continuity of carer

Pic: Ash labouring in hospital - used with permission

A mother-to-be who I will call Jenny came to my office for a pre-natal check.  Jenny is planning to give birth to her first baby in hospital, and I am providing shared antenatal care*, and planning to be with her in labour, birth, and continuing the care after her baby has been born, and visiting her at home.

Jenny has read the blogs I have written in the past week or so, and newspaper reports, about the emerging situation when a midwife is with woman in a hospital.  Jenny asked me for more information about these matters.  Jenny's questions were particularly focused on how the insurance/ reporting issues would affect my plan to be with her as her known and trusted midwife.  Jenny reiterated, without any prompting from me, that the reason she wants her own midwife to be with her in labour is her need for continuity.  

Continuity of carer refers to “a model of care providing relational continuity between each woman and midwife by continuity of midwifery carer throughout the full process of pregnancy, birth and the postnatal period, responsive to the needs and preferences of the individual woman." (Fontein 2007, p37- see full reference below)

In an ideal world that midwife would be the responsible, accountable primary care provider, who attends and 'conducts' uncomplicated births in the setting of the mother's choice, and refers to and collaborates with specialist obstetric and nursing providers when and if the need arises, all the time maintaing a unique professional relationship with the woman, regardless of the level of complexity or simplicity encountered. We clearly don't live in the ideal world, but we try to make the best of what we have.

If women were to lose the right to continuity and not be able to access personal support and interaction with their own midwife in hospital; the midwife with whom they have formed a special relationship - dare I say friendship - over a substantial period of time, those women will be the ones most adversely affected.  The old-fashioned word 'confinement' which used to be applied to childbirth is an apt description of such a situation, bringing with it the loss of liberty in personal association, and loss of freedom to choose.  It sounds like the other type of confinement, imprisonment.

But the important point to remember here is that the concept of  "offering continuity of care, and where possible carer, as a key element of quality care": a key principle agreed upon by federal and state health ministers, and published in a 2008 statement by Australian Health Ministers Advisory Council (AHMAC), Primary Maternity Services in Australia - A Framework for Implementation.  These key principles for primary maternity services have been carried through into current regulatory documentation for midwives, such as the Safety and Quality Framework for Privately Practising Midwives attending homebirths, which can be downloaded as a .pdf at the NMBA website.


STOP PRESS: 4pm, 2/9/11
A statement has just been circulated by the Nursing and Midwifery Board of Australia, concerning the role of the midwife who supports a woman admitted to a public hospital.  If you would like the full statement contact me joy[at]aitex.com.au
 

... The midwife may choose to withdraw when the care of the woman is assigned to the health facility’s health care professionals. However, should the woman request it, the midwife may choose to remain as a support person to the woman either as paid or unpaid as agreed between them. The Board recognises that the midwife has no obligation to stay with the woman and that it is an individual decision for the midwife.

If the midwife chooses to stay with the woman - and therefore take on a support person role - the midwife must articulate the change in role to the woman, who should then consent to the midwife’s involvement as a support person only. The midwife should also clarify her change in role from midwife to support person with the health service.

The decision by the midwife to remain as a support person is linked to the woman’s right to choose the person(s) whom she wishes to be with her during birth. ...

*Note: (Shared antenatal care means that Jenny has a few key reviews at the hospital, and that I provide the other antenatal checks.)

Reference: Fontein Y, 2007. Making the transition from ‘being delivered’ to ‘giving birth’. A literature review and reflections on the potential for introducing the UK model of ‘caseload midwifery’ to the Netherlands. MIDIRS Midwifery Digest, vol17, no1, March 2007, pp35-40.