Midwifery Model Of Care Research Articles

Midwifery continuity: The use of social media

BackgroundContinuity models of midwifery care improve women’s experiences of care and clinical outcomes, but organisationally driven working practices do not facilitate a continuity model and the midwifery care received by most women is fragmented (Sandall et al., 2016, NHS England, 2016). Little is known about the potential for continuity of midwifery care to be achieved using an electronic platform. This paper examines the experiences of women accessing known midwives through a social media platform and their experiences and perception of continuity of care. MethodsThe study forms part of a larger research project aiming to increase understanding about online social learning within professionally moderated social media based communities. This paper reports specifically the concept of midwifery continuity within the online communities. Two secret Facebook groups consisting of 31 mothers and 4 midwife moderators were created (17 mothers & 2 midwives / 14 mothers & 2 midwives). Primary data included 8 online and face to face focus groups, conducted at approximately 10 week intervals, and 28 individual one to one interviews with members of the online community within six weeks of giving birth. Data analysisA thematic analysis using a priori themes was undertaken. This involved coding data which evidenced relational, informational and management continuity across the entire dataset (28 interviews and 8 focus groups). The analysis was undertaken broadly following the six stages described by Braun and Clarke (2006). FindingsRelational and informational continuity were identified across the data. Relational continuity was evident for both the participants and the midwife moderators; informational continuity was described by the participants. Management continuity was not identified. Continuity through social media use was valued by both the mothers and the midwives. ConclusionInformation and relational continuity needs of women can be met using professionally moderated, social media based groups. They may provide an alternative means of facilitating the continuity that is so often lacking in traditional models of care.

Is caseload midwifery a healthy work-form? – A survey of burnout among midwives in Denmark

ObjectiveTo investigate the level of burnout among midwives working in caseloading practices compared to other models of midwifery care. Study design and settingIn this survey the Copenhagen Burnout Inventory was used to measure burnout among midwives working in a tertiary maternity unit Denmark. Main outcome measuresMean burnout scores and the proportion of midwives with high burnout scores (a score >= 50). ResultsThe response rate was 82.0% as 50 out of 61 midwives answered the questionnaire. In caseload midwifery the burnout scores in personal, work-related and client-related burnout were significantly lower when compared to “other models of care”. Among caseloading midwives, none had high scores of burnout in any of the measured domains. The proportions of high burnout scores among all of the participating midwives were 22% (95% CI: 12%–36%) in personal burnout, 20% (95% CI: 11%–34%) had high scores in work-related burnout, and 10% (95% CI: 4%–22%) had high scores in clientrelated burnout. ConclusionCaseload midwifery was associated with lower burnout scores, which is in accordance with the results from other studies on burnout among caseloading midwives. The proportion of high score among all the midwives in this study were low compared to results from other countries. According to the high response rate the results are valid for this maternity unit but this study is too small to be generalised. This study should be repeated among all midwives in Denmark. In studies of burnout in caseload midwifery the midwives’ self-selection into this workform needs consideration.

Concepts and Dimensions in Continuous Midwifery Care Models Based on the Experiences and Expectations of Stakeholders: A Meta-Synthesis

Context: Pregnant women’s have access to different models of care especially to those who provide continuous care and this is one of the recommendations of the world health organization (WHO) for promoting maternal health. Moreover, to provide adequate services in care models, the experiences and perceptions of mothers, providers of prenatal care, and other stakeholders should be taken into consideration. Objectives: A systematic meta-synthesis was carried out to inquire into the findings of some qualitative studies aimed to explore the concept and dimensions of continuous midwifery care including experiences, perspectives and perceptions of engaged people. Data Sources: This study was the first step of an action research designed to develop a midwifery model of care. Qualitative research articles published between 2005 and 2015 on experiences, attitudes, expectations and opinions of stakeholders in models of midwifery care were collected from Google scholar, Elsevier, and PubMed databases. Study Selection: Following the various stages of the scrutiny of the abstracts and contents of the collected articles, five faculty members finally selected 21 qualitative research articles as eligible for inclusion in the meta-synthesis. Results: The findings of meta-synthesis showed that continuous midwifery care for pregnantwomenas a highly important process revolves around at least five basic themes: continuity of care, compliance with needs satisfaction levels, regulation of care environment, and the philosophy of providing continuous care. Conclusions: Given the importance of access to healthcare as a right for pregnant women and given the key role of continuous midwifery care in health promotion and maternal satisfaction, it is suggested based on the results of the study that rigorous local and national research in this area to be carried out so that adequate models of continuous midwifery care can be designed and implemented based on the findings.

