
practice 2nd Edition. Sydney: Elsevier.
• Homer, C., Brodie, P. & Leap, N. (2008). Midwifery Continuity of Care. Sydney: Elsevier.
• Vernon, D. (2005). Having a Great Birth in Australia. Canberra: Australian College of
Midwives.
• Vernon, D. (2006). Men at Birth. Canberra: Australian College of Midwives.
• Vernon, D. (2007). With Women—midwives’ experiences: from shift work to continuity of
care. Canberra: Australian College of Midwives.
Place of provision of care
Midwives provide care in a range of places. These include a woman’s own home, other
homes, hospital antenatal clinics, community centres, community health facilities, hospital
birth suites, hospital birth centres and the operating theatre.
The place for provision of care is an important consideration in effective time management.
Providing some or most antenatal care in a woman’s home is desirable, but some midwives
may prefer to have some visits in a central setting to connect mothers and manage travelling
time for the midwife.
Community-based antenatal and postnatal care can make care much more accessible and
less stressful for women and families. For this reason, local care was a key principle in the
Re-Birthing recommendations. Provision of care in a community clinic or other appropriate
setting can facilitate group antenatal or postnatal care. This is discussed below under
scheduling of appointments.
68
Delivering continuity of midwifery care to Queensland women