Delivering continuity of midwifery care to Queensland women

Births
Most of the midwife’s on-call time is for women in labour. Good practice points for time
management for birth care include:
• Ensure that discuss the signs of early labour with the woman in the antenatal period to
ensure that women realise how much time may elapse with contractions before ‘active’
labour commences and the midwife is needed continuously.
• When early labour phone contact is initiated, ensure you spend time on the phone
discussing with the woman what is happening. If possible spend time counting and
assessing contractions on the phone for women who may not be in established labour.
• Provide home assessment in labour to encourage women to rest if latent phase of labour
is long or if you are unsure if the woman is in labour.
• The midwife should rest when possible whilst the woman is in early labour.
• If a woman is in early labour during the day, do not complete a full clinical day as the
woman is likely to labour overnight.
Non-clinical tasks
Midwives need support from other staff in performing non-clinical duties. Administration and
record keeping is a significant part of any model and dedicated administrative support must
be available. A consistent state-wide data collection system is an essential requirement
to assist midwives with data collection and evaluation. Other non-clinical tasks include
cleaning, sourcing and maintenance of equipment.
Managers It is important for continuity of care midwives to be able to focus on their clinical
workload and essential documentation. Administrative jobs such as filing, making and
changing appointments, tracking results and ensuring that note keeping and meetings
are made and dealt with are important jobs, but dedicated administrative time should be
available for these jobs. Midwifery models do not ‘fit’ with traditional methods for allocating
workloads. Administration needs to be as streamlined as possible. Mechanisms such as
using computers at home, being able to record data in electronic systems and electronic
record keeping are beneficial.
Documentation
Documentation is a specific aspect of communication within the midwifery continuity of care
model. Shared documentation in the form of pregnancy hand-held records, Queensland
Health specific pathways and processes and locally-developed, evidence-based protocols
will vary slightly from model to model. However for the purpose of data collection and audit
the aim should be to have consistent documentation and key performance indicators across
models.
A day in a caseload midwife’s life
The day starts with a 5am text from K who has had a show and is experiencing 30 minutely
contractions. She feels that this is ‘it’ but recognises, as it is her third birth, that there may
be some time until the contractions increase and labour establishes. I respond, look at the
time and decide to get up and go for a walk, with my phone attached to my shirt.
I ready myself for the day and head in to the hospital to check on a woman who is an
inpatient. I receive a call from Y who has had a slow pattern of growth for the last six weeks
and is having a second serial ultrasound scan in a nearby town. The results of this scan
will be reviewed by an obstetrician in the nearby town that afternoon and Y is a bit worried.
I reassure her that since the first scan, the baby appears to have grown and that we will
discuss the results of the ultrasound this afternoon. I have a quick catch up with my MGP
partner midwife and head out for some visits.
From about 9.30am I provide an antenatal visit and two postnatal visits in the community.
After seeing these women I receive a call about Y’s scan from the obstetrician. The scan
result is good and after this we discuss that we are all happy with the growth of the baby
since the previous scan. All is well.
A guide to implementation
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