Midwifery Continuity of Care
February 2007
The Australian College of Midwives believes that it is the right of every pregnant woman to have access to continuity of care by a known midwife for her pregnancy, labour and early postnatal period . Midwives are the most appropriate primary care providers for healthy mothers and newborn babies and are able to refer to specialist medical care if the need arises.
Definition:
Continuity of midwifery care means a woman is able to develop a relationship with a midwife to work in partnership for the provision of her care during pregnancy, labour birth and the postnatal period. Whilst there are many ways in which midwifery care may be organised, midwives can function autonomously as primary care providers, and do so with the view to personalising (individualising) care for each woman , providing referral to other health professionals if required. Group practice and team midwifery models providing continuity of care should aim to provide women with access to their primary midwife for most of their care.
Rationale:
Continuity of care is known to decrease the need for pharmacological pain relief in labour and surgical birth rates (both operative vaginal birth and caesarean section) while increasing breastfeeding rates and maternal satisfaction.
The definition of a midwife encompasses continuity of care as it states: “…The midwife is recognised as a responsible and accountable professional who works in partnership with the woman….during pregnancy, labour and the postpartum period to conduct births on the midwife’s own responsibility and to provide care for the newborn and infant”. ICM Definition of the Midwife 2005
Continuity of care is an effective primary health strategy enabling women to participate in decision making about their health and their health care.
Midwives are qualified to work in continuity of care models in a variety of settings, including public and private hospitals, community services, rural and remote health care and private practice.
Australia is one of the few developed countries where access to a known midwife for the childbirth continuum remains uncommon with fewer than 5% of women having the choice of care by a known midwife throughout their maternity episode.
Guidelines:
- The Australian College of Midwives encourages strategies that promote midwives working within midwifery continuity models as they support and protect the normal process of childbirth and enable midwives to work to their full scope of practice.
- Care of well women during pregnancy, labour, birth and the postpartum periods appropriately utilises midwifery expertise. Women who require collaboration with other practitioner or specialist obstetric services also benefit from access to a known midwife for the midwifery component of their care.
- Continuity of care is an effective maternity service workforce strategy as it offers the opportunity for all midwives to work to their full scope of practice and achieve improved job satisfaction. There needs to be appropriate support for midwives who have not recently worked across all areas of midwifery practice to strengthen their knowledge, skills , competence and confidence in this model. Resources must be allocated to enable ongoing education to ensure that midwives are competent to practice in continuity.
- Midwifery continuity of care is cost effective in the immediate and longer term and provides many opportunities for savings in maternity services spending.
- Government policy at both Federal (Medicare) and State (Hospital/community programs) level should be strengthened to enable cost effective funding of continuity of midwifery programs.
References
Hodnett E D, Gates S, Hofrney G and Sakala C. 2003. Continuous support for women during childbirth.The Cochrane Database of Systematic Reviews 2003, Issue 3.
Homer C, Davis G, Brodie P, Sheehan A, Barclay L, Wills J, Chapman G 2001. Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard hospital care Br J Obstet Gynaecol 2001;108:16-22
Maternity Coalition, 2002, National Maternity Action Plan. www.maternitycoalition.org.au/nmap
Page L A, Percival P (eds), 2000, The New Midwifery. Churchill Livingstone, London
Rowley, M, Hensley, M, Brinsmead, M, & Wlodarczyk, J. 1995. Continuity of care by a midwife team versus routine care during pregnancy and birth: a randomised trial. The Medical Journal of Australia 1995; 163 (9): 289-293.
Sally K Tracy & Donna Hartz (2006) The Quality Review of Ryde Midwifery Group Practice, September 2004 to October 2005. Final Report. Northern Sydney and Central Coast Health.
Sally K Tracy, Mark B Tracy (2003) Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data. BJOG August 2003, Vol. 110, pp. 717-724.