Midwifery Continuity Research Articles

Midwifery Continuity of Care During Pregnancy, Birth, and the Postpartum Period: A Matched Cohort Study.

To compare pregnancy outcomes in a midwifery continuity of care (MCoC) model to standard midwifery care in Sweden. Matched cohort study. Public healthcare during pregnancy and childbirth, Stockholm, Sweden. Women giving birth at Karolinska University Hospital site Huddinge in Stockholm between January 1, 2019, and August 31, 2021. Data on all births including MCoC and standard care, during the time period, were retrieved from the national Swedish Pregnancy Register. Propensity score matching was applied to obtain a matched set from the standard care group for every woman in the MCoC model. Based on the matched cohort, we estimated risk ratios (RR) for binary outcomes with 95% confidence intervals (CI). Interventions during labor, mode of birth, and preterm birth (< 37 gestational weeks). Compared with standard care, women in the MCoC model were more likely to give birth spontaneously (RR 1.06 95% CI 1.02-1.10) and less likely to have an elective cesarean on maternal request (RR 0.24 95% CI 0.11-0.51). The risk of preterm birth was also reduced in the MCoC group (RR 0.51 95% CI 0.32-0.82). The MCoC model was associated with fewer medical interventions and improved pregnancy outcomes.

Continuous Midwifery Care for Mrs. P at TPMB Karin Alesha, Subang Regency

This final project report discusses the continuous midwifery care for Mrs. P at TPMB Karin Alesha by using the case study method using continuity of care. Case taking through the SOAP approach. Observation of Mrs. P shows that COC is carried out three visits during various phases of pregnancy and childbirth, as well as appropriate examinations during the postpartum and neonate periods. Midwifery care also includes complementary therapies such as warm compresses for discomfort during pregnancy. In the delivery phase, the use of gym ball and pelvic rocking therapy to overcome pain and accelerate the smooth delivery process. In addition, postpartum care is also carried out by providing appropriate care, including the application of oxytocin massage to facilitate breast milk production. As well as providing care to neonates. Through this Final Project Report, it is hoped that health workers at TPMB Karin Alesha can maintain and improve services in providing midwifery care during pregnancy, childbirth, BBL, postpartum, and family planning, to minimize the mortality rate and/or pain rate in mothers and babies.

Sharing midwifery philosophy through a positive learning environment prepares students for a future providing midwifery continuity of care: A mixed method study

BackgroundGlobal and national frameworks for midwifery education recognise and prioritise the provision of midwifery continuity of care. Previous studies report that learning is enhanced when students have professional experience placements within these models, however there remains wide variation in midwifery students’ access to placements within these models in Australia. AimTo evaluate Bachelor of Midwifery students’ experiences in midwifery continuity of care models within two local health districts in New South Wales, Australia. MethodA mixed methods design was used: qualitative data collected through interviews, and quantitative data collected via an online survey using the Midwifery Student Evaluation of Practice (MidSTEP) tool. Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken. ResultsSixteen students responded, four students were interviewed, and 12 students completed the survey. The MidSTEP mean scores for all sub-scales rated above 3.0/4.0. Participants rated ‘work across the full scope of midwifery practice’ and five out of eight subscales of Philosophy of Midwifery Practice at 100 %. ‘Experiences prepare me to be a change agent for maternity service reform’ rated the lowest (67 %). Three qualitative themes emerged: care versus carer model; learning experience; and future career as a caseload midwife. ConclusionA mixed method approach using a validated tool to measure student experiences, contributes to the evidence that students value professional experience placements within midwifery continuity of care models. Currently this is not an option for all midwifery students and as midwifery continuity of care models expand, these findings will inform further implementation of student professional experience placement within these models.

The Impact of Obesity on Childbirth Expectations.

