Delivering continuity of midwifery care to Queensland women

• in the beginning linking with other professionals and community may literally mean doing
some leg work and visiting local medical centres, politicians or mayors and women’s groups
• various key groups linked and integral to the operation of the service should be invited to
nominate representatives to sit on steering groups and ongoing management groups at
regular planned and minuted meetings. The expected representation of various entities
on steering committees is outlined in Section 3 Steps in implementing a new model.
Communication within the service and developing trust
The development of clear communication pathways has been identified in Section 3 as a
fundamental process within the model. Trust by other clinicians in the midwives providing
primary care as autonomous practitioners is essential. Senior staff, as leaders of the
respective professions, must model and set clear parameters around acceptable processes
and behaviour.
Maternity care coordinator
The NHMRC identified a need for women to have a known ‘maternity care coordinator’ who
is ‘the person nominated by a woman to coordinate her maternity care’ (NHMRC 2010). This
is a useful mechanism to ensure communication processes are effective, as one clinician
takes a leading role in ensuring communication and decision making occurs in a coordinated
manner. In a Midwifery Group Practice model the woman’s caseload or named midwife
would take this role. The maternity care coordinator is responsible for ensuring the woman is
provided with the care required and consults, refers and transfers care when appropriate.
For some units this presents a significant change in the way midwives and medical staff
provide care, and may also change the line of responsibility for decision making in a
woman’s care.
Level of service available
In Queensland the Clinical Services Capability Framework (CSCF) (Queensland Health 2011)
provides the framework for determining what type of care is available in hospitals and
maternity care settings across the state. The CSCF continues to provide the base decisionmaking
tool around what is available in each hospital and setting, which then guides
the need for consultation, referral and transfer of care for women. Midwifery care can be
provided at all levels of Clinical Service Capability. It is possible for midwives to provide
antenatal and postnatal services in non-birthing units and to travel with women to a birthing
facility for intrapartum care.
The maternity section of the CSCF can be downloaded from: www.health.qld.gov.au/cscf
Consultation and referral
The location of the Midwifery Group Practice within the CSCF is the first thought when
considering consultation, referral or transfer. The National Midwifery Guidelines for
Consultation and Referral (ACM 2008) provides the framework for decisions regarding
consultation, referral and transfer of women’s care.
The pathway for communication needs to be appropriate to the experience of the doctors
and midwives. Midwives in continuity models should have a direct communication pathway
with senior medical staff, such as a consultant obstetrician or a GP-obstetrician. It is not
appropriate for junior medical officers to be seen as the first line of communication for
midwives wanting to consult and refer.
There are also different ways of organising medical support within larger hospitals, such
as allocating specific medical staff to support the midwives in continuity of care models. In
services where organising care in this way is possible, communication is streamlined and
the woman experiences both continuity of midwifery care and medical care. This is extremely
desirable from a woman’s perspective.
A guide to implementation
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