Concepts and Dimensions in Continuous Midwifery Care Models Based on the Experiences and Expectations of Stakeholders: A Meta-Synthesis

Concepts and Dimensions in Continuous Midwifery Care Models Based on the Experiences and Expectations of Stakeholders: A Meta-Synthesis

Models of midwifery care for Indigenous women and babies: A meta-synthesis.

Indigenous women in many countries experience a lack of access to culturally appropriate midwifery services. A number of models of care have been established to provide services to women. Research has examined some services, but there has not been a synthesis of qualitative studies of the models of care to help guide practice development and innovations. To undertake a review of qualitative studies of midwifery models of care for Indigenous women and babies evaluating the different types of services available and the experiences of women and midwives. A meta-synthesis was undertaken to examine all relevant qualitative studies. The literature search was limited to English-language published literature from 2000-2014. Nine qualitative studies met the inclusion criteria and literature appraisal - six from Australia and three from Canada. These articles were analysed for coding and theme development. The major themes were valuing continuity of care, managing structural issues, having negative experiences with mainstream services and recognising success. The most positive experiences for women were found with the services that provided continuity of care, had strong community links and were controlled by Indigenous communities. Overall, the experience of the midwifery services for Indigenous women was valuable. Despite this, there were still barriers preventing the provision of intrapartum midwifery care in remote areas. The expansion of midwifery models of care for Indigenous women and babies could be beneficial in order to improve cultural safety, experiences and outcomes in relation to pregnancy and birth.

Women's experiences of home visits by midwives in the early postnatal period

ObjectiveThe aim of the present study is to gain a deeper understanding of women's experiences of midwifery care in connection with home visits during the early postnatal period. Research design/settingA qualitative approach was chosen for data collection, and the data presented are based on six focus group interviews (n: 24). The women were both primiparous and multiparous, aged 22–37, and lived with their partners. All participants had given birth at a maternity unit responsible for about 4000 births a year. The transcribed interviews were analysed through systematic text condensation. FindingsThe findings are reflected in three main themes: ‘The importance of relational continuity’, ‘The importance of a postpartum talk’ and ‘Vulnerability in the early postnatal period’. When the woman had a personal relationship with the midwife responsible for the home visit she experienced predictability, availability and confidence. The women wanted recognition and time to talk about their birth experience. They also felt vulnerable in their maternal role in the early postnatal period and the start of the breast-feeding process. ConclusionsIt is important to promote relational continuity models of midwifery care to address the emotional aspects of the postnatal period. Women generally wish to discuss their birth experience, preferably with the midwife who was present during the birth. Due to the short duration of postnatal care in hospitals, the visit from the midwife a few days after childbirth becomes all the more important.

Az intézeten kívüli szülés helyzetének és a szülésznők szerepének alakulása hazánkban

The rate of homebirth decreased significantly by the 20th century, however, the practice has never disappeared. The Hungarian government issued a regulation of out-of-hospital birth in 2011, then allowed midwives to provide prenatal care for low-risk mothers in 2014. These were great steps toward the midwifery model of care. In this study the authors gathered the statistics of three licensed Hungarian out-of-hospital service providers. Despite the low number of cases, the data confirm that the rate of hospital transports in Hungary is quite similar to those found in other countries. The authors present five different studies to demonstrate that home births are just as safe as hospital births. Finally, the authors summarize a study in which hospital transports based on several criteria were analyzed. The authors conclude that in these events, fear and prejudice influences the participants on either side, harming interprofessional relationships. To improve the care given, mutually respectful communication and education of families about the option of hospital transport are key issues.