Positive childbirth expectations are crucial for fostering a positive labor experience and enhancing the health and well-being of both the woman and her newborn. However, the impact of obesity on childbirth expectations remains underexplored. We aim to assess childbirth expectations in women living with obesity to enhance perinatal care tailored to their specific needs. Using an adapted version of the Childbirth Expectation Questionnaire (CEQ) in a nationwide online survey, we assessed expectations on childbirth of pregnant women living in Switzerland. We performed one-way analysis of variance and independent t tests to analyze associations between childbirth expectations and women's characteristics such as body mass index (BMI). Binomial logistic regressions estimated the likelihood of positive birth expectations occurring based on individual and contextual factors. In total, 961 pregnant women responded to the CEQ through social media. Increased BMI was associated with lower mean scores in overall birth expectations (P =.008), whereas women accompanied by midwives during pregnancy showed significantly increased mean scores (P <.001). Regression analysis revealed that women living with obesity were less likely to have positive expectations for their upcoming childbirth when compared with others (adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.95; P =.027). Conversely, midwifery care and plans for nonclinical births were associated with increased positive childbirth expectations (aOR, 3.65; 95% CI, 2.11-6.32; P <.001 and aOR, 4.77; 95% CI, 3.37-6.74; P<.001, respectively). Women living with obesity exhibited significantly lower childbirth expectations compared with other women, impacting birth outcomes and satisfaction. Midwife involvement correlated with more positive expectations, emphasizing their role in improving women's realistic expectations and fostering well-being. Enhanced accessibility to models of care with midwifery continuity may be a crucial factor in promoting positive expectations among women living with obesity.

Everyone should have their own midwife: Women’s and staff experiences during the implementation of two midwifery continuity of care models in regional Australia

ProblemMidwifery Continuity of Care (MCoC) remains inaccessible for most Australian women; this is especially true in rural and regional areas. BackgroundStrong evidence demonstrates MCoC models improve experiences for women and their babies and are also shown to improve midwifery workforce wellbeing. However, implementation and upscale remains limited. AimTo explore the views and experiences of implementing MCoC for both staff and women, understanding their experiences, concerns and solutions in a regional context. MethodsQualitative data was collected via focus groups with women and healthcare staff, at six and twelve month post implementation. Data was thematically analysed using Braun and Clarke six step process. FindingsThe findings support that ‘women love it’ and midwives working in the new MCoC model ‘loved their job’. The major concern was that not all women could access the model and disconnected communication was problematic during implementation. ‘Sharing stories’ was a solution to overcoming these issues and promoting the positive impact of MCoC - in particular ways of working and adaption to an all-risk midwifery group practice. DiscussionThis study supports widespread evidence that MCoC is valued by both women and staff. In a regional context it is important to recognise challenges faced during implementation and identifying solutions that other maternity services could consider when implementing MCoC. ConclusionThe study offers strong recommendation for regional areas to consider MGP to maintain safe, quality local maternity services.

ASUHAN KEBIDANAN CONTINUITY OF CARE PADA KASUS FISIOLOGIS DI KLINIK DAN RB EVA

The high MMR (Maternal Mortality Rate) is still a crucial matter that must be resolved by the Indonesian government. Based on data from the Ministry of Health in 2022, the number of MMR reached 4,005 and in 2023 it will increase to 4,129, making Indonesia rank second in ASEAN in terms of maternal mortality. So Continuity of Care Midwifery Care is needed which aims to provide continuous care from pregnancy to preconception so that it is able to detect any health problems experienced by clients. Care is carried out at the Eva Clinic and Maternity Home in the period November 2023 to March 2024. A series of continuous midwifery care is carried out for Mrs. I during pregnancy, childbirth, newborns, postpartum, and the decision to use contraception. After carrying out midwifery management care with a comprehensive approach and SOAP documentation, it can be seen that Mrs. I in a physiological condition at each phase of care carried out. Keywords : Continuity of Care, Midwifery Care.

