Acknowledging the need for change

You’ve seen from the course so far that things can’t carry on as they are. Levels of intervention are rising globally, but poor outcomes are not decreasing at the same rate. Women and their families are suffering increasingly negative after-effects of their birth experience. Midwives are suffering too: highly stressed and burning out, it’s past time for change.

What do the studies say?

Research shows that it’s the way we deliver maternity care needs to change. And that change needs to start with the fundamentals: the very model of care through which maternity services are provided.

Both the structure and the processes used to design and provide services are in need of reform. What’s been recognised again and again is the potential that can be achieved by maximising the role of the midwife, through care that is wrapped around the woman’s needs: placing the woman at the centre of care. This doesn’t mean the midwife works alone. It’s care that’s collaborative in nature, based around the woman’s unique needs and on a foundation of supportive midwifery care that provides the best outcomes for women and babies.

A recent Cochrane systematic review of the available research on models of maternity care concluded that the optimal model of maternity care for most women is relationship-based, within a framework of midwifery continuity of care.

Just what is midwifery continuity of care?

Midwifery continuity of care refers to a model where a midwife provides holistic, primary maternity care, with a back-up of one or two midwives. The known midwife cares for the woman throughout pregnancy, during her birth, and through to the early weeks of parenting. The midwife also facilitates navigation through the health system and referral to other services if required. For example, if there are complications during pregnancy or birth, the woman will also receive care from an obstetrician, specialist or allied health professional. In cases where a woman has a pre-existing medical need, her midwife liaises with other specialist doctors caring for the woman. The key point is that just because a woman is seeing a specialist, it doesn’t negate her need for midwifery care.

What’s evident in maternity health is that all women and babies require certain kinds of care, regardless of what type of birth they are planning or whether or not there are complications during pregnancy, birth, or postpartum. This care is best provided by a midwife.

Some women will require additional support on top of their midwifery care, and this may be provided by a team of specialists, allied health professionals and other services depending on need.

What’s at the core of this model of care? Relationships. At every level. They matter.

Over to you

Had you already heard of midwifery continuity of care? What’s your experience with this model if so?

References

1. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5