Models of Postnatal Care for Low-Income Countries: A Review of the Literature Abstract

PURPOSE:This review aims to identify the key features of effective models of postnatal care involving midwifery personnel and to determine which models may be appropriate for implementation in low-income countries.STUDY DESIGN:A narrative synthesis of English language, peer-reviewed articles from 2004 to 2014 was undertaken. Four online library databases were searched. Inclusion/exclusion criterion and a quality appraisal were applied.MAJOR FINDINGS:Twenty-two studies were included in the review, but only 4 were from low-income countries. Midwifery-led models of postnatal care are cost-effective to provide high-quality care in every settings for every women in respect of 2 core components of quality care that are woman-centered care and continuity of care. Midwifery postnatal care is provided at hospital, in community settings, and at home, all presenting different strengths and weaknesses. Combinations of models of midwifery postnatal care and collaboration between stakeholders have had positive impacts on the quality of postnatal care. To be completely effective, this requires a better management and support of midwifery personnel though. Women and midwifery personnel’s satisfaction needs to be considered to identify the local means and needs and to plan a suitable model of midwifery postnatal care at each location.MAIN CONCLUSION:Low-income countries could develop a midwifery-led model of postnatal care. This will require identifying women and midwifery personnel’s needs and the available resources and involving the stakeholders collaboratively to provide a suitable model of midwifery postnatal care. Education and practice will need to be addressed as well as promotion to the population. There is a need to conduct more research on midwifery postnatal care in low-income countries to evaluate how to best use them and what aspect of the midwifery postnatal care can be strengthened.

Understanding the 'work' of caseload midwives: A mixed-methods exploration of two caseload midwifery models in Victoria, Australia.

Caseload midwifery models are becoming more common in Australian maternity care. Little is known about how caseload midwifery compares with mainstream models of midwifery care in terms of both the organisation of the work and the meaning of the work for caseload midwives. To explore caseload and standard care midwives' views and experiences of midwifery work in two new caseload models in Victoria, Australia. A mixed-methods approach was used. Quantitative data were collected using two cross-sectional surveys of midwives at the two study sites at the commencement of the caseload model and after two years. Qualitative data were collected using in-depth interviews with caseload midwives six months and two years after commencing in the role. Content analysis was used to analyse open-ended survey questions, and interview data were analysed thematically. Themes arising from these data sources were then considered using Normalization Process Theory. Two themes emerged from the data. Caseload midwifery was a 'different' way of working, involving activity-based work, working on-call, fluid navigation between work and personal time and avoiding burnout. Working in caseload was also perceived by caseload midwives to be 'real' midwifery, facilitating relationships with women, and requiring responsibility, accountability, autonomy and legitimacy in their practice. Perceptions of caseload work were influenced by understanding these differences in caseload work compared to mainstream maternity care. Increased understanding of the differences between caseload work and mainstream maternity models, and introducing opportunities to be exposed to caseload work may contribute to sustainability of caseload models.