Barriers and facilitators when implementing midwifery continuity of carer: a narrative analysis of the international literature

BackgroundMidwifery continuity of carer (MCoC) is a model of care in which the same midwife or small team of midwives supports women throughout pregnancy, birth and the postnatal period. The model has been prioritised by policy makers in a number of high-income countries, but widespread implementation and sustainability has proved challenging.MethodsIn this narrative review and synthesis of the global literature on the implementation and sustainability of midwifery continuity of carer, we identify barriers to, and facilitators of, this model of delivering maternity care. By mapping existing research evidence onto the Consolidated Framework for Implementation Research (CFIR), we identify factors for organisations to consider when planning and implementing midwifery continuity of carer as well as gaps in the current research evidence.ResultsAnalysing international evidence using the CFIR shows that evidence around midwifery continuity of carer implementation is patchy and fragmented, and that the impetus for change is not critically examined. Existing literature pays insufficient attention to core aspects of the innovation such as the centrality of on call working arrangements and alignment with the professional values of midwifery. There is also limited attention to the political and structural contexts into which midwifery continuity of carer is introduced.ConclusionsBy synthesizing international research evidence with the CFIR, we identify factors for organisations to consider when planning and implementing midwifery continuity of carer. We also call for more systematic and contextual evidence to aid understanding of the implementation or non-implementation of midwifery continuity of carer. Existing evidence should be critically evaluated and used more cautiously in support of claims about the model of care and its implementation, especially when implementation is occurring in different settings and contexts to the research being cited.

The The effectiveness of family-centered maternity care education on attitudes and behaviours of pregnant women

Stunting is a state of failure to grow experienced by children under five due to chronic malnutrition, especially in the first 1,000 days of life (HPK). The impact caused by stunting can vary, including physical growth disorders, body metabolic disorders, brain growth and development disorders. In addition, stunting is also at a higher risk of suffering from chronic diseases in adulthood. This study aims to analyze the influence of Family Centered Maternity Care education on the attitude and behavior of pregnant women in stunting prevention. This quantitative research uses a quasi-experimental design with a one-group pre-test and post-test design. Sampling for this study uses a purposive sampling technique. The sample of this study is 38 people who have met the inclusion and exclusion criteria. The instrument used was in the form of a questionnaire for measuring attitudes and behaviors that were tested for validity and reliability. Data analysis using univariate analysis, bivariate analysis using Wilcoxon Test. The results of the study showed that there was an influence of Family Centered Maternity Care education on the attitude and behavior of pregnant women in stunting prevention in the Kebumen area. Family Centered Maternity Care education has been proven to increase the knowledge of pregnant women which ultimately changes the attitude and behavior of pregnant women in stunting prevention. The application of Family Centered Maternity Care education should be considered as a health education method in providing continuous midwifery care as an effort to reduce stunting rates.

Communication Technology Facilitates Quality Care Between Midwives and Their Pregnant Clients Within a Midwifery Continuity of Care Relationship

INTRODUCTION:Communication was identified as a component of high-quality maternity care within an evidence-informed Quality Maternal and Newborn Care framework. Communication technology has been shown to enhance relationships midwives develop with their clients; however, concerns with the safety of the communication have been identified.AIM:This article reports on the contribution that communication technology makes toward quality care when used within a continuity of care relationship between midwives and their pregnant clients.METHODS:This article reports on phase 2A of a multiphase study. Semistructured interviews were conducted with lead maternity carer midwives using the online platform Microsoft Teams. Midwives who had previously undertaken an online survey in phase 1A and had indicated interest in participating in an online interview were emailed an invitation to participate. Fourteen midwives responded to the email invitation. Thematic analysis was used to analyze the interview data.FINDINGS:The findings indicate that communication technology facilitates quality care within a midwifery model of continuity of care. This is achieved in two ways through (a) connectedness and being known and (b) an awareness of challenges which in turn enables midwives to develop strategies for ensuring quality care.DISCUSSION:Communication technology, when used within a continuity of care relationship, facilitates quality care. It does this through enabling a connection continuation of connectedness and knowingness which enables midwives to negotiate safe and appropriate means for contact. It also privileges midwives with knowledge of challenges when using communication technology and enables strategies to be developed.

