Midwifery Model Of Care Research Articles

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.

'She knows how we feel': Australian Aboriginal and Torres Strait Islander childbearing women's experience of Continuity of Care with an Australian Aboriginal and Torres Strait Islander midwifery student.

Marked differences exist between the maternal and neonatal outcomes of Australian Aboriginal and Torres Strait Islander women and their babies compared with the outcomes for other Australian women and their babies. Australian government policies underline the need to increase the number of practising Aboriginal and Torres Strait Islander midwives and nurses as a strategy for delivering culturally appropriate healthcare to improve health outcomes for Aboriginal and Torres Strait Islander families. Additional challenges are experienced by Aboriginal and/or Torres Strait Islander midwifery students providing Continuity of Care (COC) to Australian Aboriginal and/or Torres Strait Islander childbearing women. One such example is the challenge presented due to the close connections and relationships that exist within some Aboriginal and/or Torres Strait Islander cultures in terms of the maintenance of a professional relationship, in particular, the maintenance of professional boundaries. Whilst there is a growing body of evidence on the benefits to women of continuity of midwifery care models, little is known about the experiences of Aboriginal and Torres Strait Islander women who receive COC from Aboriginal and Torres Strait Islander midwifery students. To explore the experiences of Australian Aboriginal and Torres Strait Islander childbearing women who participated in a Continuity of Care journey with an Aboriginal and/or Torres Strait Islander Bachelor of Midwifery student. Exploratory, descriptive study using semi-structured interviews informed by an Indigenous Research Methodology. Thematic analysis identified four major themes: (i) communicating our way, (ii) the role of relationships, (iii) support and assistance and (iv) challenges of the system. The findings illustrated the benefits Aboriginal women experience as a result of having Aboriginal and/or Torres Strait Islander midwifery students provide Continuity of Care. Increasing the number of Australian Aboriginal and/or Torres Strait Islander midwives is essential to improving health outcomes for Australian Aboriginal and Torres Strait Islander childbearing women and their families. Caseload midwifery models with Aboriginal and Torres Strait Islander midwives across Australia are needed. Health services, in partnership with Universities and Aboriginal and Torres Strait Islander communities, have a vital role to play in the development and expansion of these models.

'Choice, culture and confidence': key findings from the 2012 having a baby in Queensland Aboriginal and Torres Strait Islander survey.

BackgroundTo describe the maternity care experiences of Aboriginal and/or Torres Strait Islander women in Queensland, Australia and to identify areas for policy and practice improvements.MethodsA culturally-tailored survey requesting both quantitative and qualitative information was completed by respondents either independently (online or in hard copy) or with the assistance of a trained peer-interviewer. Data were analysed using descriptive statistics and thematic analysis.Eligible women were over 16 years of age, identified as Aboriginal and/or Torres Strait Islander, resided in Queensland, and had a live, singleton birth between the first of July 2011 and the first of July 2012.Results187 women of 207 respondents were included in analyses. Women reported high rates of stressful life events in pregnancy, low levels of choice in place of birth and model of care and limited options to carry out cultural practices. High levels of confidence in parenting were also reported. Women were less likely to report being treated with kindness, understanding and respect by maternity care staff than women answering a similar mainstream survey.ConclusionsAboriginal and Torres Strait Islander women have additional needs to mainstream Australian women. This study identified a number of recommendations to improve services including the need to enhance the cultural competence of maternity services; increase access to continuity of midwifery care models, facilitate more choices in care, work with the strengths of Aboriginal and Torres Strait Islander women, families and communities, and engage women in the design and delivery of care.

Renegotiating inter‐professional boundaries in maternity care: implementing a clinical pathway for normal labour

This article presents findings from a study of a clinical pathway for normal labour (Normal Labour Pathway) implemented in Wales, UK. The study was conducted between 2004 and 2006. The pathway aimed to support normal childbirth and reduce unnecessary childbirth interventions by promoting midwife-led care. This article focuses on how the pathway influenced the inter-professional relationships and boundaries between midwives and doctors. Data are drawn from semi-participant observation, focus groups and semi-structured interviews with 41 midwives, and semi-structured interviews with five midwifery managers and six doctors, working in two research sites. Whereas some studies have shown how clinical pathways may act as ‘boundary objects’, dissolving professional boundaries, promoting interdisciplinary care and de-differentiating professional identities, the ‘normal labour pathway’ was employed by midwives as an object of demarcation, which legitimised a midwifery model of care, clarified professional boundaries and accentuated differences in professional identities and approaches to childbirth. The pathway represented key characteristics of a professional project: achieving occupational autonomy and closure. Stricter delineation of the boundary between midwifery and obstetric work increased the confidence and professional visibility of midwives but left doctors feeling excluded and undervalued, and paradoxically reduced the scope of midwifery practice through redefining what counted as normal.

