Continuity Of Midwifery Care: A Review Of Australian Studies

Selected Research Papers

Discuss about the Midwifery for Continuity of Midwifery Care.

1. The selected topic for the assignment is ‘Continuity of midwifery care’. The selected research papers for critical appraisal have been listed below.

• Tracy, S. K., Hartz, D. L., Tracy, M. B., Allen, J., Forti, A., Hall, B., Kildea, S. (2013). Caseload midwifery care versus standard maternity care for women of any risk: [email protected], a randomised controlled trial. Lancet, 382(9906), 1723– 1732. 
• Cummins, A. M., Denney-Wilson, E., & Homer, C. S. E. (2015). The experiences of new graduate midwives working in midwifery continuity of care models in Australia. Midwifery, 31(4), 438–444. 

2. This step has been presented in the templates for qualitative and quantitative studies.

3. Search engines used: Medline, EMBASE, CINAHL, PsycINFO and Cochrane Library.

Limits applied: Range of the date of publication – 2006 to 2016.

Inclusion and exclusion criteria: Journals from Australian and midwifery background were included and journals of other healthcare disciplines, out of the publication date range and not of Australian origin were excluded.

Search terms used: Midwifery, Australia and continuity of care. 

Assessment of articles: The selected papers satisfied the inclusion criteria and they were all within the range of date of publication. They were all carried out in the Australian backdrop keeping in focus the continuity of midwifery care.

	Article 1	Article 2	Article 3	Article 4
Author(s)	Shona Dove and Eimear Muir – Cochrane	A group of 10 researchers led by HL McLachlan	Kathryn Williams, Luise Lago, Anne Lainchbury and Kathy Eagar	Jenny Browne, Penny J Haora, Jan Taylor and Deborah L Davis
Type of study	Qualitative	Quantitative	Qualitative	Qualitative
Purpose	Examination of continuity of care on childbirth risk concepts for women and midwives	Examination of the efficiency of primary midwifery care to decrease the rate of caesarean section over standard maternity care	Evaluation of the satisfaction of mothers using the scheme of caseload midwifery	Analysis of the experiences of continuity incorporating the perspectives of diverse stakeholders for optimizing experiences
Sample	8 midwives, 1 obstetrician and 17 women	2314 pregnant women who were under low risk	174 women including 87 primiparous and multiparous women each	15 student midwives, 14 registered midwives and 6 maternity managers
Design	Critical ethnography	Randomized controlled trial	Postal survey linked with the outcomes of clinical data	Focal group
Data collection	Carspecken’s five-stage framework	Electronic obstetric database and medical records	100 questionnaires that were answered by the mothers on discharge	Focus groups and conjoint interview
Key findings	Safe mother and safe practitioner practices were achieved by decreasing childbirth risks	Caesarean births can be reduced with caseload midwifery	Midwifery group program achieved higher levels of continuity of care from the perspectives of the mothers and birth records	The study was beneficial to the students for the development of woman-centered focus and also for the other stakeholders

 4. Maternity care in Australia includes the postnatal, intrapartum and antenatal care for the babies and women that extend for six weeks after birth. The review of the maternity services identified a wide range of models for maternity care that are currently practiced in Australia with an estimation of 92.7% of the Australian women receive the care through four models. One of the four models is used that consists of shared maternity care, public hospital care, combined maternity care and private maternity care. Continuity of care has been recognized as an integral feature of the maternity care of women and the demand for the continuity of care models for the midwives is in increasing demands. Midwifery group practices providing care in the community and hospital are critical care providers of public homebirth (Health.gov.au, 2016). Recommendations from the six articles reflect what is already happening in the Australian maternity care. Cummins, Denney-Wilson & Homer (2015) recommended that midwifery continuity of care is beneficial for the new born and women and the models providing the service is increasing in Australia. This is in accordance with the Australian maternity care guidelines and the study conducted by them developed consolidated knowledge and skills and trusting relationships among the new graduate midwives. According to the recommendation by Tracy et al. (2013), the configuration of caseload model was implemented and it differed from the model of standard midwifery care. It was found from the study that although there was no significant difference achieved with the caseload model for caesarean section, it costs lesser than the standard care with almost similar outcomes. Therefore, it can be said that the studies included in this assignment reflected the present situation of the Australian maternity care.

Maternity Care in Australia

The research population selected in the studies consisted primarily of the pregnant women and the midwives. They are the providers and recipient of maternity care in Australia and therefore, it can be said that the research population in all of the studies in this assignment are similar to those who are accessing maternity care in Australia. From the study conducted by Dove & Muir-Cochrane (2014), 8 midwives were recruited along with 1 obstetrician and 17 women as the study participants. The obstetrician provided clinical support in the study and provided insight to the midwives for conceptualizing safety and risk.  The study conducted by McLachlan et al. (2012) included 2314 pregnant women who are at low risk. Power calculations based on caesarean rate were used for recruiting the women in the study. Therefore, form the studies, it can be said that the recommendations provided should be adopted for the betterment of the continuity of midwifery care for the mothers and the new born babies.