Embedding continuity of care experiences: An innovation in midwifery education

Midwife-led continuity of care models demonstrate a number of benefits to women with no adverse effects. These benefits include a reduction in childbirth interventions, an increase in spontaneous vaginal births for women of low and increased risk (Begley et al., 2011; Hartz et al., 2013; Sandall et al., 2015) and a reduction in rates of caesarean sections in women of low risk (McLachlan et al., 2012). This model of care also demonstrates increased satisfaction for women when compared to other models of maternity care (Sandall et al., 2015). Given the significant benefits to women, the inclusion of a requirement for students to experience midwife-led continuity of care models was considered to be fundamental to all midwifery education programs. Prior to the introduction of Bachelor of Midwifery programs in Australia in 2002 there were no requirements for midwifery students to experience midwifery continuity of care. Indeed, there were very few continuity of midwifery care models in Australia (Gray, 2010) and students therefore gained their midwifery knowledge, skills and abilities by working with women in models of care with little exposure to the concept of continuity. Midwifery leaders were aware of the integration of continuity experiences in midwifery education programs in the United Kingdom (Anderson and Lewis, 2000) and in New Zealand (Pairman, 2000) and the opportunities that these provided to

Midwifery education in Central-Eastern Europe

Problems in midwifery in many Central-Eastern European countries are very similar; it is possible to speak about the evolving Central-Eastern model of midwifery care. The educational models of this region have a relatively strong theoretical part; however, there is an insufficient practical dimension. Theoretical part of midwifery education in the universities is relatively autonomous and is slowly changing the professional identity of graduates.

Swedish women's interest in models of midwifery care – Time to consider the system? A prospective longitudinal survey

BackgroundSweden has an international reputation for offering high quality maternity care, although models that provide continuity of care are rare. The aim was to explore women's interest in models of care such as continuity with the same midwife, homebirth and birth center care. MethodsA prospective longitudinal survey where 758 women's interest in models such as having the same midwife throughout antenatal, intrapartum and postpartum care, homebirth with a known midwife, and birth center care were investigated. ResultsApproximately 50% wanted continuity of care with the same midwife throughout pregnancy, birth and the postpartum period. Few participants were interested in birth center care or home birth. Fear of giving birth was associated with a preference for continuity with midwife. ConclusionsContinuity with the same midwife could be of certain importance to women with childbirth fear. Models that offer continuity of care with one or two midwives are safe, cost-effective and enhance the chance of having a normal birth, a positive birth experience and possibly reduce fear of birth. The evidence is now overwhelming that all women should have maternity care delivered in this way.

“Home Birth” with an Obstetrician: A Series of 135 Out of Hospital Births

Objective: To evaluate the outcomes of properly selected women in an outof-hospital birth setting with an obstetrician’s unique skills using a midwifery model of care. Design: This is a retrospective review of 135 consecutive out of hospital deliveries over a 56 month period from 2010-2015. Setting: All births took place either in the client’s home or a midwife owned free-standing birth center. Population or Sample: Women were considered candidates if they had no major medical issues, remained healthy and compliant during the prenatal period, went to term and maintained an appropriate maternal positive mindset. Methods: The births include singleton, VBAC, breech and twin deliveries. Main outcome measures: The outcomes of the 135 births are presented in a straight statistical format for comparative analysis with current trends in the hospital birth model. Results: There were 135 women who gave birth to 147 live born infants. 89.6% of the mothers gave birth at home/birth center. The cesarean section rate was 5.9%. There were 96 singleton cephalic births, 27 singleton breech births and 12 sets of twins. There were 32 trials of labor after cesarean (TOLAC) of which 30 were successful vaginal births after cesarean (VBAC) (93.8%). 22 of 27 (81.5%) of the singleton breech babies delivered vaginally. While 11 of 12 (91.7%) of the twin pregnancies delivered at home. Conclusion: Birth at home for properly selected women with a skilled practitioner is a reasonable and ethical option.

