Midwifery-led Model Of Care Research Articles

Facilitators and barriers of midwife-led model of care at public health institutions of dire Dawa city, Eastern Ethiopia, 2022: a qualitative study

BackgroundThe midwife-led model of care is woman-centered and based on the premise that pregnancy and childbirth are normal life events, and the midwife plays a fundamental role in coordinating care for women and linking with other health care professionals as required. Worldwide, this model of care has made a great contribution to the reduction of maternal and child mortality. For example, the global under-5 mortality rate fell from 42 deaths per 1,000 live births in 2015 to 39 in 2018. The neonatal mortality rate fell from 31 deaths per 1,000 live births in 2000 to 18 deaths per 1,000 in 2018. Even if this model of care has a pivotal role in the reduction of maternal and newborn mortality, in recent years it has faced many challenges.ObjectiveTo explore facilitators and barriers to a midwife-led model of care at a public health institution in Dire Dawa, Eastern Ethiopia, in 2021.Methodology: A qualitative approach was conducted at Dire Dawa public health institution from March 1–April 30, 2022. Data was collected using a semi-structured, in-depth interview tool guide, focused group discussions, and key informant interviews. A convenience sampling method was implemented to select study participants, and the data were analyzed thematically using computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with an inductive approach goes through six steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing up.ResultTwo major themes were driven from facilitators of the midwife-led model of care (professional pride and good team spirit), and seven major themes were driven from barriers to the midwife-led model of care (lack of professional development, shortage of resources, unfair risk or hazard payment, limited organizational power of midwives, feeling of demoralization absence of recognition from superiors, lack of work-related security).ConclusionThe midwifery-led model of care is facing considerable challenges, both pertaining to the management of the healthcare service locally and nationally. A multidisciplinary and collaborative effort is needed to solve those challenges.

Midwifery Students’ Knowledge and Perceptions of a Midwifery-Led Model of Care in North Karnataka, India

ObjectiveTo assess the knowledge and perceptions of midwifery students regarding a midwifery-led model of care. DesignCross-sectional study. SettingA nursing college in North Karnataka, India. The midwifery-led care model is a relatively new concept in India. In 2018, guidelines on midwifery services in India were released during the Partners Forum held in New Delhi as the initiation of the model and with the support of the Ministry of Health and Family Welfare. The initiative began with the training of nurse practitioners in midwifery and is progressing. ParticipantsFinal-year diploma and bachelor’s degree students. MethodsParticipants completed an online survey, which consisted of a 20-item questionnaire with a 5-point Likert scale to collect their knowledge and perceptions of the midwifery-led model of care. Descriptive statistics were used to describe the knowledge and perceptions of the students, including the mean, standard deviation, frequency, and percentage. Chi-square analysis and the Pearson’s correlation coefficient were used to assess relationships between variables of interest. ResultsAmong the 165 participants, 85.5% (n = 141) had a poor level of knowledge of the midwifery-led care model, and only 14.5% (n = 24) showed average knowledge, with none possessing adequate knowledge. Notably, gender was significantly associated with knowledge (p < .05), with female participants demonstrating lower knowledge levels compared to male participants. A substantial portion (76.4%, n = 126) had a negative perception of the midwifery-led care model, 23.6% (n = 39) had a neutral perception, and none had a positive perception. There was no significant correlation between students’ knowledge and perceptions of the midwifery-led model of care. ConclusionThese results suggest that there is an urgent need for awareness, knowledge, and educational initiatives to help nursing students in India better comprehend the midwifery-led model of care and to strengthen the midwifery training in nursing colleges.

