Midwives @ Sydney and Beyond - Trail blazing with evidence based models of maternity care

a creative way of rolling with the punches

At the end of 2010 the legislative changes imposed on privately practicing midwives and allied health professionals alike meant that we had to obtain personal indemnity insurance in order to maintain our professional registration. Two packages were offered to midwives and for the first time since 2001 privately practicing midwives had insurance to practice. As with all good things- there is a catch, with insurance and registration come regulation and then professionalisation of the midwifery industry.

This regulation does not impact hospital based midwives severely but has meant that privately practicing midwives are held more accountable for their practice and must maintain transparency more than ever. Access to insurance also paved the way for medicare and PBS numbers for midwives who choose to be 'eligible' for these benefits which allow clients to get some of the out-of-pocket cost of hiring a private midwife back and also allows eligible midwives to refer their clients for antenatal testing and screening without first consulting a GP.

This arrangement is all theoretically good news for the profession of midwifery and women alike who can now access the care of their own midwife regardless of birth setting or 'risk' status. Attached to 'eligibility' and medicare is the requirement to work collaboratively with other maternity care providers, this theoretically improves continuity of care for women who choose to hire a privately practicing midwife to birth in hospital or require specialist care if complications arise during pregnancy or birth. It all sounds very complicated, and it is- and still being ironed out, like all new government policy. The changes to the face of privately practicing midwifery are inevitable and regulation of the profession has happened whether we choose to acknowledge it or not.

Midwives @ Sydney and Beyond was born out of the need to 'roll with the punches' of these changes. Melanie Jackson, Jane Palmer, Robyn Dempsey and Hannah Dahlen got together with the agreed aim of forming a private midwifery group practice to provide midwifery care to our client’s where ever they choose to birth. The Quality and safety framework under which we work allows the women 'right of refusal' and the midwife has a 'duty of care'- this clause within the framework allows mothers choice and midwives freedom to support women in this choice. We embrace and help inform a woman’s choice during pregnancy, birth and beyond and are dedicated to providing women with continuity of care, one-to-one attention and an uninterrupted physiological birth and baby-feeding experience. This concept of a group midwifery model of care is somewhat new to the private midwifery sector and we are very much feeling our way through the legislative changes as we adapt to the new world order - the benefit is that we get to do it together!.

Midwifery models of care are highly researched and supported by rigorous evidence and provide gold standard outcomes to women who choose this option for their pregnancy, birth and baby feeding experience.

Below is an excerpt from the Cochrane database of systematic reviews on midwifery models of care:

Midwife-led versus other models of care for childbearing women

Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality, continuity of care and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a

service through a team of midwives sharing a caseload, often called ’team’ midwifery. Another model is ’caseload midwifery’, where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner.

All models of midwife-led care are provided in a multi-disciplinary network of consultation and referral with other care providers. By contrast, medical-ledmodels of care are where an obstetrician or family physician

is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.

The main benefits were a reduction in the use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman’s chance of being cared for in labour by a midwife she had got to know, and the chance of feeling in control during labour, having a spontaneous vaginal birth and initiating breastfeeding. However, there was no difference in caesarean birth rates.

Women who were randomised to receive midwife-led care were less likely to lose their baby before 24 weeks’ gestation, although there were no differences in the risk of losing the baby after 24 weeks, or overall. In addition, babies of women who were randomised to receive midwife-led care were more likely to have a shorter length of hospital stay.

The review concluded thatmost women should be offeredmidwife-ledmodels of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.

Citation:

  Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women.Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub2.

It is important to know your needs, desires and philosophy about pregnancy, birth and baby-feeding and ensure your carer and place of birth match these desires to ensure the greatest success and satisfaction in your parenting journey  

with love

Melanie xo

for more information on Midwives @ Sydney and Beyond visit http://www.ellamaycentre.com/