Delivering continuity of midwifery care to Queensland women

Executive summary
1. Why provide continuity of midwifery care
Midwifery continuity models are popular with women, provide improved birth and
satisfaction outcomes, are cost-effective and are common overseas. For these reasons
Australian governments are committed to increasing women’s access to these models
as outlined in the National Maternity Services Plan and actioned by the Queensland
Government with the commitment to provide public birth care in these models. Continuity
models also have advantages in the development and retention of a skilled workforce which
is responsive to day-to-day demand.
2. Midwifery continuity models
These models provide each woman with care from a known midwife/midwives, usually to six
weeks postpartum. To meet the needs of women and be sustainable for midwives, continuity
models are innovative and flexible in relation to place of care and in midwives’ working
arrangements.
Women with any level of complexity of care benefit from continuity of midwifery care, and
midwives consult with and refer to doctors and other caregivers according to guidelines and
clinical need.
3. Steps in implementing a new model
New models are initiated by senior management, who set a capacity target, identify funding,
secure a sponsor, notify staff and other relevant stakeholders and appoint a project officer
with the required abilities.
The project officer develops a project plan, assembles a project steering committee including
appropriate internal and external stakeholders, informs staff and ensures compliance
with departmental requirements. In consultation with the steering committee and in
consideration of local needs and projections, project documents are developed, including a
philosophy, model of care, business plan and risk register.
Once the project is approved, discussions occur with partner health service providers
(including major referral hospitals and community-based services) and emergency transport
services. A local agreement is negotiated with the union and local midwives. Midwifery
position descriptions, upskilling requirements and communication and referral pathways are
developed. Clinical governance systems are defined including key performance indicators
(KPIs).
Transition to the new model must be carefully managed and monitored, with a clear
understanding of how midwifery continuity models work and with commitment and
practical support from management for midwives to innovate. Good communication
within the service, multidisciplinary case reviews, frequent team meetings and networking
relationships beyond the service enable a collaborative culture to develop.
4. Key elements to successfully implementing a midwifery continuity of care model
Five key elements to successful implementation have been identified:
• Leadership is the most critical element, requiring adaptation to the different needs,
philosophy and midwifery autonomy characteristic of these models.
• A clear vision for the model, shared by the key people who will develop and deliver it, is
required for success in achieving it.
• A woman-centred philosophy of care ensures the model delivers what women need and
clarifies the roles of caregivers.
• Communication within and beyond the service builds collaboration and understanding.
• Engagement of stakeholders helps align expectations and manage divergent motivations.
A guide to implementation
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