The relationship is everything: Women׳s reasons for choosing a privately practising midwife in Western Australia

Objectivethe purpose of this study was to describe women׳s reasons for choosing to birth with a privately practising midwife. Designa modified grounded theory methodology was used. Participants and settingthe sample comprised 14 Western Australian women who had received maternity care from a privately practising midwife within the previous five years. Findingsdata analysis revealed three categories: the first was conceptualised as ‘I knew what I wanted from my caregiver’, which included sub-categories of: I wanted continuity of care; I wanted a relationship with my care provider; and I wanted a care provider with the same childbirth philosophy as me. The second encapsulated ‘I knew what I wanted from my pregnancy and birth experience,’ with two sub-categories, I wanted a natural, active, intervention free pregnancy and birth and I wanted my partner and family to be included. The final category was labelled ‘I was willing to get the research to get what I wanted’ and incorporated two sub-categories, I researched my care options and I researched my care provider options and the evidence around pregnancy and birth to be actively involved. Key conclusionsfindings offer insight around women׳s reasons for choosing this model of midwifery care and highlight that women know exactly what they want from their caregiver. Women valued working with their midwife towards a shared goal of an intervention-free, normal birth, researched their options and found mainstream services restrictive and focused on medical risk status rather than on the individual woman. Implications for practicefindings will be of interest to maternity care practitioners and policy makers, as they highlight why some women prefer a social model of midwifery care that reflects a family centred, individualised and holistic approach. This insight can inform the development of maternity health care practices to recognise and accommodate the needs and values of all childbearing women.

Evaluating the developing families center: A unique model of midwifery care, primary care and early childhood education

However, research has shown that refugee women often are unable to access necessary health care due to an inability to overcome the geographic barrier of traveling to a medical appointment. The Refugee Reproductive Health (RRH) Committee is a coalition of refugees, government officials, and university researchers who seek to address these barriers and improve refugee health in Salt Lake County, Utah. Structure/Method/Design: In April 2014, women from the Congolese refugee community participated in a health workshop held at a local multicultural center not far from the women’s homes. Volunteers picked up participants to ensure they were able to participate in the workshop. At the conclusion of the workshop, a second set of volunteers discovered that the women were not clear about the location of their neighborhoods nor could they adequately explain how to get to their homes. The researchers completed a basic geospatial analysis of the resources available for these women and connected the resources to the location of the women’s homes. Based on this analysis, refugee communities are resettled in locations that are “resource deserts” and not close to resources such as hospitals, clinics, libraries, and grocery stores. Outcomes & Evaluation: Workshop participants varied widely in their ability to direct facilitators to their homes. Many were unable to provide a street address or directions; those who were able to provide directions to the facilitator generally relied on recognizable landmarks to navigate. Overall, returning home presented significant challenges for most of these women. In October 2014, university researchers identified six Congolese women who were willing to be filmed talking about and navigating through their neighborhoods and communities. We filmed these neighborhood walkthroughs at two different seasons to determine how women viewed their communities and how they navigated them. The overall outcome for this project will be to develop tools that women could use to better understand navigating in the Salt Lake County area. Going Forward: Because many of the workshop participants were unable to navigate to their own home, it is likely that this population also faces significant spatial barriers in accessing health care. This study suggests that interventions seeking to improve refugee women’s health should carefully evaluate the geographic barriers and seek to establish tools to expand the spatial mobility of this vulnerable population. The tool templates developed from this project will be made available for other entities working with refugee and immigrant groups. Funding: The Congolese Community Specialist (5% FTE) devotes part of her effort to this project; involvement in this project is within the scope of employment of our governmental partners. Abstract #: 02SEDH010

Exploration of preterm birth rates associated with different models of antenatal midwifery care in Scotland: Unmatched retrospective cohort analysis

