Tuesday, January 29, 2008

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


Anonymous said...

Hi, I work as a midwife in a western sydney public hospital. I am involved in a working group to establish a new midwifery model of care - caseload/team midwifery. Am very excited at the future - we are facing some criticsism from older midwives and obstetricians, but hopefully can prove them incorrect. Do you have any advice that would help us? I know that one on one care will definately improve outcomes especially lower section rates and episiotomies, reduced second stage etc

Sarah Stewart said...

Crickey, Lisa, that is a huge question. It depends what you want advice on. I am certainly very happy to talk to you about this but probably need you to be a little more specific about what you want to know.

One person I would suggest you talk to (if you haven't already done so) is Associate Professor Deborah Davis - she has a combined chair with the University of Sydney.


Deborah is very committed to caseload midwifery and has extensive experience as homebirth midwife in Australia as well as LMC in New Zealand.

My bible in the years ago when I first started looking at this was:

Effective Group Practice in Midwifery: Working with Women
by Lesley Page (Editor). 1995. Wiley-Blackwell

Please feel free to email me about this or contact me on Skype if you want a chat: sarah.m.stewart

The other people to talk to, in your part of the world, are Nicky Leap

and Maralyn Fourer


Good luck, Sarah

Sarah Stewart said...

Sorry, I should clarify - all three of those people I mentioned above are associated with UTS (University of Technology Sydney) not University of Sydney.

Anonymous said...

hi Lisap - good on you for delving into this model of midwifery - there is a country brimming with experts on this over here in NZ as we are well down the track in this model of care - just across the ditch - I think its great that you are reaching to our shores to network.

Sarah Stewart said...

Thank you, anonymous, for your encouragement to LisaP.

What would your advice be to her and anyone else setting up a one-to-one midwifery scheme? What do you see as the main issues?

Anonymous said...

oh god i almost can't even be bothered answering that - I think a basic belief in the normality of birth and the womans ability to give birth to life combined with a genuine interest in the well being of all women and a commitment to honouring womens rightful and special place in society when childbearing.
More practically - group support from colleagues who are equally dedicated and time off (time management. Respect for yourself. Enjoyment of the job. Good financial renumeration (you have self respect - you know what you are worth). Knowledge of the evidence that supports this practice and an interest in social well being.
That's all.