Defining woman-centred care: A concept analysis

ProblemIn midwifery a shared definition of woman-centred care is lacking, and this remains an identified gap in the evidence underpinning midwifery practice. BackgroundWoman-centred care is an underpinning philosophy used in midwifery practice both nationally and internationally. AimTo analyse the practice of woman-centred care to clarify its meaning and comprehension and subsequently advance an evidence-based definition of the concept. MethodsUsing an adapted theoretical and colloquial evolutionary model a three-stage concept analysis was conducted to identify attributes, antecedents, and consequences of woman-centred care and subsequently construct an evidence-based, internationally informed definition. FindingsAntecedents of woman-centred care are education, models of care and midwife characteristics. Attributes are choice and control, empowerment, and relationships. Consequences are shared and informed decision making which supports the woman in navigating complex health systems, and improved health outcomes. Whilst important to midwifery practice and midwifery-led models of care, continuity of care is not a core essential element of woman-centred care. DiscussionAnalysis, synthesis, and re-examination of the data on woman-centred care facilitated deep immersion, exploration and clarification of this concept that underpins midwifery philosophy and practice. The constructed definition can be used to inform health policy, midwifery research, education, and clinical practice. ConclusionAn evidence-based definition of woman-centred care is necessary for conversion of this essential concept to practice. Regardless of model of care all women should receive woman-centre care improving the health outcomes of both the woman and neonate.

Knowledge and skills used for clinical decision-making on childbirth interventions: A qualitative study among midwives in the Netherlands.

INTRODUCTIONAppropriate use of interventions in maternity care is a worldwide issue. Midwifery-led models of care are associated with more efficient use of resources, fewer medical interventions, and improved outcomes. However, the use of interventions varies considerably between midwives. The aim of this study was to explore how knowledge and skills influence clinical decision-making of midwives on the appropriate use of childbirth interventions.METHODSA qualitative study using in-depth interviews with 20 primary care midwives was performed in June 2019. Participants’ clinical experience varied in the use of interventions. The interviews combined a narrative approach with a semi-structured question route. Data were analyzed using deductive content analysis.RESULTS‘Knowledge’, ‘Critical thinking skills’, and ‘Communication skills’ influenced midwives’ clinical decision-making towards childbirth interventions. Midwives obtained their knowledge through the formal education program and extended their knowledge by reflecting on experiences and evidence. Midwives with a low use of interventions seem to have a higher level of reflective skills, including reflection-in-action. These midwives used a more balanced communication style with instrumental and affective communication skills in interaction with women, and have more skills to engage in discussions during collaboration with other professionals, and thus personalizing their care.CONCLUSIONSMidwives with a low use of interventions seemed to have the knowledge and skills of a reflective practitioner, leading to more personalized care compared to standardized care as defined in protocols. Learning through reflectivity, critical thinking skills, and instrumental and affective communication skills, need to be stimulated and trained to pursue appropriate, personalized use of interventions.

O9 - Keeping Rural Maternity Services a top priority: a case review of transitioning to a midwifery-led model of care

Midwifery-led Continuity of Care (MCoC) models is the gold standard in maternity care. This presentation will outline how a regional district health service in NSW implemented its first MCoC model, ensuring a small rural maternity service did not close. Evaluation of the model proved it is safe, cost-effective and highly valued by women. Case review of a district health service co-design and implementation journey that achieved access to a MCoC model in a regional context. The small rural maternity service previously supported on average 40 women a year to birth under a GP led model. The service was proving unsustainable and at risk of closure. With executive support, a MCoC model was co-designed and implemented in partnership with community, midwifery and obstetric teams. Commencing in 2020, the model successfully commenced whilst enduring the impacts of simultaneously moving to a new hospital build and managing a pandemic response. The implementation of the MCoC model enabled access to care for all women, including those with risk during pregnancy by bringing specialist obstetric care to the local community. This is of particular importance in the region to ensure access to safe care for all women and their families close to home in rural and reginal settings. Compared with the previous service, women who received care from the MCoC model in 2021 had improved outcomes, including higher rate of spontaneous labour, more likely to have a normal birth, a reduced rate of caesarean section, required less medical pain relief and were more likely to breastfeed. Access to the MCoC increased the likelihood of women to access pregnancy care early and ongoing.

