Rethinking women's access to continuity of midwife care

Abstract

Introduction: Maternity services in Australia remain highly medicalised. Women continue to report that care is fragmented and not tailored to their needs or within the context of their families. The health system gives scant attention to promoting health or building healthy communities. There is overwhelming evidence for providing women with continuity of care by a known midwife, yet few women have access to this model of care and it is disproportionately offered in the public sector. Private practice midwives with access agreements to hospitals offer safe and satisfying care for women and their families. For example, the first two years of practice data for My Midwives, Toowoomba showed that outcomes for women and newborns compared favourably with national perinatal data for each National Core Maternity Indicator. Concurrently, the number of admissions for childbirth in private hospitals under private obstetricians is falling and health funds cite the growing cost of maternity care as a key reasons for seeking a premium rise in April. The health system is failing to gain momentum in reorienting the model of maternity service delivery to align with the evidence. It is timely to examine the opportunity affordedwith the 2010maternity service reforms, including access to Medicare, from a health service perspective. Aim: To discuss the benefits to health services of facilitating access agreements for private practice midwives, including a cost analysis, and offer strategies for midwives and maternity service managers to bring about changes to models of care.