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Whitburn LY, Cullinane M, Benzie C, Newton MS, McLachlan HL, Forster DA. Women's views and experiences of a new Midwifery Group Practice model in rural Australia. Women Birth 2024; 37:101603. [PMID: 38657332 DOI: 10.1016/j.wombi.2024.101603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Women in rural Australia often have limited maternity care options available, and in Victoria, like many Australian states, numerous small hospitals no longer offer birthing services. AIM To evaluate women's views and experiences of maternity care at a local rural hospital that re-established birthing services with a Midwifery Group Practice (MGP) model of maternity care. METHODS Women who booked into the new MGP model from May 2021 to June 2022 were invited to complete an anonymous online survey and participate in an optional additional semi-structured interview to explore their views and experiences. Descriptive statistics were used for quantitative data, and open-ended survey and interview responses were analysed using a general inductive approach. FINDINGS Sixty-seven percent (44/66) of women completed the survey and five also completed an interview. Women were highly satisfied with the care they received. They felt respected, empowered, and had a sense of agency throughout their pregnancies, labour and birth, and post-birth. They reported low levels of anxiety during labour and birth, and felt that they coped physically and emotionally better than they anticipated. They felt well supported by midwives and highly valued the continuity of care within the MGP model. CONCLUSION Women's voices play a critical role in informing maternity care provision, particularly for those in rural communities who may have limited access to care options. The findings support and expand on existing research regarding the value of midwifery continuity of care models, and can inform other rural maternity services in introducing similar models.
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Affiliation(s)
- Laura Y Whitburn
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Charlie Benzie
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Royal Women's Hospital, Locked Bag 300, Grattan Street & Flemington Road, Parkville, VIC 3052, Australia
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Smith PA, Kilgour C, Rice D, Callaway LK, Martin EK. Implementation barriers and enablers of midwifery group practice for vulnerable women: a qualitative study in a tertiary urban Australian health service. BMC Health Serv Res 2022; 22:1265. [PMID: 36261823 PMCID: PMC9583548 DOI: 10.1186/s12913-022-08633-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Maternity services have limited formalised guidance on planning new services such as midwifery group practice for vulnerable women, for example women with a history of substance abuse (alcohol, tobacco and other drugs), mental health challenges, complex social issues or other vulnerability. Continuity of care through midwifery group practice is mostly restricted to women with low-risk pregnancies and is not universally available to vulnerable women, despite evidence supporting benefits of this model of care for all women. The perception that midwifery group practice for vulnerable women is a high-risk model of care lacking in evidence may have in the past, thwarted implementation planning studies that seek to improve care for these women. We therefore aimed to identify the barriers and enablers that might impact the implementation of a midwifery group practice for vulnerable women. Methods A qualitative context analysis using the Consolidated Framework for Implementation Research was conducted at a single-site tertiary health facility in Queensland, Australia. An interdisciplinary group of stakeholders from a purposeful sample of 31 people participated in semi-structured interviews. Data were analysed using manual and then Leximancer computer assisted methods. Themes were compared and mapped to the Framework. Results Themes identified were the woman’s experience, midwifery workforce capabilities, identifying “gold standard care”, the interdisciplinary team and costs. Potential enablers of implementation included perceptions that the model facilitates a relationship of trust with vulnerable women, that clinical benefit outweighs cost and universal stakeholder acceptance. Potential barriers were: potential isolation of the interdisciplinary team, costs and the potential for vicarious trauma for midwives. Conclusion There was recognition that the proposed model of care is supported by research and a view that clinical benefits will outweigh costs, however supervision and support is required for midwives to manage and limit vicarious trauma. An interdisciplinary team structure is also an essential component of the service design. Attention to these key themes, barriers and enablers will assist with identification of strategies to aid successful implementation. Australian maternity services can use our results to compare how the perceptions of local stakeholders might be similar or different to the results presented in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08633-8.