Management and sustainability of midwifery group practice: Thematic and lexical analyses of midwife interviews

BackgroundAlthough there is high-level evidence supporting positive perinatal outcomes for midwifery group practice (MGP) care, not all women can access this model due to a failure to implement or sustain it. The way that MGPs are managed could be an important factor in whether they are successful in the long-term. AimTo explore what determines optimal management of MGP in Australia, and the influence it has on sustainability of MGP. MethodsInterviews were conducted with MGP midwives (n=8). Transcriptions of the audio recordings were analysed thematically and lexically for triangulation. FindingsFollowing a thematic analysis of the data, an over-arching theme emerged – namely — being valued and supported, with three sub-themes: a nice little sweet spot, someone to stand up for you, and building relationships and support beyond the model. This revealed that value and support by all stakeholders, including the midwives themselves, was necessary to sustain an MGP. The lexical analysis revealed the themes: support, the system, and the caseload. This analysis highlighted the importance of the system – specifically, the impact of the institution on how MGP is operationalised. ConclusionFor MGP to be sustained in Australia, it needs to be prioritised, nurtured, and embraced by the whole maternity care system. Management plays an important role in ensuring the right people are employed to pivotal positions and that midwifery-led models of care are valued and supported throughout the system.

From Midwife-Dominated to Midwifery-Led Antenatal Care: A Meta-Ethnography.

Provision of antenatal care includes risk identification, prevention and management of pregnancy-related diseases, but also health education, health promotion, support and guidance to smooth the transition to parenthood. To ensure good perinatal health, high-quality, free and easily accessed antenatal care is essential. The aim of this study was to identify, integrate and synthesize knowledge of midwives’ experiences of providing antenatal care, attending to clients’ individual needs whilst facing multiple challenges. We conducted a meta-ethnography, which is a seven-step grounded, comparative and interpretative methodology for qualitative evidence synthesis. A lines-of-argument synthesis based on two metaphors was developed, based on refutational themes emerging from an analogous translation of findings in the included 14 papers. The model reflects midwives’ wished-for transition from a midwife-dominated caring model toward a midwifery-led model of antenatal care. Structural, societal and personal challenges seemingly influenced midwives’ provision of antenatal care. However, it emerged that midwives had the willingness to change rigid systems that maintain routine care. The midwifery-led model of care should be firmly based in midwifery science and evidence-based antenatal care that emphasize reflective practices and listening to each woman and her family. The change from traditional models of antenatal care towards increased use of digitalization no longer seems to be a choice, but a necessity given the ongoing 2020 pandemic.

Midwifery-led care in South Australia: Looking back to move forward

BackgroundFrom the 1980s to the turn of the century, Australia saw an evolution of midwifery-led models of care, in part due to legislative reform and federal funding, but largely owing to the efforts of strong midwifery leaders and consumers who rallied for the implementation of alternative models of care. Through persistence and extensive collaboration, the first South Australian birth centres were established. AimTo better understand the evolution of midwifery-led care in South Australia and identify the drivers and impediments to inform the upscaling of midwifery models into the future. MethodsSemi-structured interviews were conducted with ten midwifery leaders and/or those instrumental in setting up birth centres and midwifery-led care in South Australia. Data was analysed using thematic analysis. FindingsThree overarching themes and several sub-themes were identified, these included: ‘Midwifery suffragettes’ which explored ‘activism’, ‘adversity’ and ‘advocacy’; ‘Building bridges’ captured the importance of ‘gathering midwives’, a ‘movement of women’ and ‘champions and influencers’; and ‘Recognising midwifery’ identified the strong ‘sense of identity’ needed to outface ‘ignorance and opposition’ and the importance of ‘role reformation’. ConclusionThese midwifery leaders provide insight into an era of change in the history of midwifery in South Australia and contribute valuable learnings. In order to move forward, midwives must continue to embrace the political nature of midwifery, enact authentic, transformational leadership and engage women across all levels of influence. It is critical that midwives pursue equity in professional recognition, work collaboratively to provide quality, woman-centred maternity care and expand midwifery continuity of care models.

