Transition of Care between Midwives and Child and Family Health Nurses

February 2007

The Australian College of Midwives believes that effective collaboration between midwives and child and family health nurses[1] will maximise the woman’s and family’s experience and promote equity of access to services. The transition or transfer of care from midwives to child and family health nurses is a critical process.

Definitions
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice 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. A midwife may practice in any setting including the home, community, hospitals, clinics or health units.[2] The midwife practises across the interface of community and hospital settings.

Child and family health nurses provide services at the primary health care level and act as an early point of entry for clients into the community health care system. The nature of the care provided is ongoing and continuous, rather than episodic, and is focused on promoting the health of children and families through the use of a partnership model and anticipatory guidance approach.  The vast majority of child and family health nursing services are carried out in community health facilities or within the home of the client. The child and family health nurse may work as part of a nursing team of two or more nurses who share clients, within multidisciplinary teams, or as individual practitioners with a caseload. Child and family health nursing practice also occurs in residential facilities.

Principles
The provision of care through pregnancy and early childhood should be centred on the needs of the woman, infant and family. Each need should be met by the professional with the most appropriate competencies[3] to meet the need. The availability of appropriate personnel with the necessary competence and capacity will depend on geographical location and availability of resources.

The majority of care is, and should be, provided in the community. At any time in the woman, infant, family journey, there should be a clearly identified primary (Tier 1) care provider[4]. The primary care provider should be supported by a second tier of service providers (Tier 2),[5] who work in collaboration with the primary care provider to meet additional needs of the woman, infant, or family. Tier 1 and 2 providers should have ready access by referral to Tiers 3 and 4[6] for women, infants or families with more complex needs (see diagram). 

During pregnancy, the most appropriate primary care provider for most women is the midwife.[7] Where needed, care is supported by a child and family health nurse and/or other providers.

At some point during the postnatal period,[8] care will be transitioned from the midwife to the child and family health nurse as primary care provider.  The timing of this transition will depend upon the needs of the woman, infant and family and availability of appropriate personnel. Transition should be a collaborative process, the nature of which should vary according to the individual needs of the woman. Once care has transitioned to the child and family health nurse, a midwife and/or other providers may be involved during the postnatal period.

In early childhood,[9] the most appropriate primary care provider for most women is the child and family health nurse. Where needed, care is supported by other providers.

Of critical importance in the provision of care to women, infants and families is the need for continuity of service provision. This will be facilitated by communication between the primary care provider and the woman,[10] and between professionals. This is particularly important when care is handed over from one primary care provider to another. Effective and timely communication is essential in the postnatal period when care is transitioned from midwifery to child and family health nursing. Clear, comprehensive and accurate documentation is a cornerstone of safe and effective continuity of care, and provides evidence of collaboration.

Effective collaboration between midwives and child and family health nurses requires a commitment to understanding and valuing one another’s professional philosophy, scope of practice, competencies, clinical contexts, and challenges. Mutual respect is important in developing strong collegial bonds that will ultimately mean enhanced service provision for women, children and families.

[1] Child and family health nurse may also be called a maternal and child health nurse, child and youth health nurse or child health nurse in different states/territories
[2] The International Definition of the Midwife. Adopted by the International Confederation of Midwives, 19th July 2005
[3] Includes knowledge, skills and attitudes
[4] “Front line” staff providing generalist ongoing care that reaches the whole population
[5] Tier 2 supports the work of Tier 1 through collaboration, consultation and/or education
[6] Tiers 3 and 4 provide specialist intervention for specific conditions or populations and low frequency conditions
[7] World Health Organization. Report on appropriate technology for birth. Geneva: WHO, 1995; World Health Organization. (1996). Care in normal birth: a practical guide. Geneva: Maternal and Newborn Health/Safe Motherhood Unit, Family and Reproductive Health, WHO.
[8] WHO defines the postnatal period as from birth to six weeks. Source: WHO Technical Working Group. (1999). Postpartum care of the mother and newborn: A practical guide. Birth, 26(4), 255-258.
[9] For purposes of this statement, early childhood is defined as continuing from the postnatal period to school entry.
[10] In some instances, communication may be with the primary carer of the infant/child, for example, father, grandmother.