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Pregnancy Centred Care at the Royal Hospital for Women

Royal Hospital for Women
Project Added:
17 December 2012
Last updated:
21 October 2016

Pregnancy Centred Care at the Royal Hospital for Women

South Eastern Sydney Local Health District

Summary

General Practice Share Care Model (GPSC) is the chosen model of care for about half the pregnant women at the Royal Hospital for Women (RHW). The midwives found this model limited the depth and number of discussions about topics that prepare women for childbirth and motherhood. Other options of care were explored and group antenatal care – or Pregnancy Centred Care (PCC) was developed.

Background

Traditionally the RHW has offered all women who plan to give birth at the hospital the option of being cared for by midwives in a public hospital antenatal clinic (hospital based midwifery care). The women attend the clinic for antenatal care, usually about 10-12 visits during the course of their first pregnancy, and are offered consultation and referral to medical and obstetric clinics as indicated, according to the Australian College of Midwives: National Midwifery Guidelines for Consultation and Referral.

In 2009, a redesign of maternity care occurred and new models of pregnancy care were introduced to the hospital. Women were able to receive care through either the Midwifery Group Practice (MGP), midwives clinic (MWC) or through a GPSC Model.

A RHW Executive decision in 2010 determined that the GPSC model would become the default model of care for women not attending MGP, even though relatively few women (~15%) chose GPSC prior to this decision. Since this change approximately 50% of public women now access GPSC, however some of these women may not have had the option to select a midwifery model of care as the MGP may be fully subscribed by the time they book in and midwives clinic was no longer an option women could choose.

Primiparous women in the GPSC model of care receive on average 6 visits with midwives, and attend their GP for an average of 8 visits.

The redesign of clinical care has impacted the way midwives in GPSC communicate with women during antenatal visits. The midwives find the reduced number of visits limit the depth and number of discussions about topics that prepare women for childbirth and motherhood.

Group antenatal sessions

In the group antenatal sessions at RHW, the same group of 10-12 women attend 4 x 2 hour midwife facilitated antenatal sessions at approximately 20, 30, 36 and 39 weeks of pregnancy, followed by a 20 minute individual appointment at 40 and 41 weeks. All other antenatal care is provided by the woman's general practitioner.

A central component is the opportunity for pregnant women to meet other expectant women and have the ability to form support networks. The same two midwives facilitate the group's four sessions and see the women for individual appointments when the group has finished.

Pregnancy Centred Care Handbook (PDF File pdf - 237 KB)

Evaluation

Although group antenatal care (known as Centering Pregnancy) is practiced elsewhere, to our knowledge group antenatal care has not been offered to women in a GPSC model. The model has been evaluated to determine the acceptability, benefits and disadvantages for women and midwives at the RHW, and the results are documented below.

Primary Objective

To evaluate the experiences and expectations of midwives facilitating PCC groups.

Four midwives have been facilitating groups and they all participated in a focus group after they had facilitated at least two full groups. They had not offered this model of care before.

The results from the focus group demonstrate the midwives:

  • enjoy offering PCC and would like to continue offering this model of care
  • have been able to engage with the women in a very different way than is possible in a standard twenty minute appointment
  • increased their job satisfaction
  • were very excited that some women were already beginning to form support networks and were interested in the other women in their group
  • considered the attendance of a postnatal ward midwife to the last session a positive addition
  • thought the lack of administrative or clerical support is an issue that needs to be addressed to make this model sustainable
  • thought all antenatal clinic midwives need to be engaged in recruiting women to the groups to justify the midwifery hours to run a group.

Comments from the midwives

"I feel very different on my PCC day – excited about the group"

"I love that women are interested in each other and their births"

"[I] look forward to PCC. I know it will be a good day – you know you will have time to cover everything – both what is on the agenda and what women might raise"

Secondary objective

To evaluate if the care provided in PCC was acceptable to women

Questionnaires were handed out, or posted, to 43 women from four different groups. 22 questionnaires were returned (50%).

Feedback from the women was overwhelmingly positive:

  • the vast majority expressing that they felt their care was good or very good
  • the majority felt their physical and emotional needs were met
  • over 80% would recommend this model to their friends
  • most women had felt able to ask the questions they wanted to within the groups
  • most women felt that their concerns were addressed and taken seriously, and reassurance was provided
  • only one woman left the group to return to individual midwives clinic appointments
  • only one woman felt uncomfortable receiving her physical check in the same room as the group
  • only one woman was multiparous and she commented that this model was much more informative than the care she had received in her first pregnancy.

Comments from the women

"Open discussions were great; questions from others were useful as I would not have thought to ask them myself"

"The midwives were very supportive, nurturing and easy to talk to. Always ready to answer any questions and tend to concerns."

Conclusion

Overall the evaluation has shown that PCC is acceptable to women and midwives, and the women reported a generally very good experience of group antenatal care. The midwives reported an increase in job satisfaction and feel that their care is more holistic. Networking opportunities do seem to be formed, with two of the groups already having held postnatal reunion groups (to which they have invited the midwives), and most women reported that they were already, or were considering meeting up with other women from their group.

Contact


Clinical Midwifery Consultant, Midwifery Practice Development and Perinatal Research Co-ordinator
Royal Hospital for Women
Barker Street, Randwick, NSW 2031
Phone: 9382 6496

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