“A safe space”; A statewide evaluation of Midwifery Antenatal and Postnatal Service (MAPS) using the quality maternal newborn care, evidence informed framework

BackgroundThe World Health Organization recommends Midwifery Continuity of Care (MCoC) due to the consistent improvements in outcomes for mothers and babies. Surveys from the United Kingdom and Australia reported large numbers of midwives are unable to commit to the on call component required to provide MCoC across the continuum. To address this challenge a modified MCoC model called Midwifery Antenatal and Postnatal Services (MAPS) has been introduced. The aim of this study was to evaluate MAPS services in six sites across one State in Australia. Methods:A multi-site qualitative descriptive study was undertaken framed by the Quality Maternal Newborn Care (QMNC) Framework. The QMNC framework was used to develop focus group questions for data collection, and as a lens for analysing data. Data were collected via focus groups from midwives and women at six sites ranging from metropolitan to regional and rural settings and thematically analysed. FindingsParticipants (n=80) included women (n=28), midwives (n=44) and MAPS managers (n=8). This paper reports the findings from the women and midwives, presented under three themes: Getting onto the program, Knowing the story and Building confidence by sharing information. Each theme had subthemes and the findings were aligned either positively or negatively with the QMNC framework. ConclusionThis study found the MAPS model aligns in positive ways with the QMNC quality care framework with some recommendations to improve quality care. Midwives want to provide continuity of care and MAPS is a useful model for providing continuity through the antenatal and postnatal periods.

Midwifery continuity of care, breastfeeding and neonatal hyperbilirubinemia: A retrospective cohort study

AimTo examine the association between Midwifery Continuity of Care (MCoC) and exclusive breastfeeding at hospital discharge and neonatal hyperbilirubinemia. MethodsA matched cohort design was employed using data from the Swedish Pregnancy Register. The study included 12,096 women who gave birth at a university hospital in Stockholm, Sweden from January 2019 to August 2021. Women and newborns cared for in a MCoC model were compared with a propensity-score matched set receiving standard care. Risk ratios (RR) were determined with 95 % confidence intervals (CI) based on the matched cohort through modified Poisson regressions with robust standard error. A mediation analysis assessed the direct and indirect effects of MCoC on exclusive breastfeeding at hospital discharge and neonatal hyperbilirubinemia and to what extent the association was mediated by preterm birth. FindingFindings showed that MCoC was associated with a higher chance of exclusive breastfeeding rate (RR: 1.06, 95 % CI: 1.01–1.12) and lower risk of neonatal hyperbilirubinemia (RR: 0.51, 95 % CI: 0.32–0.82) compared with standard care. Mediation analysis demonstrated that lower preterm birth accounted for approximately 28 % of total effect on the reduced risk of neonatal hyperbilirubinemia. Discussion/ConclusionThis matched cohort study provided preliminary evidence that MCoC models could be an intervention for improving exclusive breastfeeding rates at hospital discharge and reducing the risk of neonatal hyperbilirubinemia.

Midwifery continuity of care for women with perinatal mental health conditions: A cohort study from Australia.

Perinatal mental health (PMH) conditions are associated with adverse outcomes such as maternal suicide, preterm birth and longer-term childhood sequelae. Midwifery continuity of care (one midwife or a small group of midwives) has demonstrated benefits for women and newborns, including a reduction in preterm birth and improvements in maternal anxiety/worry and depression. To determine if midwifery care provided through a Midwifery Group Caseload Practice model is associated with improved perinatal outcomes for women who have anxiety and depression and/or other perinatal mental health conditions. An EPDS ≥ 13, and/or answered the thought of harming myself has occurred to me and/or women who self-reported a history compared to standard models of care (mixed midwife/obstetric fragmented care). A retrospective cohort study using data routinely collected via an electronic database between 1 January 2018 31st of January 2021. The population were women with current/history of PMH, who received Midwifery Caseload Group Practice (MCP), or standard care (SC). Data were analysed using descriptive statistics for maternal characteristics and logistic regression for birth outcomes. One-to-one matching of the MCP group with the SC group was based on propensity scores. 7,359 births were included MCP 12% and SC 88%. Anxiety was the most common PMH with the same proportion affected in MCP and SC. Adjusted odds of preterm birth and adverse perinatal outcomes were lower in the MCP group than the SC group (aOR (95%CI): 0.77 (0.55, 1.08) and 0.81 (0.68, 0.97), respectively) and higher for vaginal birth and full breastfeeding (aOR (95% CI): 1.87 (1.60, 2.18) and 2.06 (1.61, 2.63), respectively). In the matched sample the estimate of a relationship between MCP and preterm birth (aOR (95% CI): 0.88 (0.56, 1.42), adverse perinatal outcomes (aOR (95% CI): 0.83 (0.67, 1.05)) and breastfeeding at discharge (aOR (95% CI): 1.82 (1.30, 2.51)), stronger for vaginal birth (aOR (95% CI): 2.22 (1.77, 2.71)). This study supports positive associations between MCP and breastfeeding and vaginal birth. MCP was also associated with lower risk of adverse perinatal outcomes, though in the matched sample with a smaller sample size, the confidence interval included 1. The direction of the association MCP and preterm birth was negative (protective). However, in the matched sample analysis, the confidence interval was wide, and the finding was also consistent with no benefit from MCP. Randomised controlled trials are required to answer questions around preterm birth and adverse perinatal outcomes and further research is being planned.