The art of student continuity experience

The Logan and Beaudesert Hospital Midwifery Group Practice (MGP) Queensland is an all risk midwifery model of care with a specific objective to care for vulnerable and socially disadvantaged women.Working through adversity has been a challenging journey which has positively influenced midwives practice and professional growth. This journeybeganwithmajor changes inMidwifery management leading to instability in leadership, a decrease inmidwifery autonomy, withdrawal of medical support and attempts to close the service. This caused emotional stress within the MGP and attempts to improve the situation, with support from the Queesland Nurses Union (QNU) were unsuccessful. This led to long term sick leave, work cover claims, discontinued care of women, a reduction in midwives, a change in the remaining midwifery culture, loss of income and emotional distress. Women were affected by withdrawal of their midwifery model of care which also caused them emotional stress. This significantly influenced their decision making processes for their births and affected their outcomes as well as the service statistics. Midwives worked together to challenge the adversity they faced. Professional and consumer bodies such as the Australian College of Midwives, Maternity Coalition, Midwives Australia and the QNU assisted Midwives to negotiate with management. The midwives wrote to and visited Members of Parliament and met with the Health Minister which led to meetings with management, an external review of the service and an improvement in Midwifery leadership. Supporting each other and standing strong helped strengthen the midwives passion for midwifery. It empowered them to return to work and continue promoting professional midwifery practice. Many midwives have improved the workplace culture, supported new graduate positions, gained eligibility, prescribing rights and commenced private practice. These efforts have also led to a Health Minister promise to return birthing to Beaudesert Hospital by 2014. Overcoming adversity has developed stronger more empowered midwives significantly benefiting them and the women in their care.

Working through adversity in a Midwifery Group Practice

The Logan and Beaudesert Hospital Midwifery Group Practice (MGP) Queensland is an all risk midwifery model of care with a specific objective to care for vulnerable and socially disadvantaged women.Working through adversity has been a challenging journey which has positively influenced midwives practice and professional growth. This journeybeganwithmajor changes inMidwifery management leading to instability in leadership, a decrease inmidwifery autonomy, withdrawal of medical support and attempts to close the service. This caused emotional stress within the MGP and attempts to improve the situation, with support from the Queesland Nurses Union (QNU) were unsuccessful. This led to long term sick leave, work cover claims, discontinued care of women, a reduction in midwives, a change in the remaining midwifery culture, loss of income and emotional distress. Women were affected by withdrawal of their midwifery model of care which also caused them emotional stress. This significantly influenced their decision making processes for their births and affected their outcomes as well as the service statistics. Midwives worked together to challenge the adversity they faced. Professional and consumer bodies such as the Australian College of Midwives, Maternity Coalition, Midwives Australia and the QNU assisted Midwives to negotiate with management. The midwives wrote to and visited Members of Parliament and met with the Health Minister which led to meetings with management, an external review of the service and an improvement in Midwifery leadership. Supporting each other and standing strong helped strengthen the midwives passion for midwifery. It empowered them to return to work and continue promoting professional midwifery practice. Many midwives have improved the workplace culture, supported new graduate positions, gained eligibility, prescribing rights and commenced private practice. These efforts have also led to a Health Minister promise to return birthing to Beaudesert Hospital by 2014. Overcoming adversity has developed stronger more empowered midwives significantly benefiting them and the women in their care.

Enhancing choice and improving outcomes through the mediation of childbirth risk discourses within a midwifery model of care: Findings from a critical ethnography

Enhancing choice and improving outcomes through the mediation of childbirth risk discourses within a midwifery model of care: Findings from a critical ethnography

