Delivering continuity of midwifery care to Queensland women

2004). However it is important that any burnout is identified and addressed. It is possible
that involvement of personnel external to the unit may be required. The unit needs to have
strategies in place to ensure midwives who are fatigued or demonstrate signs of burnout are
managed carefully. Any management strategy which creates additional stress for remaining
colleagues is unlikely to deal with this issue.
Midwives may or may not be able to verbalise strategies to deal with stressors associated
with the caseload role or their personal life. A professional mentor or in-house psychologist
could be helpful particularly if midwives express feelings of fatigue or frustration and these
concerns appear to be related to internal processes. Additionally engagement of external
midwifery continuity of care experts to strategise and find solutions with midwives is
important. Regular processes which encourage discussion about support at home, stressors
within the home and problem solving strategies to reduce overall stress are vitally important
and should be factored into the model.
Evaluating outcomes—clinical and staffing
Evaluating outcomes and collecting sufficient information to support the model is critical
yet it is a step that may not be undertaken well, or may not be undertaken at all. Adding
an administrative or research load to the midwives caseload in recording and evaluating
outcomes is inappropriate. A process to collect data from that which is already entered by
the clinician is essential. Provision of dedicated time for evaluation of data is also required.
Models with few or no clear data collection systems typically have difficulty demonstrating
their safety record. This can be a significant barrier to sustainability.
How to benchmark
Private clinicians (e.g. GPs, private midwives)
Benchmarking is an additional step in evaluating outcomes as it ensures that people who
create the models are aware of the relationship between their outcomes and those of
similar models. The first step in benchmarking data is to ensure collection of common data
in similar ways. It is also important to compare like services. This can be extremely difficult
in midwifery models as variations in fundamental elements of care provided can have a
dramatic impact.
Example
Model A offers continuity of care in early labour with midwives providing labour assessment
in the woman’s home. The midwives are provided with emergency birthing materials and
follow appropriate safety processes for home visiting. Through this model midwives are
able to ascertain whether the woman is in ‘active’ labour prior to transfer to hospital. The
provision of care in this way has the impact of demonstrating to the woman that early labour
is a natural part of the process, facilitates adequate rest, hydration and nutrition in early
labour and reduces stress for the woman by her being in her own environment. It also has
the knock-on effect of reducing the midwife’s hours as she may not remain with the woman
in situations where her continuous presence is not required, when the woman is not in
established labour.
Model B provides continuity of care only in the hospital environment in labour and the
woman must come to hospital to be assessed. The midwives also must remain at the
hospital with the woman if she is in labour and in birth suite or the woman must transfer
to the ward where she may be in a shared room. This mechanism of providing care impacts
on the woman’s level of fatigue, requires more midwifery hours and may result in other
unassessed outcomes.
Obviously data collected from both models about a range of outcomes will be different, but
data to be collected would be determined through the management committee and include
state-wide KPIs as identified for midwifery models by NMOQ. Benchmarking between
models may be challenging, but commonalities would be found to guide practice.
A guide to implementation
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