Various practical issues have to be considered to adopt the recommendations stated in the studies. This may include the availability of equipment, additional training and cost. From the study conducted by Williams et al. (2010), it was recommended that having a known midwife during the time of labor provides advantages to the women as they feel assured that their caregivers respects, understands and knows them. It was also suggested by the authors that the definition of continuity goes beyond the known midwifery in case of labor and accommodates postnatal and antenatal care. Therefore, the new midwifery graduates need to be trained to develop supportive relationships with the women. The training would provide them with the adequate skills and knowledge required for the implementation of the recommendation by the researchers. As evident from the study by Tracy et al. (2013), it can be said that adoption of the caseload midwifery care model against the standard care procedure is cost effective and the clinical outcomes are similar. Public health expenditure can be reduced to greater extent by reducing the costs of maternity care as it is one of the leading causes for hospital admission in Australia. Introduction of sophisticated equipment to support the care models can further benefit this process and therefore considering these practical issues, the recommendations provided in the studies can be adopted.

The recommendations that were not explored in the papers consisted of the implications for the future study and were beyond the scope of the papers. Therefore, following those recommendations will benefit the healthcare system of Australia with their adoption. According to the research work by Cummins, Denney-Wilson & Homer (2015), the unexplored part of the research consisted of the discovery of the need for the new graduates midwives to complete the transition support program or should gather sufficient relevant experience prior to working in the midwifery continuity. According to this recommendation, adopting it will benefit the Australian community in terms of health as with better-skilled midwives, better care can be achieved. According to Dove & Muir-Cochrane (2014), the unexplored part included the identification of the operating location of the cultural themes and finding out their constraint or beneficial nature towards the expressions of identity. Adopting these recommendations will reframe the relationships of the midwives with the medical staffs and the cross-cultural communication barriers can be addressed as they very crucial and problematic in the present scenario of Australian healthcare. Therefore, it can be said that it will benefits all over if the unexplored recommendations are followed from the papers as they take the individual studies to their next level where better care options are available that will benefit both the midwives and the mothers.

The recommendations of all the authors agreed at a common point that continuity of midwifery care is an essential aspect of the mother and the new born child. Different authors have adopted different strategies to implement different methods to improve this process with a common aim of recommending a better solution to the existing problems in the Australian community. Different settings were selected for the individual studies and apart from the mothers and the midwives, other stakeholders of healthcare were also included in the studies to determine the effectiveness of the implementation of the recommendations. All turned out to be effective enough in terms of reduced costs, trained new midwifery graduates, developed relationships and reduced caesarean births and therefore, it can be said that there was agreement among all the authors on the proposed recommendations.

5. The best aspects of this assignment have been listed below.

• A descriptive concept of the present situation in the Australian midwifery community.
• Detailed knowledge of the various care models for the mothers and the babies adopted by the midwives.
• Exposure to the cost effective ways to provide midwifery care through caseload midwifery.

1. The following aspects could have been improved.

• Reviewing a larger number of articles to achieve further exposure of the research studies on midwifery.
• Reviewing the journals and articles from out of Australia as continuity of midwifery care is a global issue.
• Working on the recommendations provided by the articles to gather a broader concept of the research studies.

1. Feedback is requested on the critical review of the research papers and their in-depth analysis carried out in this assignment.

References

Browne, J., Haora, P. J., Taylor, J., & Davis, D. L. (2014). “continuity of care” experiences in midwifery education: Perspectives from diverse stakeholders. Nurse Education in Practice, 14(5), 573-578. doi:10.1016/j.nepr.2014.01.014

Cummins, A. M., Denney-Wilson, E., & Homer, C. S. E. (2015). The experiences of new graduate midwives working in midwifery continuity of care models in australia.Midwifery, 31(4), 438. doi:10.1016/j.midw.2014.12.013

Department of Health | Provision of maternity care. (2016). Health.gov.au. Retrieved 6 August 2016, from https://www.health.gov.au/internet/publications/publishing.nsf/Content/pacd-maternityservicesplan-toc~pacd-maternityservicesplan-chapter3

Dove, S., & Muir-Cochrane, E. (2014). Being safe practitioners and safe mothers: A critical ethnography of continuity of care midwifery in australia. Midwifery, 30(10), 1063. doi:10.1016/j.midw.2013.12.016

McLachlan, H., Forster, D., Davey, M., Farrell, T., Gold, L., Biro, M.. . Waldenström, U. (2012). Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: The COSMOS randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 119(12), 1483-1492. doi:10.1111/j.1471-0528.2012.03446.x

Tracy, S. K., Hartz, D. L., Tracy, M. B., Allen, J., Forti, A., Hall, B.. . Kildea, S. (2013). Caseload midwifery care versus standard maternity care for women of any risk: [email protected], a randomised controlled trial. Lancet (London, England), 382(9906), 1723-1732. doi:10.1016/S0140-6736(13)61406-3

Williams, K., Lago, L., Lainchbury, A., & Eagar, K. (2010). Mothers’ views of caseload midwifery and the value of continuity of care at an australian regional hospital.Midwifery, 26(6), 615-621. doi:10.1016/j.midw.2009.02.003