The Case for Expanding the Midwifery-led Model of Care

The Case for Expanding the Midwifery-led Model of Care

Birth models of care and intervention rates: The impact of birth centres

Birth centres offer a midwifery-led model of care which supports a non-medicalised approach to childbirth. They are often reported as having low rates of birth intervention, however the precise impact is obscured because less disadvantaged mothers with less complex pregnancies, and who prefer and often select little intervention, are more likely to choose a birth centre. In this paper, we use a methodology that purges the impact of these selection effects and provides a causal interpretation of the impact of birth centres on intervention outcomes. Using administrative birth data on over 364,000 births in Australia’s most populous state between 2001 and 2012, we implement an instrumental variables framework to address confounding factors influencing choice of birth setting. We find that giving birth in a birth centre results in significantly lower probabilities of intervention, and that critically, this impact has been increasing over time. Our estimates are larger than those in existing studies, reflecting our newer data, diverging intervention rates across birth settings, and our accounting for important selection effects. The results emphasise the greater role of birth centres in delivering on policy priorities which include greater maternal autonomy, lower intervention rates, and lower health system costs.

Two decades of Birth Centre and midwifery-led care in South Australia, 1998–2016

BackgroundBirth Centres (BC) are underpinned by a philosophy of woman- centred care and were pivotal in growing models of midwifery-led care in South Australia (SA). AimTo describe BC utilisation and the growth of midwifery-led care in SA over the past two decades. MethodsThe SA Perinatal Statistics Collection was used to describe women birthing from 1998 to 2016. Number of births through midwifery-led services from 2004 to 2016 were obtained from unit managers. Analyses are descriptive. FindingsWomen who birthed in BC in SA from 1998 to 2016 comprised approximately 6% of all births per year, and numbers have remained static. Three BC models operate in SA, all with different capacity. Proportionally, women not born in Australia are as likely to birth in BC as labour wards. The proportion of women who received midwifery-led care (whether affiliated with a BC or not), increased from 8.3% in 1998 to 19.2% of all births in 2016. Of the women who received midwifery-led care in 2016, 15.3% went on to birth in a midwifery-led model of care. ConclusionWhilst the overall number of BC births has not increased, women seeking midwifery-led care has more than doubled over the past two decades. BC encompass the midwifery philosophy, quality of care, and a physical home-like environment. The BC models in SA are managed through the three tertiary maternity units enabling women to access publicly funded midwifery care and should be more widely available.

A Review Related to Midwifery Led Model of Care

Background: Midwifery led care (MLC) is a model of care in which perinatal care is provided to women throughout different phases of childbirth by a midwife. Objective: This paper aims to provide a literature review on MLC. Methods: A variety of databases and reports were considered to do the literature review on MLC. The search was limited from 1991 to 2011 by using keywords. A total of 50 articles were critically appraised for this review. Findings: The main theme that emerged was women’s satisfaction with MLC. Satisfaction was integrated with midwife’s presence throughout childbirth, experience to enhance normality in childbirth, cost-effectiveness of MLC, and facilitation of women’s choice and control during labor. Conclusion: The review concludes that MLC is women-friendly as it considers and respects women’s needs holistically during childbirth.

Midwives' and women's views of childbirth in the Gaza Strip, occupied Palestinian territory: an exploratory study

