Thursday, January 31, 2008
One-to-one midwifery care: managing change
In a previous post I talked about the one-to-one midwifery care schemes that are slowly being developed in Australia. This is very exciting for women and midwives in Australia.
I was very pleased to hear from a midwife in Sydney, who is involved with in developing some such scheme. One of the issues that she raised was that older midwives and obstetricians were resistant to the idea of one-to-one midwifery care. This made me reflect on how important it is to manage the process when it comes to implementing a change such as this.
There is a lot of literature about this, and I am really sorry I do not have time to present it here as I would like to. So my writing is very much based on my personal thoughts, experiences and observations. However, midwives such as Nicky Leap, Jane Sandall and Lesley Page have all written about developing caseload midwifery for some years. Maralyn Foureur, an Australian midwife, carried out a RCT looking at total midwifery care in Australia some years ago with results that supported the effectiveness of one-to-one midwifery care - just cannot find the reference for that research anywhere, so you may have to contact Maralyn directly to find out more.
My main thoughts are that it is very important to include everyone in the development of such a model of care, but the one also has to accept that there will always be resistance. Even now, after 15 years of caseload midwifery in New Zealand, there are attacks from various quarters. A lot of it is about loss of power, control and money.
I think it is vital not to alienate the midwives who will continue to provide core facility services. For whatever reason there will always be midwives who cannot work in a caseload situation. These midwives should be valued because they provide the support to midwives who support women. At the same time, core midwives must recognize that the way they provide that support makes a tremendous difference to outcomes, both for the caseload midwife and women.
For me, the key to one-to-one midwifery care is the relationship with the woman. The woman and her family is the reason for providing that model of care, not the midwife. If you do not work in 'partnership' with women, then it does not matter what model of care you use.