Delivering continuity of midwifery care to Queensland women

Example
Mary presents to Miles Hospital (a small rural hospital) pregnant with her third baby. She
has had two previous caesarean sections. Jenny is the Midwifery Group Practice midwife
providing Mary’s care. Jenny considers Mary’s situation within the context of the CSCF.
• Regardless of Mary’s choices around her birth (vaginal or repeat caesarean section) there
will need to be consultation with and referral to Toowoomba Hospital for birth care, as
Miles will not be providing birthing services to Mary.
• Jenny explains to Mary that within the context of the CSCF there will need to be
consultation with Toowoomba Hospital and referral to Toowoomba for birth care.
• Jenny then completes the necessary booking for Mary, including considering Mary’s
situation in relation to any further indicators within the ACM consultation and referral
guidelines. Jenny will complete the required paperwork including a referral to Toowoomba
Hospital for a consultation to discuss birth care.
• Jenny explains to Mary that she will continue to provide primary maternity care to Mary
locally, but that Mary will also need secondary care in Toowoomba for her birth care.
Development of consultation and referral pathways for use within an MGP would include a
range of documents for local processes. The essential documents would include:
• a map which details consultation, referral and transfer processes both within a service
and to another service
• an outline of a case review process that enables discussion of women’s cases where
consultation and/or referral may be required. A weekly or fortnightly case review process
with midwives, onsite obstetric staff and/or medical staff from secondary or tertiary
referral facilities is recommended
• a form to enable documentation of consultation, referral and transfer of care. A
mechanism to ensure outcomes data is captured is also necessary
• clear documentation of discussion and plan for ongoing care where a woman declines
recommended care.
Multidisciplinary case review
A process of regular multidisciplinary case review is very helpful in developing collaborative
relationships. This is covered on pages 19 and 46 of the NHMRC Guidance for Collaborative
Maternity Care (2010). Obstetric support should be engaged to establish a case review
process early in the development of the model. While Queensland Health does not currently
have specific multidisciplinary case review templates, it is important to develop a clear
process for reviewing care requirements.
Bumps and blocks
The NHMRC guidance document clearly outlines the need for development of trust.
Engaging with a range of practitioners before development of the model begins is essential
to commence the process of building confidence and trust. This would include medical
practitioners within Queensland Health and GPs and allied health practitioners from the
local area. Ongoing communication is essential to underpin the way care is provided with all
practitioners being aware of their roles and responsibilities, as well as the areas for which
they are not responsible. Having a known maternity care coordinator for each woman is an
ideal way to ensure smooth communication.
Collaborating with other facilities
Some Midwifery Group Practices will not have on-site obstetric or medical staff or access to
local obstetric care may be intermittent. In these situations processes for consultation and
referral will depend on collaboration with caregivers in other facilities. Trusting relationships
and effective communication pathways will need to be developed to ensure women have
access to the right care at the right time.
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Delivering continuity of midwifery care to Queensland women