BackgroundIn a quality-of-care assessment of mothers and newborn babies in maternity units in the Gaza Strip, occupied Palestinian territory (oPt), WHO oPt identified poor management of normal childbirth, early discharge, and lack of privacy for women as challenges for the delivery of care to pregnant women. The Palestinian Ministry of Health agreed that these challenges could be addressed by the introduction of a midwifery-led model of care. The aim of this study was to solicit the views of staff and women who had been through childbirth with respect to the introduction of the midwifery-led model of care.MethodsSix focus groups were organised and each group consisted of eight to 12 health professionals (midwives, nurses, or doctors). Selection criteria for the health professionals were experience in midwifery-led model of care and working in a maternity unit of one of the main hospitals in the Gaza Strip. Two focus groups had midwives, two had male and female obstetricians, one had nurse managers, and one had primary health-care midwives and doctors. Three other focus groups were formed with women who had given birth at any time in their lives. Thematic analysis was used to identify themes and subthemes to form the basis for the analysis, and NVivo (version 8) was used to code and emerge themes and subthemes. The Ministry of Health provided the approval to do the study. All participants provided verbal informed consent.FindingsMidwives stated that they lacked training in evidence-based practice. The consensus opinion of the doctors was that normal childbirth is the responsibility of midwives, and they mentioned that the midwives needed training. Managers stated that midwives with a postgraduate education could cope with the increased responsibility, but new graduates needed additional training. Professionals working in primary health care recommended better documentation in the mother–child handbook. Most women said that they preferred women to care for them during childbirth; however, they could not differentiate between midwives and female doctors, and claimed they were not kept well informed about progress and did not have sufficient support during childbirth.InterpretationBefore the midwifery-led model of maternity care can be introduced in the Gaza Strip, midwives need to be given additional training so that they can focus on their core responsibility. The health-care system will assist midwives to respond to these challenges to improve the continuity of care.FundingWHO oPt. In a quality-of-care assessment of mothers and newborn babies in maternity units in the Gaza Strip, occupied Palestinian territory (oPt), WHO oPt identified poor management of normal childbirth, early discharge, and lack of privacy for women as challenges for the delivery of care to pregnant women. The Palestinian Ministry of Health agreed that these challenges could be addressed by the introduction of a midwifery-led model of care. The aim of this study was to solicit the views of staff and women who had been through childbirth with respect to the introduction of the midwifery-led model of care. Six focus groups were organised and each group consisted of eight to 12 health professionals (midwives, nurses, or doctors). Selection criteria for the health professionals were experience in midwifery-led model of care and working in a maternity unit of one of the main hospitals in the Gaza Strip. Two focus groups had midwives, two had male and female obstetricians, one had nurse managers, and one had primary health-care midwives and doctors. Three other focus groups were formed with women who had given birth at any time in their lives. Thematic analysis was used to identify themes and subthemes to form the basis for the analysis, and NVivo (version 8) was used to code and emerge themes and subthemes. The Ministry of Health provided the approval to do the study. All participants provided verbal informed consent. Midwives stated that they lacked training in evidence-based practice. The consensus opinion of the doctors was that normal childbirth is the responsibility of midwives, and they mentioned that the midwives needed training. Managers stated that midwives with a postgraduate education could cope with the increased responsibility, but new graduates needed additional training. Professionals working in primary health care recommended better documentation in the mother–child handbook. Most women said that they preferred women to care for them during childbirth; however, they could not differentiate between midwives and female doctors, and claimed they were not kept well informed about progress and did not have sufficient support during childbirth. Before the midwifery-led model of maternity care can be introduced in the Gaza Strip, midwives need to be given additional training so that they can focus on their core responsibility. The health-care system will assist midwives to respond to these challenges to improve the continuity of care.

Evaluating midwifery-led antenatal care: Using a programme logic model to identify relevant outcomes