Post-structural feminist interpretive interactionism

To present an adaptation of interpretive interactionism that incorporates and honours feminist values and principles. Interpretive interactionism as described by Denzin can be useful when examining interactive processes. It is especially useful when events affect turning points in people's lives. When issues of power and power imbalances are of interest, a critical post-structural lens may be of use to the researcher. The authors planned to examine the interactions between midwives and women at the 'epiphaneal' points of decision making during second-stage labour. It became clear that it was necessary to honour and thus incorporate feminist principles and values in their methodology. This paper draws on a recently completed PhD project to demonstrate the application of post-structural feminist interpretive interactionism. Twenty six midwives representing each state and territory across Australia who were representative of every model of midwifery care offered in Australia were interviewed to gauge their experiences of what they believed represented good and poor case examples of decision making during second-stage labour. The authors critique the philosophical underpinnings of interpretive interactionism, and then modify these to acknowledge and incorporate post-structural and feminist ideologies. Interpretive interactionism is a useful methodology when the research question is best addressed by examining interactional processes and the meanings people make of them, especially if these occur at turning points in people's lives. Interpretive interactionism methodology can and should be improved by taking account of issues of power, feminism and post-structural values. Post-structural feminist interpretative interactionism has much to offer healthcare researchers who want to develop methodologically robust findings. Post-structural feminist interpretive interactionism enables the researcher to be more cognisant of the complex social political and historical context of midwifery. Researchers using feminist and post-structural ideologies will enhance research findings when these tools are applied consciously and reflexively.

Safe Delivery Posts: An intervention to provide equitable childbirth care services to vulnerable groups in Zahedan, Iran

Backgroundrecently, there has been a shift towards alternative childbirth services to increase access to skilled care during childbirth. Objectivethis study aims to assess the past 10 years of experience of the first Safe Delivery Posts (SDPs) established in Zahedan, Iran to determine the number of deliveries and the intrapartum transfer rates, and to examine the reasons why women choose to give birth at a Safe Delivery Post and not in one of the four large hospitals in Zahedan. Designa mixed-methods research strategy was used for this study. In the quantitative phase, an analysis was performed on the existing data that are routinely collected in the health-care sector. In the qualitative phase, a grounded theory approach was used to collect and analyse narrative data from in-depth interviews with women who had given birth to their children at the Safe Delivery Posts. Settingwomen were selected from two Safe Delivery Posts in Zahedan city in southeast Iran. Participantsnineteen mothers who had given birth in the Safe Delivery Posts were interviewed. Findingsduring the 10-year period, 22,753 low-risk women gave birth in the Safe Delivery Posts, according to the records. Of all the women who were admitted to the Safe Delivery Posts, on average 2.1% were transferred to the hospital during labour or the postpartum period. Three key categories emerged from the analysis: barriers to hospital use, opposition to home birth and finally, reasons for choosing the childbirth care provided by the SDPs. Key conclusion and implications for practiceimplementing a model of midwifery care that offers the benefits of modern medical care and meets the needs of the local population is feasible and sustainable. This model of care reduces the cost of giving birth and ensures equitable access to care among vulnerable groups in Zahedan.

Midwifery care at a freestanding birth center: a safe and effective alternative to conventional maternity care.

To estimate the effect of a midwifery model of care delivered in a freestanding birth center on maternal and infant outcomes when compared with conventional care. Birth certificate data for women who gave birth in Washington D.C. and D.C. residents who gave birth in other jurisdictions. Using propensity score modeling and instrumental variable analysis, we compare maternal and infant outcomes among women who receive prenatal care from birth center midwives and women who receive usual care. We match on observable characteristics available on the birth certificate, and we use distance to the birth center as an instrument. Birth certificate data from 2005 to 2008. Women who receive birth center care are less likely to have a C-section, more likely to carry to term, and are more likely to deliver on a weekend, suggesting less intervention overall. While less consistent, findings also suggest improved infant outcomes. For women without medical complications who are able to be served in either setting, our findings suggest that midwife-directed prenatal and labor care results in equal or improved maternal and infant outcomes.

The Midwifery Model of Care: Structural Support for Diversity in Health Care

The Midwifery Model of Care: Structural Support for Diversity in Health Care

Immersion in water in labour and birth.

Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care. Critics cite the risk of neonatal water inhalation and maternal/neonatal infection. To assess the evidence from randomised controlled trials about immersion in water during labour and waterbirth on maternal, fetal, neonatal and caregiver outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2011) and reference lists of retrieved studies. Randomised controlled trials comparing immersion in any bath tub/pool with no immersion, or other non-pharmacological forms of pain management during labour and/or birth, in women during labour who were considered to be at low risk of complications, as defined by the researchers. We assessed trial eligibility and quality and extracted data independently. One review author entered data and the other checked for accuracy. This review includes 12 trials (3,243 women): 8 related to just the first stage of labour: one to early versus late immersion in the first stage of labour; two to the first and second stages; and another to the second stage only. We identified no trials evaluating different baths/pools, or the management of third stage of labour. Results for the first stage of labour showed there was a significant reduction in the epidural/spinal/paracervical analgesia/anaesthesia rate amongst women allocated to water immersion compared to controls (478/1,254 versus 529/1,245; risk ratio (RR) 0.90; 95% confidence interval (CI) 0.82 to 0.99, six trials). There was also a reduction in duration of the first stage of labour (mean difference -32.4 minutes; 95% CI -58.7 to -6.13). There was no difference in assisted vaginal deliveries (RR 0.86; 95% CI 0.71 to 1.05, seven trials), caesarean sections (RR 1.21; 95% CI 0.87 to 1.68, 8 trials), use of oxytocin infusion (RR 0.64; 95% CI 0.32 to 1.28, 5 trials), perineal trauma or maternal infection. There were no differences for Apgar score less than 7 at 5 minutes (RR 1.58; 95% CI 0.63 to 3.93, 5 trials), neonatal unit admissions (RR 1.06; 95% CI 0.71 to 1.57, three trials), or neonatal infection rates (RR 2.00; 95% CI 0.50 to 7.94, five trials). Of the 3 trials that compared water immersion during the second stage with no immersion, one trial showed a significantly higher level of satisfaction with the birth experience (RR 0.24; 95% CI 0.07 to 0.80). A lack of data for some comparisons prevented robust conclusions. Further research is needed. Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia and duration of the first stage of labour. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth. However, the studies are very variable and considerable heterogeneity was detected for some outcomes. Further research is needed.

Missing Midwifery: Relevance for Contemporary Challenges in Maternal Health

Midwifery is rooted in public health, and most of its history has been community oriented. In India, midwifery evolved during the British rule; but over the years with changes in political and program priorities, the role and the capacity of midwives has changed substantially. The verticalization of national health programs has obscured the midwives’ community focus and inhibited its contribution to the wider public health. There is a global acceptance and recognition of the midwifery model of care and skilled delivery for ensuring effective maternal health outcomes. The approaches are in line with local needs and have proved its effectiveness in resource-constrained settings. It is important to recognize the substantial contribution they make to public health, working to promote the long-term well-being of women, their babies and families, by offering information and advice on nutrition, supplementation, breastfeeding, and immunization. There is considerable scope for developing the midwifery model through enhancing the extent of their involvement in assessing health needs of local populations, designing, managing and evaluating maternal and health services, making timely and effective referrals and developing family-centered care.

Continuity of Care: Supporting New Graduates to Grow Into Confident Practitioners

AIM:This article describes how newly qualified midwives experienced their rotation into birth suite and a continuity of midwifery care model. The findings are part of a larger study that aimed to describe graduate midwives’ expectations and experiences of their transition to practice.BACKGROUND:Knowledge and understanding of how midwives make the transition from student to registered midwife remain limited. However, the literature suggests that this time is a critical period for a new graduate. Although transition support programs for midwives exist in New South Wales, Australia, there appears to be an ad hoc approach to their design, implementation, and effectiveness.METHOD:A descriptive qualitative approach to elicit the experiences of 38 newly qualified Australian midwives. Telephone interviews and focus groups were used to collect the data. Content analysis was used to analyze the data set.FINDINGS:The birthing environment was identified as the clinical area, which elicited the greatest level of apprehension for the midwives, whereas those with the opportunity to rotate into a midwifery continuity of care model rated the experience positively.CONCLUSION:The findings of the study suggest that the newly graduated midwives felt a sense of social and professional belonging to the midwifery continuity of care models in which they worked.KEYWORDS:newly graduated midwife; transition support programs; birth suite; models of care; continuity of care; hierarchy

Childbirth experience of migrants in China: A systematic review

As preliminary research into the childbirth experience of migrants in China, this paper presents a systematic review of Chinese and English literature published between 1999 and 2011 on childbirth in migrants in China. Electronic databases were accessed and papers were found by keyword search. A total of 132 Chinese and 9 English papers were catalogued for review. These papers address migrant maternity issues concerning antenatal, intrapartum, postnatal care, institutional issues, family planning or birth control. Since China's economic reforms, the healthcare infrastructure has been inadequate for childbirth in migrants. They experience more adverse birth outcomes than local residents. This suggests that the effects of change upon childbirth and the existing urban and rural care systems cannot meet the needs of the migrants. There is a lack of research in the childbirth experience of women. Knowledge of their childbirth experience will contribute to the understanding of these needs, informing systems' reform. The medical approach results in many unnecessary interventions and higher costs. It is argued here that a midwifery model of care is most appropriate for the childbirth experience of migrant women.

