Australian maternity reform through clinical redesign

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Contents Vol 36(2)

doi:10.1071/AH11012

Journal of the Australian Healthcare & Hospitals Association

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Australian maternity reform through clinical redesign

Donna L. Hartz ^A ^D, Jan White ^B, Kathleen A. Lainchbury ^B, Helen Gunn ^B, Helen Jarman ^B, Alec W. Welsh ^B ^C, Daniel Challis ^C and Sally K. Tracy ^A ^B ^C

^A University of Sydney, Midwifery and Women’s Health Research Unit, Level 1, Royal Hospital for Women, Barker Street, Randwick, NSW 2031, Australia. Email: sally.tracy@sydney.edu.au
^B Royal Hospital for Women, Barker Street, Randwick, NSW 2031, Australia. Email: jan.white@sesiahs.health.nsw.gov.au; anne.lainchbury@sesiahs.health.nsw.gov.au; helen.gunn@sesiahs.health.nsw.gov.au; helen.jarman@sesiahs.health.nsw.gov.au
^C University of NSW, Sydney, NSW 2052, Australia. Email: alec.welsh@unsw.edu.au; daniel.challis@sesiahs.health.nsw.gov.au
^D Corresponding author. Email: donna.hartz@sydney.edu.au

Australian Health Review 36(2) 169-175 http://dx.doi.org/10.1071/AH11012
Submitted: 15 February 2011 Accepted: 16 August 2011 Published: 4 May 2012





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Abstract

The current Australian national maternity reform agenda focuses on improving access to maternity care for women and their families while preserving safety and quality. The caseload midwifery model of care offers the level of access to continuity of care proposed in the reforms however the introduction of these models in Australia continues to meet with strong resistance. In many places access to caseload midwifery care is offered as a token, usually restricted to well women, within limited metropolitan and regional facilities and where available, places for women are very small as a proportion of the total service provided. This case study outlines a major clinical redesign of midwifery care at a metropolitan tertiary referral maternity hospital in Sydney. Caseload midwifery care was introduced under randomised trial conditions to provide midwifery care to 1500 women of all risk resulting in half of the publicly insured women receiving midwifery group practice care. The paper describes the organisational quality and safety tools that were utilised to facilitate the process while discussing the factors that facilitated the process and the barriers that were encountered within the workforce, operational and political context.

What is known about the topic? Caseload midwifery models of care have been established in a variety of community based and hospital settings throughout Australia with a reported reduction in clinical intervention rates while maintainning safety of mothers and babies.

What does this paper add? This case study illustrates the strategies used to achieve a large sustainable clinical service redesign project based on the introduction of the caseload midwifery model of care.

What are the implications for practitioners? Establishing midwifery group practice care within the mainstream maternity services has far reaching implications for the retention and recruitment of midwives and the improvement of clinical outcomes in childbirth.

References

[1] Tracy S, Hartz D, Nicholl M, McCann Y, Latta D. An integrated service network in maternity; the implementation of a midwifery-led unit. Aust Health Rev 2005; 29: 332–9.
| CrossRef |

[2] Tracy SK, Hartz D. The quality review of Ryde Midwifery Group Practice, September 2004 to October 2005: Final Report. Sydney: Northern Sydney and Central Coast Area Health Service; 2005.

[3] Hartz D, Foureur M, Tracy SK. Australian caseload midwifery; the exception or the rule. Women Birth 2011; : .
| CrossRef |

[4] Improving maternity service in Australia; report of the Maternity Services Review. Department of Health and Ageing; 2009.

[5] Australian Health Ministers’ Conference (AHMC). National Maternity Services Plan. Canberra: Commonwealth of Australia. http://www.health.gov.au/internet/main/publishing.nsf/Content/349C976EEDDB5EB0CA257862001B3657/$File/01311%20DoHA%20Maternity%20Plan_tagged%20FA%203%2006.07.11.pdf. [Accessed 20 July 2011].

[6] Betron AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, Wagner M. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007; 21: 98–113.
| CrossRef |

[7] Laws PJ, Li Z, Sullivan EA. Australia’s mothers and babies 2008. Sydney: AIHW National Perinatal Statistics Unit; 2010. Perinatal statistics series no. 24.

[8] MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clinics in Perinatology 2008; 35: 293–307.
| CrossRef |

[9] Gibbons L, Belizán J, Lauer J, Betran A, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Report. 2010. Background Paper, No. 302010. Geneva: World Health Organisation. Available from http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf. [Accessed 30 July 2011].

[10] Laws PJ, Abeywardana S, Walker J, Sullivan EA. Australia’s mothers and babies 2005. Sydney: AIHW National Perinatal Statistics Unit; 2007. Perinatal statistics series no. 20.