Backgrounda range of initiatives has been introduced in Ireland and internationally in recent years to establish midwifery-led models of care, generally aimed at increasing the choices available for women for maternity care. A midwifery-led antenatal clinic was first established at the study site (a large urban maternity hospital in Dublin) and extended over recent years. This paper reports on the design of an evaluation of these midwives clinics, in particular the use of a programme logic model to select outcomes to be included in the evaluation. Aims and objectivesthe programme logic model is used to identify the theory of a programme and is an integrative framework for the design and analysis of evaluations using qualitative and quantitative methods. Through an inclusive approach, the aim was to identify the most relevant outcomes to be included in the evaluation, by identifying and linking programme (midwifery-led antenatal clinic) outcomes to the goals, inputs and processes involved in the production of these outcomes. Methodsthe process involved a literature review, a review of policy documents and previous reviews of the clinics, interviews with midwives, obstetricians and managers to identify possible outcomes, a focus group with midwives, obstetricians, managers and women who had attended the clinics to refine and prioritise outcomes, and a follow-up survey to refine and prioritise the outcomes identified and to identify sources of data on each outcome. Findingsseven categories of outcomes were identified: (1) choice, (2) relationship/interaction with caregiver, (3) experience of care, (4) preparation and education for childbirth and parenthood, (5) effectiveness of care, (6) organisational outcomes, and (7) programme viability. A range of sources of information was identified for each outcome, including existing documentation and data, chart audit, survey of women, and interviews and focus groups with midwives, obstetricians, managers and women. Conclusionsthe programme logic model provided an inclusive, systematic and transparent approach to identifying relevant outcomes to be included in the evaluation. The information obtained has been used since to design the evaluation project, which is currently being concluded.

Women's experiences of care during labour in a midwifery-led unit in the Republic of Ireland

The first two midwifery-led units (MLUs) in the Republic of Ireland were opened in July 2004 in the north east of the country. This study explores women's experiences of a midwifery-led model of care during labour in a midwifery-led unit in the Republic of Ireland. Methods: A descriptive qualitative research study ( Sandelowski, 2000 ) using an interpretive phenomenological analysis and Colaizzi's (1978) process of phenomenological data analysis was used to explore and interpret women's experiences of a midwifery-led model of care during labour in an MLU in the Republic of Ireland. Individual in-depth semi-structured interviews were undertaken with eight women who had given birth in the unit. The interviews were transcribed verbatim. Findings: The themes that emerged were condensed and the findings focused on two categories: homely atmosphere and woman in control. Within the homely atmosphere, the women felt at ease in the MLU and were able to relax, which encouraged them to labour in their own time in their own way. Women felt in control of both the pain of their labour and in their ability to make decisions as they were encouraged to make choices throughout their labour, which served to empower them and provided them with a positive birthing experience. Conclusion: This research study provides a revealing insight into the components of midwifery-led care that are essential to women accessing this model. This includes them having the freedom to do their own thing, progressing their labour in their own way, and receiving support and assistance when requested from a supportive midwife. All of the women reported a thoroughly positive experience of giving birth in the MLU. These components of midwifery-led care could possibly be transferred to other models of maternity care provided the women were in the low-risk category.

Midwifery group practice and mode of birth

Midwifery-led models of care, specifically Midwifery Group Practices (MGPs), have been promoted as one way to address the increasing caesarean rate. Whilst women report a high level of satisfaction, and experience lower rates of induction and epidural analgesia, a Cochrane review reported no differences in mode of birth. A retrospective cohort study was performed using routinely collected de-identified data of all term births between 2006 and 2010. Outcomes for 1545 women under MGP model were compared with 13,880 women cared for in all other models. Primary outcome measure was unassisted vaginal birth. Predictors investigated were model of care, induction and epidural analgesia. Both bivariate analysis and multivariate logistic regression analysis was undertaken (controlling for important confounders) with adjusted odds ratios (aOR) and 95% confidence intervals (CI) presented. Significant differences were demonstrated in the demographic and clinical characteristics of the groups. Compared with those in other models of care, women in MGP care had similar rates of induction but significantly fewer received epidural analgesia (28.4% vs 33.5%; p<0.001). There was no difference in the mode of birth. When adjusted for confounders, women in MGP care were no more or less likely to have an unassisted vaginal birth (aOR 1.07; 95% CI 0.92-1.24; p=0.397), birth assisted by instrument (aOR 1.02; 95% CI 0.86-1.21; p=0.852) or emergency caesarean section (aOR 0.89; 95% CI 0.74-1.06; p=0.193). However, in the subgroup of women who did not receive epidural analgesia, women in MGP care had an increased likelihood of an unassisted vaginal birth (aOR 1.29; 95% CI 1.06-1.58; p=0.013). Women in MGP care are no more or less likely to have an unassisted vaginal birth.

