One-to-one midwifery care in Australia

Meredith at the Baby Bump Project has drawn my attention to a research study that is currently being carried out in Australia, which is aiming to show that one-to-one midwifery care improves pregnancy and birth outcomes. In other words, if you have the same midwife caring for you throughout your pregnancy and birthing experience, you are more likely to successfully breastfeed, have a normal birth and less postnatal depression.

Research over the last 10-15 years has consistently shown that one-to-one midwifery care has increased positive birth outcomes. One only has to look back at the work of the Albany Midwifery Group and Lesley Page in London in the mid 1990s. However, you could be forgiven for pointing that that whilst we have been providing continuity of midwifery care to women for nearly 20 years in New Zealand, that has not stopped our national cesarean section rate increasing.

So my feelings are (from my own personal experience as well as research findings*) that the key to successful one-to-one midwifery schemes are:

midwives work in very small practices and not big teams;
they have a moderate size caseload;
they are well supported by midwives and doctors in hospital;
they have a well-thought out arrangement for taking time off.

If midwives are working in sustainable practices, are supported by both midwifery and obstetric colleagues in promoting normal birth and are themselves committed to working with women in 'partnership', then we will see a reduction of intervention rates.

How do you feel about midwives: would you prefer one or two midwives only to look after you throughout your pregnancy and birth, or do you think it matters as long as the midwife you meet is nice and knowledgeable?

If you are a midwife, how do you prefer to work: team, one-to-one or hospital shifts? What do you feel are the issues facing midwives carrying a caseload?

*Ball L, Curtis P & Kirkham M, Why do Midwives Leave? Royal College of Midwives Publications, London, 2002.

*Sandall J (1997) Midwives’ burnout and continuity of care. British Journal of Midwifery 15 (2): 106-111

Image: 'Midwives...' Ross
www.flickr.com/photos/13757887@N00/21220649