Delivering continuity of midwifery care to Queensland women

How to sustain your model
The ability to sustain midwifery continuity of care models relies on several elements:
• the ability to sustain the midwives
• communication and good working relationships with colleagues
• safety and quality within the service.
Midwife managers have a responsibility to ensure midwives practice self-care. There has been
a discussion about self-care in Section 10. However a further list of important elements are:
• regular scheduled days off-call
• arrangements for times where a midwife is unavailable (when not off-call)
• robust cover arrangements for unexpected leave or relief
• a system for provision of collegial advice and support
• regular supervision/mentoring/support for the midwife with a focus on self-care (Homer,
et al. 2008).
The requirement for communication and good working relationships with colleagues is
essential for longevity. Situations where models are under threat of closure are often due to
a lack of communication or lack of a developed working relationship between colleagues—
particularly medical colleagues involved in the model or providing backup. Several strategies
for dealing with this are outlined in Section 11 but can be summarised as:
• direct engagement and involvement of medical colleagues in development of the model
• regular scheduled communication and case review on a cycle of two to four weeks
• formal and informal processes of welcoming new members of the collaborative team
• management support for midwives, particularly those having difficulty communicating or
consulting and referring to colleagues
• case review with a range of members of the team, specifically where poor outcomes
occurred, where communication has broken down, where collaborative care worked well
or where the woman made decisions outside unit/professional guidance
• regular meetings with core staff and other members of the wider team.
Safety and quality is another element that is often put forward as being a reason to change
or close midwifery models. Obviously safety is paramount however it is rare that significant
safety issues arise in a well-developed or well maintained midwifery model of care.
Sustainability can be greatly supported by the informed and supportive management and
availability of outcome data to support the model’s safety record. Some steps to ensure
sufficient transparency of the model’s processes and outcomes include:
• collection and reporting of data relating to KPIs, including outcomes that may be
problematic
• support of staff including appropriate leave, numbers of staff, numbers of clients, working
environment
• transparent processes where care falls outside of agreed pathways that support the
midwife and woman involved.
Retention and managing burnout
Retention of midwives in midwifery models of care is important. Caseload models have been
found to enhance midwife retention rates (Lester 2009; Sandall, Davies & Warwick 2001).
Midwives tend to leave models where they feel a lack of support, receive poor communication
or feel undervalued. Therefore it is important for managers to ensure enough flexibility for
midwives to choose the way they work but provide enough mentoring and supervision to
ensure midwives are using self-care mechanisms to support the way they work.
Burnout and midwife dissatisfaction has been identified in the literature within team models
rather than in MGP models (McCourt & Page 1996; McCourt & Stevens 2009; Reed & Walton
2009; Sandall 1997; Todd, Farquhar, & Camilleri-Ferrante 1998; Walker, Moore, & Eaton
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Delivering continuity of midwifery care to Queensland women