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.

From coercion to respectful care: women’s interactions with health care providers when planning a VBAC

“…Women were aware of the tension, which led to confusion and confliction. Disagreements are often based on divergent philosophies with midwives supporting physiological birth and obstetricians favouring interventions which impact on women who are seeking a physiological and active labour and birth, including access to water immersion [ 44 , 45 ].…”

A lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical needs—a qualitative study among multiparous women in Somaliland

“…According to Yu et al [ 30 ], the well-functioning midwife-led birthing centers studied in Australia result in significantly lower intervention rates, greater feelings of reproductive agency, and lower health system costs than carrying out normal births in hospitals, while avoiding some of the risks inherent in home births. Australia and Somaliland are obviously very different [ 38 ], but a similar study examining the specific circumstances of introducing midwife-led continuity of care in public health facilities in Somaliland would be informative, especially if carried out in combination with an investigation of the different functions and roles midwives and TBAs occupy, and how they could use their respective abilities to provide quality care for women and newborns. Addressing these challenges could encourage women to more willingly consider facility-based births, which would reduce adverse maternal and newborn health outcomes locally and globally.…”

“…Our preconceptions as midwives may have shaped our understanding in the analysis. By using the content analysis method with all authors involved in the analysis process, we aimed to provide confidence to the reader of the reliability of the findings [ 24 , 38 ]. The key strength of this study was therefore the research process and the personal interviews which gave voice to some of Somaliland’s women.…”

The impact of pre-registration education on the motivation and preparation of midwifery students to work in continuity of midwifery care: An integrative review

“…The term 'continuity of midwifery care' (CoMC) refers to a model of care whereby a primary midwife (backed up by up to three other known midwives) provides 'on-call' continuity of care to a woman throughout her pregnancy, birth and postnatal period (Cummins et al, 2019). This model of care is promoted internationally as there is now overwhelming evidence that CoMC improves health outcomes for mothers and babies, with women less likely to have a preterm or stillbirth and more likely to experience a spontaneous vaginal birth with fewer interventions including epidurals, episiotomy and instrumental birth (Sandall et al, 2016).…”

“…In 2010, the Australian government made a commitment to improve access to CoMC (Australian Government 2011), resulting in changes to the way midwifery education is designed -and increasingly -how maternity services are implemented. Despite this commitment, access for women to these models remains limited (Cummins et al, 2019).…”