Delivering continuity of midwifery care to Queensland women

0.5FTE caseload vs 0.5FTE shift work
A caseload midwife providing care as a 0.5FTE employee provides care for up to 20
women per annum, approximately two women per month. Allowing for the occasional oncall
situation of backing up a colleague, midwives will be required to attend births in an
unplanned fashion twice per month and are probably likely to have two or four more urgent
call-outs per month that cannot be postponed to routine care. The remainder of the time the
midwife can provide care at her convenience, scheduling visits at times that best suit other
commitments such as family.
A midwife working as a 0.5FTE employee will have two eight hourshifts one week and three
eighthour shifts on the second week. The midwife may have some control over timing of
these shifts, depending on hospital workforce circumstances. In some rural units midwives
expect to be on-call to some extent even in a shift-work model.
For managers it is important to identify barriers and actively work toward ensuring they
are addressed. If midwives remain unclear about how to develop a flexible model to meet
their needs, engaging an experienced continuity of care midwife to provide guidance is an
important step. It is appreciated that experienced midwifery managers may not have the
skills to easily transition to managing a continuity model or readily identify the flexibility
required to support continuity of care midwives. Therefore, regardless of expertise, it is
recommended that managers develop their own networks and engage with NMOQ for advice
and support.
I want more information and support in developing a continuity model. Where can
I find colleagues who are experts in continuity of care
These models are new to most Queensland midwives and managers and it is really important
to recognise our own limitations and use the support which is available. Queensland
Health’s Nursing and Midwifery Office (NMOQ) is well placed to provide support and advice,
with both their own staff and referral to experts in other facilities. The College of Midwives
Queensland Branch (ACMQ) is also able to facilitate linkages between midwives to share
knowledge and experience.
I am nervous about providing antenatal care from a community-based setting.
What happens if I need to contact a doctor quickly
Providing care in a community-based setting requires good processes for seeking urgent
review from doctors. Midwives have skills to identify deviations from normal regardless of
where care is provided and this requires prompt action in accordance with consultation
and referral guidelines. If women are already experiencing complexity in their pregnancy,
it is likely they will be receiving medical care at a secondary level and midwives should
make phone contact with the woman’s doctor. Community-based clinics should have preestablished
lines of communication with obstetricians or GP-obstetricians for urgent as well
as non-urgent referral.
References
Hodnett, E. D., Downe, S., Walsh, D. & Weston, J. (2010). Alternative versus conventional
institutional settings for birth. Cochrane Database of Systematic Reviews. Issue 9. Art.
No.: CD000012. DOI: 10.1002/14651858.CD000012.pub3.
Homer, C. Brodie, P. & Leap, N. (2008), Midwifery Continuity of Care. Sydney: Elsevier.
McCourt, C. & Stevens, T. (2009). Relationship and reciprocity in caseload midwifery. In B.
Hunter & R. Deery (Eds.), Emotions in midwifery and reproduction (pp. 17-35). New York:
Pelgrave Macmillan.
Toohill, J., Turkstra, E., Gamble, J. & Scuffham, P. (2011). A non-randomised trial investigating
the cost-effectiveness of midwifery group practice compared with standard maternity
care arrangements in one Australian hospital. Manuscript submitted for publication.
Vernon, D. (2007). With Women – midwives’ experiences: from shift work to continuity of
care. Canberra: Australian College of Midwives.
A guide to implementation
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