Implementing Community Midwifery Across NSW

In November 2002, The NSW Branch developed an implementation document based on the principles on the National Maternity Action Plan and in line with NSW Health Policy.  This document has been presented to NSW's Health's peak policy committee, the Maternal and Perinatal Committee and has been received positively.  The Maternity Coalition is seeking an election commitment to implement community midwifery across NSW, starting in the Hunter and Illawarra. See the full version of "Implementing Community Midwifery Across NSW" (pdf format.)

In Summary

This document outlines how the National Maternity Action Plan (NMAP)¹ would be implemented in NSW and should be read in conjunction with it. It proposes that the government establish a statewide midwifery program, to be managed by NSW Health as part of the Families First initiative. The objective of the proposed NSW Community Midwifery Program (NSW CMP) would be to provide NSW women with the option of receiving primary care from a known midwife on a one-to- one basis throughout their pregnancy birth and postnatal time.

The key elements of the proposed Program are entirely consistent with the NSW Government's Families First Initiative², the NSW Framework for Maternity Services³ and the principal objectives of the NSW Maternity Services Advisory Committee⁴. We envisage that it would be implemented consistent with these initiatives.  The proposed Program provides for women anywhere across NSW to have the option of maternity care "that ensures choice, control, continuity of care and safety for all women in all phases of pregnancy and birth."⁵  The Program proposes that women would access caseload midwifery care within the public system, regardless of whether the midwives are contracted or employed. In some settings, caseload care may be offered through a hospital based delivery suite or birth centre. In areas outside the immediate geographic area of such hospital based programs it will be imperative that services are offered through contracting midwives either as a midwifery group practice or as a sole provider to provide caseload care wherever there is a demand for it.

Collaboration and teamwork are the central components of this program. It envisages that all women would have the option to choose a midwife to provide caseload care across the continuum of maternity care. Where indicated, in the care of women with specific medical needs or complications, effective collaboration with relevant medical practitioners would occur.  A suggested framework outlining the consultation process is outlined as Appendix A. These referral guidelines are based on a best practice framework, and are in use in Ontario, Canada. They confirm the midwife as a primary carer with specific reference to backup midwives, General Practitioners (GP's) and Specialist Obstetricians.  It is therefore envisaged that midwives will form strong links with other maternity service providers.  The primary health focus will promote positive links within the service networks outlined in the Families First 'interagency planning process'  at the conclusion of the postnatal episode. These links with General Practitioners, and/or child and family health nurses facilitate a seamless transfer of care after the midwives role is complete. The Ontario referral guidelines should provide the framework within which caseload midwifery services are delivered across the state.   

It is essential that the government uses experienced caseload midwives to establish these programs and to precept wishing to move into caseload practice. Although one to one care requires considerable dedication on behalf of the midwife, it provides considerable job satisfaction, and particularly good outcomes for both woman and child. 

One to one midwifery care should be accessible to all women.  Regardless of their health profile, research has shown that all women can benefit from one to one care.  The critical element of this care is the integration of a high degree of continuity in which a named midwife provides most of the hands-on care. In planning care together with the woman, a trusting relationship is formed between the woman and the midwife. A safe, high quality service that is accessible to any woman who chooses a midwife as her lead maternity carer must have an element of flexibility.  Midwives would:

• Have experience in offering caseload care or be precepted by midwives with experience of caseload care  
• Be credentialed by the Australian College of Midwives Midwifery standards for practice.
• Practice within the state wide referral guidelines  (outlined in Appendix A)
• Be contracted by NSW Health and covered by state government Professional Indemnity cover. 
• Be paid on a per birth payment, to ensure a consistent service of high quality and to prevent midwife burnout and allow part-time work.
• Provide their own business infrastructure, this would include cars, communication equipment and birthing equipment.
• Be contracted by NSW Health either as a sole provider or as a Midwifery Group Practice.

See the full version of "Implementing Community Midwifery Across NSW" (pdf format.)

Links

• NSW Branch
• Report on the NMAP launch in NSW
• Implementing Community Midwifery Across NSW (pdf)

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