Objectivespreterm birth represents a significant personal, clinical, organisational and financial burden. Strategies to reduce the preterm birth rate have had limited success. Limited evidence indicates that certain antenatal care models may offer some protection, although the causal mechanism is not understood. We sought to compare preterm birth rates for mixed-risk pregnant women accessing antenatal care organised at a freestanding midwifery unit (FMU) and mixed-risk pregnant women attending an obstetric unit (OU) with related community-based antenatal care. Methodsunmatched retrospective 4-year Scottish cohort analysis (2008–2011) of mixed-risk pregnant women accessing (i) FMU antenatal care (n=1107); (ii) combined community-based and OU antenatal care (n=7567). Data were accessed via the Information and Statistics Division of the NHS in Scotland. Aggregates analysis and binary logistic regression were used to compare the cohorts׳ rates of preterm birth; and of spontaneous labour onset, use of pharmacological analgesia, unassisted vertex birth, and low birth weight. Odds ratios were adjusted for age, parity, deprivation score and smoking status in pregnancy. Findingsafter adjustment the ‘mixed risk’ FMU cohort had a statistically significantly reduced risk of preterm birth (5.1% [n=57] versus 7.7% [n=583]; AOR 0.73 [95% CI 0.55–0.98]; p=0.034). Differences in these secondary outcome measures were also statistically significant: spontaneous labour onset (FMU 83.9% versus OU 74.6%; AOR 1.74 [95% CI 1.46–2.08]; p<0.001); minimal intrapartum analgesia (FMU 53.7% versus OU 34.4%; AOR 2.17 [95% CI 1.90–2.49]; p<0.001); spontaneous vertex delivery (FMU 71.9% versus OU 63.5%; AOR 1.46 [95% CI 1.32–1.78]; p<0.001). Incidence of low birth weight was not statistically significant after adjustment for other variables. There was no significant difference in the rate of perinatal or neonatal death. Conclusionsgiven this study׳s methodological limitations, we can only claim associations between the care model and or chosen outcomes. Although both cohorts were mixed risk, differences in risk levels could have contributed to these findings. Nevertheless, the significant difference in preterm birth rates in this study resonates with other research, including the recent Cochrane review of midwife-led continuity models. Because of the multiplicity of risk factors for preterm birth we need to explore the salient features of the FMU model which may be contributing to this apparent protective effect. Because a randomised controlled trial would necessarily restrict choice to pregnant women, we feel that this option is problematic in exploring this further. We therefore plan to conduct a prospective matched cohort analysis together with a survey of unit practices and experiences.

Does midwifery philosophy affect perceptions of students regarding female reproduction?

The purpose of the study was to identify views of Slovenian midwifery students about menstruation. We were interested in whether opinions about menstruation change during the study of midwifery and whether perceptions are affected by a midwifery philosophy that promotes the physiology of female reproduction. We used a descriptive and causal non-experimental empirical method with a literature review of professional and scientific references as a first step. Findings were upgraded with quantitative findings. Descriptive statistics were performed; statistically significant differences were determined by χ2 -test and Kullback 2Î test. A high proportion of respondents reported negative feelings about menarche, however they were currently in general positive towards menstruation; third-year students were more positive than first-year students. Compared with past Slovenian studies, performed in the general population of students, midwifery students show more open attitudes regarding menstruation, which may partially be the result of promoting a physiological view on menstruation and reproduction throughout the study programme. Based on our results we conclude that the socialisation processes that occurs during professional midwifery education should promote and encourage a midwifery model of care which is based on respect for the intricacy of physiology; in this case the menstrual and reproductive cycle. Midwifery study programmes that enable practical training in settings that promote physiological birth promote better midwifery philosophy about the physiology of female reproductive cycles; therefore these students take a more physiological view of menstruation.

Continuity, Confidence, Compassion and Culture: Lessons learned from Japanese midwives

