Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework |
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| Institution: | 1. Department of Women and Children''s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King''s College London, United Kingdom;2. Midwifery Research Unit, Mater Medical Research Institute, University of Queensland, Australia;3. Midwifery Group Practice, Alice Springs Hospital, Central Australian Health Service, Australia;4. The Royal Women''s Hospital, Melbourne, Australia;5. Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Australia;6. Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Australia;7. Burnet Institute, Melbourne, Australia;1. Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, DD1 4HJ, United Kingdom;2. Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom;3. Maternity Unit, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom;4. Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia |
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| Abstract: | ProblemMidwifery-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.BackgroundIt 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.AimWe 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.MethodsData 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.FindingsGood 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.DiscussionMidwifery-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. Organisations 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.ConclusionThe QMNC Framework is a useful tool for exploring the facilitators and barriers to the widespread provision of midwifery-led continuity of care. |
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| Keywords: | Continuity of care Birth Health services Quality of health care |
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