Delivering continuity of midwifery care to Queensland women

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Hybrid private and public models Women may be able to receive continuity of midwifery carer with their midwife in private practice for antenatal and postnatal care, and with their midwife working in employed public hospital practice for intrapartum care. This model will depend on good collaboration between private midwives and public hospital management. Rural GP-obstetricians frequently work under arrangements of this type. Section 19.2—Rural and remote public facilities Section 19.2 of the Health Insurance Act 1953 allows specific public facilities to be enabled by the Commonwealth minister to work under different rules. Section19.2 allows public hospital employees to provide MBS-rebated outpatient services in declared rural and remote locations. In these locations eligible midwives might work as employees while providing MBS bulk-billed outpatient care. See: www.health.qld.gov.au/publications/Guidelines_COAG_19.2.pdf Aboriginal medical services or other entities An eligible midwife employed in an Aboriginal Medical Service (AMS), which also employs a GP-obstetrician, would meet the requirements of option 1 for ‘collaborative arrangements’ (see 5 (1) (a) in the Determination, Appendix 13.02). Such a midwife could also be employed by a public facility for provision of intrapartum care. Midwives employed by private obstetricians or GP-obstetricians Some private specialist obstetricians or GP-obstetricians may employ eligible midwives in their practices. These midwives could potentially provide care in private hospitals as well as doctors’ rooms. Private hospitals Eligible midwives could potentially provide intrapartum care in private hospitals, in private midwifery practice. This would require cooperation with private obstetricians and supportive hospital management. Possible implications for Queensland Health maternity services It is hard to predict how the gradual introduction of eligible midwives into the maternity care system will affect public maternity services. Possible options include: • A state-wide process and document set is being developed to support collaborative arrangements between public hospitals and eligible midwives. This will include credentialing for visiting access, in order to support intrapartum care by eligible midwives in public hospitals. • Midwives working in public MGP models will find gaining eligibility much easier than many midwives in other models and consequently may have more options for practice. • Women could be referred, by public hospitals or hospital clinicians, to eligible midwives for antenatal or postnatal care (if by a doctor, this may create a ‘collaborative arrangement’). • It is conceivable that employed eligible midwives could be granted ‘right to private practice’, like doctors and create new revenue options for public facilities. • Contractual arrangements with eligible private midwives might be used to provide services when public facilities are running at or over capacity. 86 Delivering continuity of midwifery care to Queensland women
Section 14 Frequently asked questions Women birthing here are already cared for by midwives. How is continuity of midwifery care different Differences for women in continuity models are: • knowing their carer(s), thus feeling safer and more confident • having access to a known carer 24/7 • receiving responsive, personalised care • having carers who understand and support their choices • having carers with a more thorough understanding of their circumstances, needs and preferences, strengths and capabilities • being more satisfied with their care • better clinical outcomes. Knowing their carer means knowing the midwife’s name, phone/contact number, when to call and how to call, who she works with and when she will visit. There remains limited opportunity for most women accessing public health services to know their carer(s). What is different for midwives working in continuity of care models that needs to be understood and supported Differences for midwives are: • the ability to work to the full scope of midwifery practice across the continuum of the woman’s childbirth experience • getting to know the women they care for • midwives work autonomously but not independently of the broader health team • the level of clinical decision making under the midwife’s own responsibility is significantly increased • there is an opportunity to work across and between the woman’s home, community and hospital sites • midwives work flexibly across 24/7 under safe industrial arrangements • high levels of job satisfaction. The meaning of midwife is to be ‘with woman’. However there are barriers within mainstream care to fulfil this educationally prepared professional role. Studies report that in practice, midwives in mainstream or traditional models may spend relatively little time directly supporting or working with women (McCourt & Stevens 2009). Midwives working in continuity of carer models are required to work to their full scope of midwifery practice. Partnering with women, they provide ongoing care across the continuum. They link with other maternity carers in response to the woman’s needs. This leads to improved clinical effectiveness. Midwives make clinical decisions under their own responsibility and consult and refer to obstetricians and other health professionals as required. This is not a specialist role, but the role midwives have been educationally prepared for. What are the cost implications for establishing a midwifery continuity of care model New models can be resourced within existing budgets with little or no additional cost. Where additional positions are required for a new service, managers can often access existing positions within their budget that have been vacant and realign these existing resources to the new model. More commonly however, proportionate resources can be redirected from antenatal, intrapartum and postnatal (including home visiting) budgets to the new model where the care will now be provided (Homer, et al. 2008). Some services have also A guide to implementation 87
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Nursing and Midwifery Office, Queen
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Nursing and Midwifery Office, Queen
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Section 9 Professional development
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4 Delivering continuity of midwifer
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5. Cultural change—building a sup
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Section 1 Why provide continuity of
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These reforms can be seen as part o
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The emotional and social benefits w
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Section 2 Midwifery continuity mode
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shifts, but also rotate across ante
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For well women, evidence supports t
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Gottvall, K., Waldenstrom, U., Ting
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• The project officer develops se
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- on-call arrangements - relief - (
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Section 4 Key elements to successfu
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Key issues for leaders in midwifery
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At the Gold Coast Hospital Birth Ce
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Goondiwindi A review of Goondiwindi
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Culture of birth—current issues I
Page 40 and 41: A mechanism to inform and engage th
Page 42 and 43: Section 6 Clinical governance Eleme
Page 44 and 45: Consumer participation and informed
Page 46 and 47: Clinical practice guidelines To ens
Page 48 and 49: Award levels for midwives Often mid
Page 50 and 51: Balance of service demand and resou
Page 52 and 53: Considerations when implementing ca
Page 54 and 55: Section 8 Industrial issues The ann
Page 56 and 57: Example: A new MGP model is impleme
Page 58 and 59: References Collins, C., Fereday, J.
Page 60 and 61: Each midwife working in Queensland
Page 62 and 63: Midwives working in continuity of c
Page 64 and 65: Skills for managers Managers suppor
Page 66 and 67: • Midwifery Practice Review (MPR)
Page 68 and 69: • Find a few sources of evidence
Page 70 and 71: Interactions within the whole MGP T
Page 72 and 73: Measurement of continuity provided
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Page 76 and 77: At 1 pm I receive a call from K, sh
Page 78 and 79: Section 11 Collaborative maternity
Page 80 and 81: Example Mary presents to Miles Hosp
Page 82 and 83: Collaboration with GPs A range of m
Page 84 and 85: How to sustain your model The abili
Page 86 and 87: References Homer, C. Brodie, P. & L
Page 88 and 89: MBS rebates are available for a ran
Page 92 and 93: operationalised the universal postn
Page 94 and 95: Glossary This glossary includes all
Page 96 and 97: Team midwifery: A model of maternit
Page 98 and 99: 94 Department of Health and Ageing.
Page 100 and 101: Queensland Health. (2008b). Queensl
Page 102 and 103: Acknowledgments Queensland Health w
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Delivering continuity of midwifery care to Queensland women

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