Delivering continuity of midwifery care to Queensland women

operationalised the universal postnatal contact funding by applying this to MGP to allow
postnatal care to be extended to six weeks.
Where areas find after using the BPF that they are under-resourced for their level of activity
within their mainstream maternity service, any additional secured budget can be invested in
establishing or expanding a continuity of care model. Due to additional savings from reduced
sick leave in continuity models, a proportion of existing budgets for on-call or agency and
relief staff can also be redirected to the new continuity model. Where budgets are developed
for refurbishment or for new maternity facilities, provision should be made to cost birth
space and associated staffing costs for a continuity model of care. It has been found that in
alternative birthing facilities, reduced unnecessary interventions occur including lowering
the caesarean section and induction rates compared with care provided in a general birthing
area (Hodnett, et al. 2010; Toohill, et al. 2011).
As throughput of women increases in continuity models, greater savings can be realised
due to reduced usage of theatre, special care and maternity beds, reduced antenatal
presentations and lower postnatal readmission rates. Areas such as Goondiwindi, Logan,
Ipswich and Mater Mothers have established their MGP models within existing budgets
(sometimes with minimal start-up funds) through evaluating whole of service resources and
redirecting existing funds to continuity of care models.
The managers/doctors/GPs/midwives in my area don’t want to develop a midwifery
continuity of care model. What will happen
The issues surrounding organisational resistance are addressed in Section 5 Building a
Supportive Cultural Environment. It will be an inadequate response for services to actively
refuse to develop models as Queensland Health has established a range of targets and
timelines around model development. Resistance to change can be endemic and therefore
this document offers a range of mechanisms to develop thinking and action (see Section
5). Resistance to change is often based on a lack of understanding of the model or a lack of
exposure to successful, functioning examples.
A lack of knowledge and exposure to midwifery continuity of care can be addressed in a
straightforward fashion. The midwifery continuity of care model is well explained throughout
this document (please review Section 4.3 for a précis of woman-centred care and Section
2 and 10 for explanations of the model). Please refer to the last question in this section for
further assistance.
Midwives here don’t want to work in midwifery continuity of care, what do I do
Again, the reasons for midwives reluctance to change may include a lack of knowledge about
the model. Inviting midwives who have worked or are working in midwifery continuity of care
models, and consumers who have experienced continuity of midwifery care, to speak to
midwives within the service is one initial strategy for commencing the process. There may be
a need to recruit experienced continuity of care midwives to provide support to the service
for a short period to assist in the transition.
I can’t be on-call—I have small children/family needs/carer issues, but the entire
unit is moving to continuity of care. What can I do
Not all midwives may feel ready or able to work in continuity models. It is important to
understand the source of any reluctance or apprehension and determine it is not a symptom
of internal workplace pressure to resist change or due to myths surrounding what it is like
to work in a caseload or continuity model. A number of midwives in Australia working in
continuity models and specifically MGP models have shared their stories of how they have
adapted and coordinated their professional and personal lives around family needs (Homer,
et al. 2008; Vernon 2007).
Midwives have the opportunity to schedule on-call time, as they do with shifts, and to fit
appointment times around their other commitments. Many midwives with young families
comment how smoothly caseload work can work around their family life if they are organised
appropriately.
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Delivering continuity of midwifery care to Queensland women