ASUHAN KEBIDANAN PADA IBU BERSALIN NY P DENGAN PEMBERIAN KELAPA UNTUK MENINGKATKAN TENAGA PERSALINAN DI PUSKESMAS TANJUNG BALAI KARIMUN

Childbirth is influenced by three main elements, namely energy (his power of straining), the condition of the birth canal, and the size of the fetus. Foods and drinks that are scientifically proven to be used to facilitate labor are dates, young coconut water, honey and soy milk. Objective To provide comprehensive and continuous midwifery care for mothers giving birth, with management of midwifery care in accordance with midwifery service standards. The midwifery care that is applied is Midwifery Care for Mrs. P. Giving Birth Coconuts to Increase Labor Force. The practice report preparation method is descriptive research using the case study method. The research was conducted at the Tanjung Balai Karimun Health Center in March 2023. The subject used in this case study with midwifery care management was Mrs. P. Results and Conclusions Evaluation of the care provided related to the implementation Midwifery Care for Maternity Mrs. P By Giving Coconuts to Increase Labor Force, there is an Increase in Labor Force for Mothers

Blacktown Midwives: Prioritising Perinatal Mental Health Support

The increasingly comprehensive psychosocial screening tools used in pregnancy have been instrumental in highlighting the experiences of expectant parents with mental health issues to their midwives. We are privy to revelations about the significant trauma that some have endured. I would like to share with you my experiences working in MAPS (Midwifery Antenatal Postnatal Services), a model providing midwifery continuity of care (MCoC) to more vulnerable families at Blacktown Hospital. I will share insights into how working within this model continues to influence my practice and work-life balance.

The effect of a midwifery continuity of care program on clinical competence of midwifery students and delivery outcomes: a mixed-methods protocol

BackgroundThe midwifery continuity of care model is one of the care models that have not been evaluated well in some countries including Iran. We aimed to assess the effect of a program based on this model on the clinical competence of midwifery students and delivery outcomes in Ahvaz, Iran.MethodsThis sequential embedded mixed-methods study will include a quantitative and a qualitative phase. In the first stage, based on the Iranian midwifery curriculum and review of seminal midwifery texts, a questionnaire will be developed to assess midwifery students’ clinical competence. Then, in the second stage, the quantitative phase (randomized clinical trial) will be conducted to see the effect of continuity of care provided by students on maternal and neonatal outcomes. In the third stage, a qualitative study (conventional content analysis) will be carried out to investigate the students’ and mothers’ perception of continuity of care. Finally, the results of the quantitative and qualitative phases will be integrated.DiscussionAccording to the nature of the study, the findings of this research can be effectively used in providing conventional midwifery services in public centers and in midwifery education.Trial registrationThis study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1401.460). Also, the study protocol was registered in the Iranian Registry for Randomized Controlled Trials (IRCT20221227056938N1).

Continuity obstetric care demonstrates greater vaginal birth after caesarean success.

