The development of a classification system for maternity models of care

Donnolley, Natasha; Butler-Henderson, Kerryn; Chapman, Michael; Sullivan, Elizabeth A.

doi:10.1177/1833358316639454

Cited by 25 publications

(29 citation statements)

References 5 publications

(6 reference statements)

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“…However, there are many more nuances in the way maternity models of care are configured, depending on the sector (public or private), the risk status of the pregnant woman (low risk, high risk, or mixed), the carer (midwife, doctor, Aboriginal health worker), the way care is organised (caseload, collaborative links), the location (hospital, community, home) and the way women move through the model from entry to exit 8 . To deal with these complexities, a national project has been developing a classification system for models of maternity care 11 , 12 . This project has identified the major categories of models of care, including midwifery models of care that provide continuity of care (Box).…”

Section: What Are Models Of Maternity Care?mentioning

confidence: 99%

“…8 To deal with these complexities, a national project has been developing a classification system for models of maternity care. 11,12 This project has identified the major categories of models of care, including midwifery models of care that provide continuity of care (Box). Midwife-led continuity of care models include midwifery group practice caseload care, team midwifery care and private midwifery care.…”

Section: What Are Models Of Maternity Care?mentioning

confidence: 99%

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Models of maternity care: evidence for midwifery continuity of care

Homer

2016

Medical Journal of Australia

140

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There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects. Non-randomised studies have shown benefits of midwifery continuity of care for specific groups, such as Aboriginal and Torres Strait Islander women. There are also benefits for midwives, including high levels of job satisfaction and less occupational burnout. Implementing midwifery continuity of care in public and private settings in Australia has been challenging, despite the evidence in its favour and government policy documents that support it. A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.

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Section: What Are Models Of Maternity Care?mentioning

confidence: 99%

Section: What Are Models Of Maternity Care?mentioning

confidence: 99%

Models of maternity care: evidence for midwifery continuity of care

Homer

2016

Medical Journal of Australia

140

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“…In the private health system (where 25% of births take place), women receive antenatal care from private obstetricians or midwives employed by obstetricians. Hospital midwives attend their labour and birth and the obstetrician attends during the labour and is usually at the birth 2 3. There are some differences across Australia in the way care is provided, especially the local guidelines and the choices available to women.…”

Section: Introductionmentioning

confidence: 99%

Maternal and perinatal outcomes by planned place of birth in Australia 2000 – 2012: a linked population data study

et al. 2019

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ObjectiveTo compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home.DesignA population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ2tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance.SettingAll eight Australian states and territories.ParticipantsWomen with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks’ gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home.Main outcome measuresMode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death).ResultsCompared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth.ConclusionsThis is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes.

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“…Firstly, as with all qualitative research, the intention is to explore rather than to generalise, and we cannot extrapolate these findings to other models of care of the same name. Indeed, as Donnolley et al (2016) point out, while caseloading is a widely used term, it has been used to describe very different models of care. The caseload model in this study provided continuity of care during the antenatal and postnatal period.…”

Section: Discussionmentioning

confidence: 99%