[11] Thomas J, Paranjothy S. National sentinel caesarean section audit report. Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit; 2001.

[12] Births and Babies. National Services Scotland, Information Services Division; 2009.

[13] NSW Health Primary Health and Community Partnerships. Towards normal birth in NSW. Policy directive 2010_045. Sydney: NSW Department of Health; 2010 http://www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_045.pdf. [Accessed 30 July 2011].

[14] MacLachlan H, Forster DA, Davey M-A, Lumley J, Farrell T, Oats J, et al. COSMOS: comparing standard maternity care with one-to-one midwifery support: a randomised controlled trial. 2008: Available at http://www.biomedcentral.com/1471-2393/8/35. [Accessed 30 July 2011].

[15] Shaw R, Saxton A, Hastie C. Belmont birthing services, evaluation & clinical outcomes. Belmont and John Hunter Hospitals, Hunter New England Area Health Service; 2006.

[16] Turnbull D, Baghurst P, Collins C, Cornwell C, Nixon A, Donnelan-Fernandez R, et al An evaluation of midwifery group practice. Part I: clinical effectiveness. Women Birth 2009; 22: 3–9.
| CrossRef |

[17] Johnson M, Stewart H, Langdon R, Kelly P, Yong L. Women-centred care and caseload models of midwifery. Collegian 2003; 10: 30–4.

[18] Johnson M, Stewart H, Langdon R, Kelly P, Yong L. A comparison of the outcomes of partnership caseload midwifery and standard hospital care in low risk mothers. Aust J Adv Nurs 2005; 22: 21–7.

[19] Nixon A, Byrne J, Church A. An evaluation of the set-up of the Northern Women’s Community Midwives Project. Adelaide: Northern Metropolitan Community Health Service; 2003.

[20] Knight K, Kemp L, Brodie P, Passant L. The Camden Midwifery Group Practice: clinical outcomes, costs and acceptability. Sydney: CHETRE, UNSW Research Centre for Primary Health Care and Equity; 2007.

[21] Scherman S, Smith J, Davidson M. The first year of a midwifery-led model of care in Far North Queensland. Med J Aust 2008; 188: 85–8.

[22] Williams K, Lainchbury A, Eagar K. The Illawarra Midwifery Group Practice Program; the evaluation of a pilot program to introduce a safe and continuous model of care. Wollongong: Centre for Health Service Development, University of Wollongong; 2005.

[23] Annual report 07/08. Fremantle: Community Midwifery Western Australia; 2008.

[24] Homer C, Caplice S. Evaluation of the publicly-funded homebirth program in South East Sydney Illawarra Area Health Service. Sydney: St George Hospital, South East Sydney Illawarra Area Health Service; 2007.

[25] Tracy SK, Hartz D, Hall B, Allen J, Forti A, Lainchbury A, et al A randomised controlled trial of caseload midwifery care: M@NGO (Midwives @ New Group practice Options). BMC Pregnancy Childbirth 2011; 11: 82.

[26] New South Wales Mothers and Babies 2008. Sydney: Centre for Epidemiology and Research, NSW Department of Health; 2011.

[27] NSW Health. Model pilot agreement for midwifery caseload practice annualised salary agreement. Information Bulletin 2008_012. Sydney: Employee Relations, NSW Department of Health; 2008.

[28] McCourt C, Page L. Report on the evaluation of one-to-one midwifery. London: Hammersmith Hospitals NHS Trust and TVU; 1996.

[29] Page L, McCourt C, Beake S, Vail A, Hewison J. Clinical interventions and outcomes of One-to-One midwifery practice. J Public Health Med 1999; 21: 243–8.
| CrossRef | CAS |

[30] NSW Patient Safety and Clinical Quality Program. Sydney: NSW Department of Health, NSW Health Quality and Safety Branch; 2005.

[31] The clinician’s toolkit for improving patient care. Sydney: NSW Department of Health, NSW Health Quality and Safety Branch; 2001.

[32] National midwifery consultation and referral guidelines. Canberra: Australian College of Midwives; 2004.

[33] Handbook – Risk Management Guidelines: Companion to AS/NZS 4360:2004 (HB 436:2004). HB 436:2004. Standards Australia and Standards New Zealand; 2004.

[34] Weaver EW, Clark KF, Vernon BA. Obstetricians and midwives modus vivendi for current times. Med J Aust 2005; 182: 436–7.

[35] MGP Evaluation Group. Midwifery group practice: an evaluation of clinical effectiveness, quality and sustainability. Adelaide: Children, Youth and Women’s Health Service, Women’s and Children’s Hospital Adelaide; 2005.

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