Australia's caesarean rate is higher than Organisation for Economic Co-operation and Development (OECD) average, and is rising. Vaginal birth after caesarean (VBAC) is safe for selected women. Midwifery continuity of care (CoC) is associated with higher rates of vaginal birth compared to other models; however, impacts on VBAC attempts and success are unknown. The primary aim was to determine if there is a difference in achieving VBAC between CoC and non-CoC (NCoC) models. The secondary aim was to determine if there is a difference in the proportion of women attempting VBAC between these models. Retrospective review of antenatal records and birthing data of all women who birthed in 2021 with one or more previous caesareans. Women were included if they had two or fewer caesareans. Women were excluded if contraindications to VBAC existed. There were 142/1109 (12.8%) women who had previous caesareans and were eligible to attempt VBAC. There were 47/109 (43.1%) women who attempted vaginal birth after one caesarean with 78.7% success. After one caesarean, women in CoC were more likely to achieve VBAC than NCoC (45.2% vs 26.1%; relative risk (RR) 1.76, 95% CI 1.04-3.00), although when stratified by private and midwifery CoC models, women in midwifery CoC models were more likely to be successful (private RR 0.69, 95% CI 0.23-2.07 vs midwifery RR 2.48, 95% CI 1.50-4.11). Women in CoC were more likely to attempt VBAC (54.7% vs 34.8%; RR 1.57, 95% CI 1.02-2.41), and receive counselling about VBAC (92.5% vs 62%; RR 1.48, 95% CI 1.41-3.11). CoC improves the rate of attempted and successful VBAC through several factors, including increased counselling and greater provision of birth choices.

The Role of Continuity of Care (CoC) in Supporting Pregnant Women at Risk of Chronic Energy Deficiency (CED) in Improving Nutritional Status: A Case Report

Background: Nutritional issues in pregnant women occur during the 1,000 Days of Life (HPK) period. If nutritional problems during pregnancy are not addressed, they can disrupt fetal development. The government has undertaken efforts such as providing supplementary feeding (PMT). This PMT activity should also be accompanied by nutritional education to promote behavioral change. Midwives are among the healthcare professionals who can provide comprehensive support. This support is aimed at optimizing continuous midwifery care, with the expectation of reducing the impact of Chronic Energy Deficiency (CED) on both pregnant women and their fetuses. Methods: This case report is compiled using a descriptive method with a case study approach. The researcher supported Continuity of Care (CoC) to one patient in the working area of the Surabaya Community Health Center, from the pregnancy period through to the postpartum period and the newborn phase. Case Presentation: A 20-year-old pregnant woman was identified as at risk for Chronic Energy Deficiency (CED) due to a measurement of Mid-Upper Arm Circumference (MUAC) &lt; 23.5 cm. The woman received continuous support, including monitoring her intake of prenatal vitamins, Antenatal Care (ANC) support, counseling, and nutritional education. By the end of the pregnancy, there was an increase in her MUAC, and she was no longer at risk of CED. Conclusion: With support in the form of monitoring and holistic, comprehensive, and collaborative midwifery care from the beginning of pregnancy, optimal care targets can be achieved. The role of support throughout the pregnancy and postpartum period has been carried out effectively, resulting in the mother being free from the risk of Chronic Energy Deficiency (CED) and the baby not experiencing Low Birth Weight (LBW).

Exploring Adolescent Pregnancy Expectations in Continuity of Midwifery Care: A Qualitative Study in Indonesia

