Approaches to third stage in caseload practice and continuity of care

Abstract

Midwifery Group Practice (MGP) is a public health service provided by the Children's Youth and Women's Health Service (CYWHS) that focuses on a midwifery model of care. It is coordinated out of the Women's and Children's Hospital, a tertiary referral maternity hospital in Adelaide, South Australia. Unlike many international or conventional midwifery models, this service has involved the implementation of an integrated 'all risk' caseload practice that interfaces with other services provided by the CYWHS, and is based on an ethic of access and equity for all women seeking continuity of midwife care within a defined geographic catchment. The midwives work within four Midwifery Group Practices and now provide nearly 1000 cases of maternity care per year, with each midwife providing care for 40 women per year, working their hours flexibly around the needs of women, with assistance provided in the community, the hospital and the home throughout the woman's pregnancy, labour, birth, and up until 6 weeks postnatal. Under this midwifery-led model of care, an independent evaluation (2005) has reported high levels of both maternal and midwife satisfaction and fewer interventions such as induction of labour, epidural analgesia, reduced incidence of forceps and ventouse births, reduced elective and emergency caesarean sections, less maternal perineal trauma, and fewer women's assessment service presentations and hospital admissions across all risk categories.