Midwives in Australia are passionate about quality care delivery and are aware of the impact that caseloads can have on healthcare outcomes. In a recent edition of Midwifery – Research Review a summary of the survey ‘Operationalising caseload midwifery in the Australian public maternity system:
Findings from a national cross-sectional survey of maternity managers‘ was provided.
‘A national, cross-sectional, online survey explored the operation of caseload models across Australia and specific practice arrangements, organisational barriers and facilitators, and workforce requirements of caseload care using responses from maternity managers in public maternity hospitals with birthing services.
Overall, 149 of 253 (63%) eligible hospitals provided responses to the survey, only 44 (31%) operated a caseload model. Caseload midwives were
commonly required to work more than 0.5 FTE, have >1 year of experience and have skills across the entire scope of practice. Leave coverage was often ad-hoc and complex. Fulltime midwives usually had a caseload of 35-40 women, with reduced caseloads when caring for higher risk women and the duration of home-based postnatal care was varied but often provided to 6 weeks. Access to caseload care for women was affected by many factors, but location and
obstetric risk were the most common.
This is an important paper that describes the operationalisation of caseload midwifery models in Australia. While the data may not accurately reflect current service provision (as it was collected in 2013) it provides valuable insight to those planning new services, or considering upscaling current services. The authors clearly demonstrate the evidence supporting the introduction of this model of care, yet we know the numbers of women able to access caseload care remain low.
It was, therefore, encouraging to see that within the 43 units that reported the existence of a caseload model of care, one-quarter of respondents only provided maternity care within a caseload model. These were all rural/remote hospitals with low birth numbers, confirming the sustainability of using this model to support rural birthing services.
The paper also identified other factors that could support wider implementation. For example, the majority of hospitals offering caseload models accept midwifery students into their caseload models. While most services expect midwives to have at least 1 year of post registration experience, one quarter
took graduates into the models, with more planning to take new graduates in the future. The midwifery education standards in Australia prepare midwives to work in these models so it is encouraging to see these opportunities developing.
Most hospitals provide opportunities for non-caseload midwives to be seconded into the caseload model to gain experience, further increasing exposure within the current workforce to this way of working. These strategies, if continued, should ensure adequate workforce numbers of midwives willing and ready to work in these models, which would enable the speedier transition to caseload models across Australia. While the authors cite a small Australian study suggesting midwives working in caseload models experience better emotional well-being, two larger studies have since been published confirming this to be the case.
There is a risk though of disillusionment and attrition if we do not upscale these models, which could lead to midwifery workforce attrition.
A recent survey of midwives in Australia identified “being unable to provide woman-centred care” as one of the most cited reasons for wanting to leave the profession. This paper should, therefore, be required reading for every operational manager with responsibility for the commissioning and delivery of maternity services. We know we need to implement these models widely, midwives are ready, willing and able to work in this way, and this paper provides valuable guidance on operational issues.
Reference: Women Birth 2017;Sep 27 Abstract>>
Authors: Dawson K et al.
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