Table of Contents
A review of articles on midwifery care in Australia is offered, and recommendations are made for the application of the existing literature to the Australian maternity services.
Summary of Existing Literature
The Continuity of Care is one of the instruments for application in midwifery care in Australia and was introduced in the midwifery curriculum. Using a qualitative study and the Continuity of Care Program at one of the Australian universities, Sweet and Glover (2013) the Continuity of Care program and experience promote strong relationships between midwifery students and clients. Similarly, facilitation, on the Continuity of Care experience also promotes relationships between midwifery students and clinicians into better learning outcomes. Clinical facilitation on the Continuity of Care concept can also ensure early reinforcement of learned concepts to facilitate effectiveness in the delivery of midwifery services (Sweet & Glover, 2013). Results from a study on midwives’ experience with the Continuity of Care model in Australia supports the results from the study by Sweet and Glower. Cummings, Denney-Wilson, and Homer (2015) established the significance of relationships in the delivery of midwifery services. Newly graduate midwives, according to the results, value relationships with their clients and with other professionals with which the new midwives work. The development of trust, development of knowledge and skills, support from other professionals, and self-confidence in the delivery of midwifery care are important to the valued relationships. The factors to the value of relationships explain midwife’s perception of competence in the practice.
Women, as clients in midwifery, are involved in making decisions on their preferred care models and a study of a sample of the population from Queensland, Australia, identifies the women’s need that midwifery should consider. Only 26.7 per cent of the investigated women had prior knowledge on all available models for midwifery care, and a majority of them (90.4 per cent) needed access to information on applicable models. Almost all of the women (99 per cent) desired to play active roles in making decisions on offered midwifery care. The necessary information for making the decision included information on cost, birth and care provider choices, provider contact, continuity of caregiver during labor and birth, and issues around involved medical procedures. The developed knowledge applied to women across different demographic factors (Stevens, Miller, Watson, & Thompson, 2016).
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Toohill, Turkstra, Gamble, and Scuffham (2012) focused on the difference between cost and effectiveness of models for midwifery care and noted the cost-effectiveness of the Midwifery Group Practice over the standard maternity care. The study, which was conducted in an Australian hospital, established that the Midwifery Group Practice, compared to the standard care approach, reduces the likelihood of being induced into labor, the number of antenatal care visits, and the likelihood of neonates’ admission for special care. The group practice model, according to the results, however, results in more post-natal care to neonates than do the standard approach and is associated with a lower total cost of during pregnancy and up to six months after delivery (Toohill, Turksra, Gamble, &Scuffham, 2012). The lower cost of the group care approach than for the standard approach is significant for both hospitals ($ AUD 4696 vs. 5521) and the government ($AUD 4722 vs. 5641). A comparison of the Midwifery Group Practice model among selected aboriginal communities in Australia and the general population of aboriginal communities supports the more post natal care in which the group practice model results. The model also results in more of other neonates’ care needs, such as ultrasounds and hospital admission, but is associated with the benefit of lower length of stay in special care nursery, should the admission occur (Gao, Gold, Josif, Bar-Zeev, Steenkamp, Barclay, …, Kildea, 2014). A comparison of the Caseload Midwifery model and the standard maternity care also identifies a higher cost of the standard care model (Tracy, Harts, Tracy, Allen, Forti, Hall, …, Kildea, 2012). Fewer women, according to the results, also have elective caesarian section delivery in the Caseload Midwifery model than in the standard model, an indication of a higher level of confidence for safe delivery in the caseload model (Tracy et al., 2013).
Recommendations
The results identify the significance of different models to the effectiveness of care in midwifery and apply to midwifery in Australia in which the results are developed. A recommendation is made for the promotion of the Continuity of Care model, the Midwifery Group Model, and the Caseload model for the realization of the benefits with which the results associate the three models. In addition, an evidence-based approach to practice is recommended for the identification of other midwifery models that can improve care outcomes. The results identify the effectiveness of different models against the standard model and an evaluation of the relative effectiveness of all the applicable models is recommended. The evidence-based approach could also help in the identification of differences in the effectiveness of the models across population segments and demographic factors. Learning institution and care facilities, therefor, should promote knowledge and skills for existing midwifery models as well as research competence for the reliance on evidence that will promote cost-effective service delivery in midwifery in Australia. A recommendation is also made for educating women on midwifery models and factors around the models. In addition, the women should be involved decision making for effective care outcomes.
- Cummins, A. M., Denney-Wilson, E., & Homer, C. S. E. (2015). The experiences of new graduate midwives working in midwifery continuity of care models in Australia. The Midwifery, 31(4), 438-444.
- Gao, Y., Gold, L., Josif, C., Bar-Zeev, S., Steenkamp, M., Barclay, L., …, Kildea, S. (2014). A cost-consequences analysis of a Midwifery Group Practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia. The Midwifery, 30(4), 447-455.
- Stevens, G., Miller, Y., Watson, B., Thompson, R. (2015). Choosing a model of maternity care: Decision support needs of Australian women. The Birth, 43(2), 167-173.
- Sweet, L. & Glover, P. (2013) An exploration of the midwifery continuity of care program at one Australian University as a symbiotic clinical education model. The Nurse Education, 33(3), 262-267.
- Toohill, J., Turkstra, E., Gamble, J., Scuffham, P. (2012). A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital. The Midwifery, 28(6), e874-e879.
- Tracy, S., Hartz, D., et. al. (2013). Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. The Lancet, 382(9906), 1723-1732.