Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework

Abstract

Problem: Midwifery-led continuity of care has well documented evidence of benefits for mothers and babies, however uptake of these models by Australian maternity services has been slow. Background:It is estimated that only 10% of women have access to midwifery-led continuity of care in Australia. The Quality Maternal Newborn Care (QMNC) Framework has been developed as a way to implement and upscale health systems that meet the needs of childbearing women and their infants. The Framework can be used to explore the qualities of existing maternity services. Aim:We aimed to use the QMNC Framework to explore the qualities of midwifery-led continuity of care in two distinct settings in Australia with recommendations for replication of the model in similar settings.Methods: Data were collected from services users and service providers via focus groups. Thematic analysis was used to develop initial findings that were then mapped back to the QMNC Framework.Findings: Good quality care was facilitated by Fostering connection, Providing flexibility for women and midwives and Having a sense of choice and control. Barriers to the provision of quality care were: Contested care and Needing more preparation for unexpected outcomes.Discussion: Midwifery-led continuity of carer models shift the power dynamic from a hierarchical one, to one of equality between women and midwives facilitating informed decision making. There are ongoing issues with collaboration between general practice, obstetrics and midwifery. Maternity services have a responsibility to address the challenges of contested care and to prepare women for all possible outcomes to ensure women experience the best quality care as described in the Framework. Conclusion:The QMNC Framework is a useful tool for exploring the facilitators and barriers to the widespread provision of midwifery-led continuity of care.

Healthy Mothers, Healthy Children: A Keystone for Happiness in Society

“…The different model of care provided by midwives and obstetricians shows a preference of women toward the midwives in Cyprus. Midwives offer a woman-centered model of childbirth care [68] characterized by equality between the women and their midwives [69] and the avoidance of unnecessary interventions [70] in comparison to a more medicalized hierarchical care as provided by obstetricians and supported by the overall culture of the health care system in Cyprus [33].…”

Transforming the Quality Maternal Newborn Care Framework into an index to measure the quality of maternity care

“…31 A distinct advantage of the QMNCFi is that it reflects a global synthesis of the evidence from the Framework, and is, in theory at least, applicable globally. 1 Following the Framework's successful adaptation as a qualitative data collection tool, [8][9][10][11][12][13] this paper reports its transformation into a survey instrument -the QMNC Framework index (QMNCFi). Our intention was to produce an instrument that can be used in a wide variety of settings.…”

“…Following the Framework's successful adaptation as a qualitative data collection tool, 8–13 this paper reports its transformation into a survey instrument – the QMNC Framework index (QMNCFi). Our intention was to produce an instrument that can be used in a wide variety of settings.…”

“…8 It has since been used successfully in qualitative studies with different stakeholders and in a range of settings in Scotland and Australia. [9][10][11][12][13] In these qualitative studies, the QMNC Framework informed the focus group and interview prompts; data were analyzed thematically, and the final themes were aligned with the Framework using a visual depiction scale. Preliminary analyses using the Framework have demonstrated the value of this tool for identifying where maternity care is functioning well versus aspects of care in need of improvement.…”

“…It has been proposed as a structure around which improvements in midwifery can be made globally 7 as a result of which the feasibility of adapting it as a data collection tool was tested 8 . It has since been used successfully in qualitative studies with different stakeholders and in a range of settings in Scotland and Australia 9–13 . In these qualitative studies, the QMNC Framework informed the focus group and interview prompts; data were analyzed thematically, and the final themes were aligned with the Framework using a visual depiction scale.…”