Mining for liquid gold: midwifery language and practices associated with early breastfeeding support.

Internationally, women give mixed reports regarding professional support during the early establishment of breastfeeding. Little is known about the components of midwifery language and the support practices, which assist or interfere with the early establishment of breastfeeding. In this study, critical discourse analysis has been used to describe the language and practices used by midwives when supporting breastfeeding women during the first week after birth. Participant observation at two geographically distant Australian health care settings facilitated the collection of 85 observed audio-recorded dyadic interactions between breastfeeding women and midwives during 2008-2009. Additionally, 23 interviews with women post discharge, 11 interviews with midwives and four focus groups (40 midwives) have also been analysed. Analysis revealed three discourses shaping the beliefs and practices of participating midwives. In the dominant discourse, labelled 'Mining for Liquid Gold', midwives held great reverence for breast milk as 'liquid gold' and prioritised breastfeeding as the mechanism for transfer of this superior nutrition. In the second discourse, labelled 'Not Rocket Science', midwives constructed breastfeeding as 'natural' or 'easy' and something which all women could do if sufficiently committed. The least well-represented discourse constructed breastfeeding as a relationship between mother and infant. In this minority discourse, women were considered to be knowledgeable about their needs and those of their infant. The language and practices of midwives in this approach facilitated communication and built confidence. These study findings suggest the need for models of midwifery care, which facilitate relationship building between mother and infant and mother and midwife.

Newly qualified midwives' transition to qualified status and role: Assimilating the ‘habitus’ or reshaping it?

Aimto ascribe meaning to the everyday experiences of midwives during their first year of practice as they interact with their social environment. Designa qualitative, ethnographic study. Settinga major maternity department located in the West Country, UK. Participantsseven newly qualified midwives working in the chosen setting. Measurementsas befits an ethnographic approach, observant participation and interviews in the field were the selected data collection tools. Reflexivity was at the hub of the research process. A field diary was kept in order to ensure that the researcher took into account both her own perceptions and the interactions with participants and significant others. This paper draws on data that illustrates some of the predispositions that may constitute the midwifery habitus. Findingsthe main themes that emerged from the data were in relation to the culture of midwifery, fitting into the culture and determining what type of midwife the neophytes wanted to be (‘what is a midwife?’). To enhance transparency, the latter theme is focused upon in this paper using a model that is a synthesis of some of the findings and Bourdieu's notion of habitus. Key conclusions and implications for practicethis research provides insight into the professional and cultural experiences of newly qualified midwives, especially how cultural interactions, education and expectations may shape the midwifery habitus. It would seem that midwives who take a critical and reflective approach to practice are key players in the cultural re-creation of midwifery. Accordingly, to enable the aforementioned approach to practice, it is important that reflective and reflexive practices are an integral part of midwifery education. Nevertheless, the implications for practice are not merely one-dimensional. Observations in the field suggest the importance of making the quality of midwives' working lives a priority by facilitating a more supportive working environment. Moreover, midwives should not be marginalised for preferring to work in the community, the birth centre or the high-risk environment. Future planning of the maternity services needs to consider how a ‘being with the woman’ approach can be facilitated for all women, balancing the virtues of both the medical and midwifery models of care.

Publicly-funded homebirth models in Australia

Publicly-funded homebirth programs in Australia have been developed in the past decade mostly in isolation from each other and with limited published evaluations. There is also distinct lack of publicly available information about the development and characteristics of these programs. We instigated the National Publicly-funded Homebirth Consortium and conducted a preliminary survey of publicly-funded homebirth providers. To outline the development of publicly-funded homebirth models in Australia. Providers of publicly-funded homebirth programs in Australia were surveyed using an on-line survey in December 2010. Questions were about their development, use of policy and general operational issues. A descriptive analysis of the quantitative data and content analysis of the qualitative data was undertaken. In total, 12 programs were identified and 10 contributed data to this paper. The service providers reported extensive multidisciplinary consultation and careful planning during development. There was a lack of consistency in data collection throughout the publicly-funded homebirth programs due to different databases, definitions and the use of different guidelines. Publicly-funded homebirth services followed different routes during their development, but essentially had safety and collaboration with stakeholders, including women and obstetricians, as central to their process. The National Publicly-funded Homebirth Consortium has facilitated a sharing of resources, processes of development and a linkage of homebirth services around the country. This analysis has provided information to assist future planning and developments in models of midwifery care. It is important that births of women booked to these programs are clearly identified when their data is incorporated into existing perinatal datasets.