Reviewing and reflecting on practice: The midwives experiences of credentialling

What are the experiences of midwives working in midwifery-led models of care in NSW who undertake the credentialling process? In 2005, the NSW Health Department issued a directive requiring midwives who worked in midwifery-led models of care to undergo a process known as credentialling. Credentialling involved a four-step process: self-assessment, face-to-face panel review of midwifery practice, assessment of emergency management skills and discussion of a case study from practice. A descriptive exploratory study examined the experiences of the midwives who undertook the credentialling process in NSW. Data were collected through in-depth, semi-structured interviews with 12 midwives who had experienced credentialling and analysed using descriptive and thematic analysis. The themes were preparing for credentialling; doing credentialling; achieving credentialling; valuing credentialling; and, improving credentialling. Initially, the midwives were self-focused in their understanding and impressions of the value of credentialling. There were a number of contentions including seeing credentialling as another 'hoop to jump through' or a need to 'tick the box' and not as a framework for practice. Some viewed it as a necessary move to increase professionalism and facilitate practice review. Others felt they were being unfairly targeted as not all midwives were expected to undertake it. The midwives were cognisant of the need for a process that encouraged responsibility for ongoing professional development and continuing competence and believed the process would be useful in promoting deeper reflection on practice. Credentialling was recognised as being valuable for all midwives to undertake as it encourages both a review of, and reflection on, practice. The process has further developed into Midwifery Practice Review (MPR) and is administered by the national professional association for midwifery.

Consultation, Referral, and Collaboration Between Midwives and Obstetricians: Lessons From New Zealand

There has been substantial growth in the provision of midwifery-led models of care, yet little is known about the obstetric consultation and referral practices of these midwives or the quality of the collaboration between midwives and obstetricians. This study aimed to describe these processes as they are practised in New Zealand, where midwifery-led maternity care is the dominant model. A total population postal survey was conducted that included 649 New Zealand midwives who provided midwifery-led care in 2001. There was a 56.5% response rate, describing care for 4251 women. Within this cohort, there was a 35% consultation rate and 43% of these women had their lead carer role transferred to an obstetrician. However, the midwives continued to provide care in collaboration with obstetricians for 74% of transferred women. Seventy-two percent of midwives felt that they were well supported by the obstetricians to continue care. Midwifery-led care is reasonable for the general population of childbearing women, and a 35% consultation rate can be seen as a benchmark for this population. Midwives can, when well supported, provide continuity of care for women who experience complexity during pregnancy and/or birth. Collaboration with obstetricians is possible, but there needs to be further work to describe what successful collaboration is and how it might be fostered.

The first year of a midwifery‐led model of care in Far North Queensland

To describe a midwifery-led model of care in Far North Queensland and the outcomes obtained in its first year of operation. Prospective analysis of data for all women who were booked for antenatal care with the midwifery-led unit at Mareeba District Hospital (MDH) and who gave birth during its first year of operation, from 27 June 2005 to 30 June 2006. Number of women giving birth at MDH; antenatal, intrapartum and postpartum transfers to a higher-level referral centre (Cairns Base Hospital [CBH]); and labour and delivery outcomes. Of the 203 women who were booked for antenatal care at MDH and gave birth in the 12-month period, 170 were categorised as low risk and suitable to give birth at MDH. Of these, 147 (86%) did give birth at MDH, while 17 women (10%) had their care transferred antenatally to CBH, and six (4%) were transferred intrapartum. Of the 33 women categorised as high risk, 22 (67%) gave birth at CBH as planned, seven (21%) had elective caesarean sections performed by a general practitioner at MDH, and four (12%) presented to MDH in labour and gave birth there with no complications. Of the 158 women who gave birth at MDH, 146 (92%) had a spontaneous vertex delivery. Outcomes for the first year of operation of the midwifery-led model of care are consistent with a viable maternity unit, with delivery outcomes and transfer rates that compare favourably with other similar units in Australia.