Dr Elysse Prussing

Midwifery continuity of care has demonstrated improved outcomes for mothers and babies including higher rates of spontaneous vaginal birth and more positive birth experiences, with health services cost savings, than non-continuity of care. However, midwives report challenges with continuity of care, such as on-call for labour/birth. Health services have responded with a new model, Midwifery Antenatal and Postnatal Service (MAPS), with care from a known midwife only during pregnancy and the early postnatal period. Women in the MAPS model have intrapartum care by rostered birth suite midwives (potentially unknown to the woman) whereas Midwifery Group Practice have a known midwife. Aim: To determine if MAPS is associated with similar perinatal outcomes for women and babies as the Midwifery Group Practice (MGP) model. Methods: A retrospective study was undertaken using de-identified routinely collected maternity data. All women who booked in and gave birth with MGP or MAPS at one hospital in New South Wales, Australia between April 2022 - April 2023. Descriptive and inferential statistics were used to describe the data. Results: A total of 1303 births were analysed (MGP=349, MAPS =954). The MGP cohort were more likely to experience spontaneous labour (< 0.001) with local anaesthesia or no analgesia, vaginal births without instruments (<0.001), and exclusive breastfeeding at discharge (0.004) compared to MAPS births. Conclusion: Continuity of care with a known midwife (antenatal, labour/birth, and postnatal) was associated with less intervention and improved breastfeeding rates as supported by international literature. Future research is needed comparing MAPS to standard fragmented midwifery care.

Problem: Midwifery Continuity of Care (MCoC) remains inaccessible for most Australian women; this is especially true in rural and regional areas. Background: Strong evidence demonstrates MCoC models improve experiences for women and their babies and are also shown to improve midwifery workforce wellbeing. However, implementation and upscale remains limited. Aim: To explore the views and experiences of implementing MCoC for both staff and women, understanding their experiences, concerns and solutions in a regional context. Methods: Qualitative data was collected via focus groups with women and healthcare staff, at six and twelve month post implementation. Data was thematically analysed using Braun and Clarke six step process. Findings: The findings support that 'women love it' and midwives working in the new MCoC model 'loved their job'. The major concern was that not all women could access the model and disconnected communication was problematic during implementation. 'Sharing stories' was a solution to overcoming these issues and promoting the positive impact of MCoC - in particular ways of working and adaption to an all-risk midwifery group practice. Discussion: This study supports widespread evidence that MCoC is valued by both women and staff. In a regional context it is important to recognise challenges faced during implementation and identifying solutions that other maternity services could consider when implementing MCoC. Conclusion: The study offers strong recommendation for regional areas to consider MGP to maintain safe, quality local maternity services.

Background: Global and national frameworks for midwifery education recognise and prioritise the provision of midwifery continuity of care. Previous studies report that learning is enhanced when students have professional experience placements within these models, however there remains wide variation in midwifery students' access to placements within these models in Australia. Aim: To evaluate Bachelor of Midwifery students' experiences in midwifery continuity of care models within two local health districts in New South Wales, Australia. Method: A mixed methods design was used: qualitative data collected through interviews, and quantitative data collected via an online survey using the Midwifery Student Evaluation of Practice (MidSTEP) tool. Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken. Results: Sixteen students responded, four students were interviewed, and 12 students completed the survey. The MidSTEP mean scores for all sub-scales rated above 3.0/4.0. Participants rated 'work across the full scope of midwifery practice' and five out of eight subscales of Philosophy of Midwifery Practice at 100 %. 'Experiences prepare me to be a change agent for maternity service reform' rated the lowest (67 %). Three qualitative themes emerged: care versus carer model; learning experience; and future career as a caseload midwife. Conclusion: A mixed method approach using a validated tool to measure student experiences, contributes to the evidence that students value professional experience placements within midwifery continuity of care models. Currently this is not an option for all midwifery students and as midwifery continuity of care models expand, these findings will inform further implementation of student professional experience placement within these models.