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Affiliation(s)
- Patricia A Smith
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.
| | - Catherine Kilgour
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, 4072, Brisbane, QLD, Australia
| | - Deann Rice
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia
| | - Leonie K Callaway
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston Road, 4006, Herston, Brisbane, QLD, Australia
| | - Elizabeth K Martin
- Mater Research Institute, Faculty of Medicine, University of Queensland, Raymond Terrace, 4101, South Brisbane, Brisbane, QLD, Australia
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Callander EJ, Slavin V, Gamble J, Creedy DK, Brittain H. Cost-effectiveness of public caseload midwifery compared to standard care in an Australian setting: a pragmatic analysis to inform service delivery. Int J Qual Health Care 2021; 33:6275641. [PMID: 33988712 DOI: 10.1093/intqhc/mzab084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 05/13/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Decision-makers need quantifiable data on costs and outcomes to determine the optimal mix of antenatal models of care to offer. This study aimed to examine the cost utility of a publicly funded Midwifery Group Practice (MGP) caseload model of care compared to other models of care and demonstrate the feasibility of conducting such an analysis to inform service decision-making. OBJECTIVE To provide a methodological framework to determine the value of public midwifery in different settings. METHODS Incremental costs and incremental utility (health gains measured in quality-adjusted life years (QALYs)) of public MGP caseload were compared to other models of care currently offered at a large tertiary hospital in Australia. Patient Reported Outcomes Measurement Information System Global Short Form scores were converted into utility values by mapping to the EuroQol 5 dimensions and then converting to QALYs. Costs were assessed from a health system funder's point of view. RESULTS There were 85 women in the public MGP caseload care group and 72 received other models of care. Unadjusted total mean cost for mothers' and babies' health service use from study entry to 12 months post-partum was $27 618 for MGP caseload care and $33 608 for other models of care. After adjusting for clinical and demographic differences between groups, total costs were 22% higher (cost ratio: 1.218, P = 0.04) for other models of maternity care. When considering costs to all funders, public MGP caseload care cost $5208 less than other models of care. There was no significant difference in QALY between the two groups (difference: 0.010, 95% CI: -0.038, 0.018). CONCLUSION Public MGP caseload care costs 22% less than other models of care, after accounting for differences in baseline characteristics between groups. There were no significant differences in QALYs. Public MGP caseload care produced comparable health outcomes, with some indication that outcomes may be better for lower cost per woman.
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Affiliation(s)
- Emily J Callander
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Valerie Slavin
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Nursing and Midwifery, Griffith University, 68 University Dr, Meadowbrook, QLD 4131, Australia.,Women, Newborn and Children's, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
| | - Jenny Gamble
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Nursing and Midwifery, Griffith University, 68 University Dr, Meadowbrook, QLD 4131, Australia
| | - Deera K Creedy
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Nursing and Midwifery, Griffith University, 68 University Dr, Meadowbrook, QLD 4131, Australia
| | - Hazel Brittain
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Nursing and Midwifery, Griffith University, 68 University Dr, Meadowbrook, QLD 4131, Australia.,Women, Newborn and Children's, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
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Baird K, Hastie CR, Stanton P, Gamble J. Learning to be a midwife: Midwifery students' experiences of an extended placement within a midwifery group practice. Women Birth 2021:S1871-5192(21)00002-0. [PMID: 33518492 DOI: 10.1016/j.wombi.2021.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/28/2020] [Accepted: 01/02/2021] [Indexed: 11/21/2022]
Abstract
AIM To investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice. METHODS Focus groups were conducted with fifteen third - year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia. RESULTS Four main themes were identified in the data: Expectations of the Placement; Facilitating learning within a midwifery group practice model; Transitioning between models of care and Philosophy and culture of midwifery group practice. DISCUSSION AND CONCLUSION Third-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned 'how to be a midwife'. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital. IMPLICATIONS AND RECOMMENDATIONS Undertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates' capabilities and competencies 3-5 years post registration should be conducted.
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