Introduction: Adolescent pregnancy presents a significant challenge to global reproductive health, including in Indonesia. The unique obstacles that young pregnant women encounter when seeking appropriate and supportive healthcare services call for a deeper understanding to improve maternal care. Purpose: This study aims to explore the expectations of young pregnant women regarding continuous midwifery care in Indonesia. Method: This research employed an exploratory qualitative approach, conducting 13 face-to-face interviews between January and June 2022. Participants included midwives, young mothers, a coordinating midwife, and Mother and Child Health (MCH) program holders. Interviews, lasting 1-1.5 hours, were conducted, and the interview data were rigorously analyzed thematically by the research team, strengthening data reliability through triangulation. Results: Continuity management emphasizes friendly service, privacy, clear communication, and comprehensive health assessments. Informational continuity involves comprehensive information, direct communication, attractive aids, and health education evaluation. Relational continuity highlights comprehensive maternal care, family tradition approval, reminders, and efficient care. The study underscores the importance of tailored, holistic, and culturally sensitive midwifery care for young pregnant women's overall well-being. Conclusion: This study highlights adolescent pregnant women's unique needs, focusing on continuity management, informational continuity, and relational continuity. Proposed strategies include tailored health services, comprehensive maternal education, cultural sensitivity training for healthcare providers, policy integration, and diverse research. Successfully implementing these measures can significantly enhance maternal care outcomes for Indonesian adolescents.

Birth under restrictions: Exploring women's experiences of maternity care in Aotearoa New Zealand during the COVID-19 lockdown of 2020

Introduction: In Aotearoa New Zealand the COVID-19 pandemic in 2020 resulted in a four-week lockdown in March and April of 2020 with ongoing restrictions for several weeks. Aim: To explore the experiences of women who were pregnant, giving birth and/or managing the early weeks of motherhood during the 2020 COVID-19 alert levels 3 and 4 in Aotearoa New Zealand. Method: This qualitative study used semi-structured interviews to explore childbirth experiences during the COVID-19 alert level restrictions. Reflexive, inductive, thematic analysis was used to identify codes, subthemes and themes. Findings: Seventeen women participated in the study. Analysis of the qualitative interviews revealed four themes. The first of these was: Relationship with my midwife, in which participants described the importance of the midwifery continuity of care relationship, with midwives often going above and beyond usual care and filling the gaps in service provision. In the Disruption to care theme the participants described feeling anxious and uncertain, with concerns about the hospital restrictions and changing rules. The participants also described their Isolation during postnatal care in a maternity facility due to separation from their partners/whānau; they describe receiving the bare necessities of care, feeling they were on their own, and working towards their release home; all of which took an emotional and mental toll. The final theme, Undisturbed space, describes the positive aspects of the lockdown of being undisturbed by visitors, being better able to bond with the baby and being able to breastfeed in peace. Conclusion: Midwifery continuity of care appears to have supported these women and their families/whānau during the service restrictions caused by the COVID-19 lockdown. The partner, or other primary support person, and whānau should be considered essential support and should not be excluded from early postpartum hospital care.

'There is no other option': Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia.

In the past 30 years, 60% of South Australia's rural maternity units have closed. Evidence demonstrates midwifery models of care offer regional Australia sustainable birthing services. Five birthing sites within the York and Northern Region of South Australia, designed in collaboration with key stakeholders, offered a new all-risk midwifery continuity of care model (MMoC). All pregnant women in the region were allocated to a known midwife once pregnancy was confirmed. In July 2019, the pilot program was implemented and an evaluation undertaken. The study aimed to evaluate the effectiveness, acceptability, and sustainability of the new midwifery model of care from the perspective of health care providers. The evaluation utilised a mixed methods design using focus groups and surveys to explore experiences of health care providers impacted by the implementation of the MMoC. This paper reports on midwives, doctors and nurses experiences at different time points, to gain insight into the model of care from the care providers impacted by the change to services. The first round of focus groups included 14 midwives, 6 hospital nurses/midwives and 5 doctors with the overarching theme that the 'MMoC was working well.' The second round of focus groups were undertaken across the five sites with 10 midwives, 9 hospital nurses/midwives and 5 doctors. The overarching theme captured all participants commitment to the MMoC, with agreement that 'there is no other option - it has to work'. All participants reported positive outcomes and a strong commitment to navigate the changes required to implement the new model of care. Collaboration and communication was expressed as key elements for success. Specific challenges and complexities were evident including a need to clarify expectations and the workload for midwives, and for nurses who were accustomed to having midwives 24 hours a day in hospitals. This innovative model responds to challenges in providing rural maternity care and offers a sustainable model for maternity services and workforce. There is an overwhelming commitment and consensus that there is 'no other option-it has to work'.