Consultation, Referral, and Collaboration Between Midwives and Obstetricians: Lessons From New Zealand

Abstract

There has been substantial growth in the provision of midwifery-led models of care, yet little is known about the obstetric consultation and referral practices of these midwives or the quality of the collaboration between midwives and obstetricians. This study aimed to describe these processes as they are practised in New Zealand, where midwifery-led maternity care is the dominant model. A total population postal survey was conducted that included 649 New Zealand midwives who provided midwifery-led care in 2001. There was a 56.5% response rate, describing care for 4251 women. Within this cohort, there was a 35% consultation rate and 43% of these women had their lead carer role transferred to an obstetrician. However, the midwives continued to provide care in collaboration with obstetricians for 74% of transferred women. Seventy-two percent of midwives felt that they were well supported by the obstetricians to continue care. Midwifery-led care is reasonable for the general population of childbearing women, and a 35% consultation rate can be seen as a benchmark for this population. Midwives can, when well supported, provide continuity of care for women who experience complexity during pregnancy and/or birth. Collaboration with obstetricians is possible, but there needs to be further work to describe what successful collaboration is and how it might be fostered.

Bridging Between Professionals in Perinatal Care: Towards Shared Care in The Netherlands

“…We searched for descriptions of different forms of collaboration between obstetric professionals in other countries, such as Canada, Australia, New Zealand and the United Kingdom [20][21][22][23][24][25]. There were a number of different approaches: shared care provided by midwives and obstetricians for low and/or high risk cases, a form of case management or community antenatal care combined with intrapartum care delivered by hospital-based professionals.…”

Interprofessional cooperation by midwives in the field of out-of-hospital obstetrical care: an integrative review / Interprofessionelle Kooperation von Hebammen im Handlungsfeld der ambulanten geburtshilflichen Versorgung: ein integratives Review

“…This is confirmed by 1,418 members of health and social services who took part in a cross-sectional study, giving leadership and formalised structures a lower ranking than interprofessional relational factors (Clancy et al, 2013). Working relationships between midwives and physicians are the subject of other studies (Murray-Davis et al, 2011;Pollard, 2011;Skinner & Foureur, 2010). In a quantitative survey (Skinner & Foureur, 2010), midwives rated these as being excellent, but a qualitative study indicated that midwives experience their working relationships to physicians diversely (Pollard, 2011).…”

“…Midwives participated exclusively in five of the studies (Ayerle et al, 2014;Fontein-Kuipers, Budé, Ausems, Vries, & Nieuwenhuijze, 2014;Murray-Davis, Marshall, & Gordon, 2011;Nagel-Brotzler et al, 2005;Skinner & Foureur, 2010), of which one had a qualitative design (Murray-Davis et al, 2011). The populations of all the other studies were of varying composition, consisting midwives, nurses, physicians, associated health professionals, addressees of the care system, professional groups from social services, representatives of administration and politics, as well as members of other professions.…”

“…Apart from this, the health care services of both countries monitor the children from birth on up to toddler age; in Australia, this is carried out by child and family health nurses, in Sweden by child health care nurses (Barimani & Hylander, 2008;Homer et al, 2009). In six other studies, the primary interest lies in interprofessional cooperation between midwives and physicians (Ratti et al, 2014;Schölmerich et al, 2014;Shaw, 2013;Skinner & Foureur, 2010;Smith et al, 2009;Vedam et al, 2012). Three studies examine the introduction of child or family health promotion programmes involving various groups of professions (Edvardsson et al, 2011;Edvardsson et al, 2012;Schmied et al, 2015), while four studies focus on the cooperation between professions in the health and social service sectors (Ayerle et al, 2014;Clancy, Gressnes, & Svensson, 2013;Miers & Pollard, 2009;While, Murgatroyd, Ullman, & Forbes, 2006).…”

“…Working relationships between midwives and physicians are the subject of other studies (Murray-Davis et al, 2011;Pollard, 2011;Skinner & Foureur, 2010). In a quantitative survey (Skinner & Foureur, 2010), midwives rated these as being excellent, but a qualitative study indicated that midwives experience their working relationships to physicians diversely (Pollard, 2011). On the one hand, they perceive their own profession on an equal footing with that of obstetricians in the health care system, describing their relationships as equitable; on the other hand, they endeavour to attain professional recognition in a hierarchical system.…”