Delivering continuity of midwifery care to Queensland women

When medical support is some distance away, decisions regarding potential place of
birth need to be made in a timely fashion within the context of the CSCF (Queensland
Health 2011). Planning these processes should take account of the potential for births to
occur unexpectedly at any site or for women to make choices in their care that are outside
recommendations.
Case conferencing and consultation and referral can occur at a distance through phone
conversations, video links or in a face to face arrangement as possible.
Case conferencing at Mareeba
Face to face regular meetings occur between Mareeba MGP midwives and the consultant
obstetrician from Cairns. Together the interdisciplinary team review and determine the
appropriate level of care and birth place for each woman at booking and across her
pregnancy, consistent with the ACM Consultation and Referral Guidelines.
Women in the town who book for maternity care are aware that their care may be shared
with or transferred to Cairns, in consideration of their history or in response to indications
during pregnancy or labour.
When a midwife observes deviations in the woman’s pregnancy that require attention
prior to the next planned case conferencing session, or deviations occur in labour,
telephone consultation occurs using the SBAR tool (see Appendix 11.01) to provide clear
communication of the woman’s Situation, Background, Assessment and Recommendation
so that the birth suite registrar in Cairns can provide advice or determine that liaison with
the obstetric consultant is required.
Mareeba midwives are experienced in assessing timeliness and mode of transport
requirements for transfer out of this rural site as no local obstetric support is rostered.
However if local escalation is necessary to manage care on-site, the midwives have
developed communication channels within the hospital and with local GPs.
Collaborating with clinicians outside the service
Engagement with private clinicians
Services will have different needs regarding engagement of clinicians outside of the facility.
A metropolitan hospital might initially involve those staff working in the maternity area only,
whereas a rural service would be best to include all staff at the hospital.
Rural hospitals reliant on local GPs for obstetric and anaesthetic support would view their
relationships as vital to the model and ensure inclusion at each stage of planning together
with membership of management groups. Alternatively a metropolitan hospital might see
GPs as external stakeholders not intimately involved with service change and provide them
with periodic updates. Communication mechanisms need to be suited to local needs.
Engagement with private midwives will also vary depending on the circumstances. In some
communities private midwives may be valuable members of reference for management
groups, bringing experience of caseload practice. Potentially, public hospitals may develop
continuity models which involve eligible midwives providing some care privately. Medicareeligible
midwives collaborating with public hospitals will be explored in Section 13.
Some suggestions for involvement of GPs include:
• providing an overview of the proposal to a standing meeting of GPs
• conducting forums with existing GP groups
• developing a flyer that is updated regularly (this could be sent to a range of groups)
• distributing a regular newsletter
• one on one meetings with key GPs or other stakeholders
• lunch time meetings
• developing an intranet or internet site.
A guide to implementation
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