PurposeTo explore midwifery practice through the eyes of Japanese midwives and midwifery students, with the aim of identifying traditional childbirth practices and models of midwifery care that lead to higher rates of physiologic birth as experienced by women in Japan.Research QuestionsWhat specific cultural factors influence pregnancy care and childbirth practices in Japan? What factors and practices are associated with physiologic birth in Japan? How could traditional Japanese practices be utilized by midwives in the United States to improve birth outcomes?SignificanceDespite its relationship with Western culture, Japan continues to promote physiologic birth without complications, at lower rates than many other developed nations. With a comparatively low cesarean rate of 18.6% in 2011 and one of the lowest maternal mortality rates in the world, cultural factors are clearly important. Recognition of traditional Japanese midwifery practices and unique models of midwifery care that can increase opportunities for physiologic birth have the potential to reverse the increasing trend for birth intervention in other countries.MethodsMixed methods were used to explore midwifery practices in Japan. A pilot survey, translated into Japanese, was administered to midwives (n = 9) and midwifery students (n = 9) in 2 prefectures in Japan (one urban, one rural). Two focus groups were conducted to further explore culturally specific midwifery attitudes, practices, and future challenges in maintaining low birth‐intervention rates in Japan. Visits to hospital and community settings (Josanin or birthing homes) enhanced understanding of described practices.ResultsThe prominent role of midwives in all low‐risk pregnancies in Japan was felt to increase opportunities for women to achieve physiologic birth. Interventions commonly used in the United States were reserved for complicated pregnancy. Japanese midwives recognized danger in increasing epidural use and the value of midwifery care in preventing unnecessary intervention. Important aspects of care included midwifery presence, compassion, confidence in women, non‐pharmacologic pain relief, movement/upright labor positions, and education provided by midwives.DiscussionGreater access to continuity of midwifery care in the United States could contribute to better birth outcomes. A larger study of Japanese midwives is planned to further explore effective practices that could be used in US settings to improve opportunities for physiologic birth.

Continuity of care in pregnancy and labour – the EMMa Care experience

Background: Since the beginning of time, it was ordinary practice for women to support other women while in labour. Today, it is commonplace for women to seek the professional care of a Certified Nurse Midwife for their birth experience, hence replacing the role of female relatives and neighbours. In Singapore, maternity care is traditionally managed by obstetricians. The role of midwives in Singapore encompasses patient care in the delivery suite, supporting women in labour, yet having little involvement in the antenatal or postnatal care. Objective: Studies have shown continuity of care for women throughout pregnancy and delivery provides higher satisfaction of women's birth experience. The EMMa Care Program at National University Hospital was implemented in 2011, aiming to provide women with obstetric care in collaboration with midwifery care and support throughout pregnancy, and birth. Methods: Initially in 2011, a team of three midwives provided one to one midwifery support, whereby a woman was scheduled with a personally dedicated midwife that saw her throughout her pregnancy, labour, and postnatal period. Results: Today, EMMa Care employs four midwives, using a team approach and allowing women to acquaint themselves with all four midwives in order to provide sustainable, more comprehensive care. We work during office hours in addition to on call service. This proved to be a challenge in attracting new midwives to join EMMa Care as nurses and midwives in Singapore are not accustomed to an on call system. Discussion: To ensure sustainability without compromising continuity of care, we devised a shift-roster system to our team allowing our midwives-nurses the opportunity to rotate between clinic responsibilities and the delivery suite. Conclusion: In turn, women have benefited greatly from this holistic midwifery care model. The EMMa Care model is women centred and holistically embraces the interconnectedness of body, mind, and emotion.

Technologies of birth and models of midwifery care.

This article is based on a study of a reform in the organisation of maternity services in the United Kingdom, which aimed towards developing a more woman-centred model of care. After decades of fragmentation and depersonalisation of care, associated with the shift of birth to a hospital setting, pressure by midwives and mothers prompted government review and a relatively radical turnaround in policy. However, the emergent model of care has been profoundly influenced by concepts and technologies of monitoring. The use of such technologies as ultrasound scans, electronic foetal monitoring and oxytocic augmentation of labour, generally supported by epidural anaesthesia for pain relief, have accompanied the development of a particular ecological model of birth - often called active management -, which is oriented towards the idea of an obstetric norm. Drawing on analysis of women's narrative accounts of labour and birth, this article discusses the impact on women's embodiment in birth, and the sources of information they use about the status of their own bodies, their labour and that of the child. It also illustrates how the impact on women's experiences of birth may be mediated by a relational model of support, through the provision of caseload midwifery care.