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Shared Care Community Midwifery - Maternity Model of Care

Project Added:
13 March 2015
Last updated:
25 March 2015

Shared Care Community Midwifery - Maternity Model of Care

Summary

When birthing ceased in 2011, women who gave birth outside Narrandera and returned home to Narrandera had no access to follow-up services or to a midwife in the first two weeks after birth.  Shared Care Community Midwifery (SCCM) engaged the support of General Practitioner Visiting Medical Officer (GP VMO)/Obstetricians in providing antenatal clinics and support for midwives to conduct clinical review and post natal home visits.

The evaluation of this model of care supports that the model is effective, safe and sustainable. 

Aim

To deliver a sustainable midwifery service that has expanded pre and post natal care for women in the Narrandera community and support for early transfer of care of mothers from birthing facilities to return home.

Benefits 

  • Improved access to care through antenatal services for mothers after giving birth.
  • educed length of stay in birthing hospital.
  • Provides continuity of care throughout the antenatal and postnatal phase, prior to being followed up by the Child and Family Health Nurse at two weeks after birth.

Project Status

  • Project started in 2012 at Narrandera, MLHD
  • Project status: Sustained - the project has been implemented, is sustained in standard business.

Background 

When birthing services at Narrandera ceased in 2011 because of an inability to recruit registered nurses and midwives, women who were giving birth elsewhere and returned home had no access to follow up services or to a midwife in the first two weeks after giving birth.

Narrandera historically provided approximately 100 births per annum. Birthing services ceased in June 2011, with only elective caesareans being provided and one unplanned normal birth delivery. Only two Full Time Equivalent (FTE) Registered Nurse/Midwives (RNMs) were available for the roster, short of the required 5.4 FTE RNMs to maintain safe functioning maternity services. Combined with a recruitment shortage, this led to an unsafe and unsustainable service under the existing model of care.

It had become apparent that the existing maternity service model, low risk maternity services with higher risk maternity patients referred to Wagga Wagga Base Hospital, at Narrandera Hospital was not sustainable long term. 

Implementation

Shared Care Community Midwifery engaged the support of GP VMO/Obstetricians in providing antenatal clinics and support for midwives to conduct clinical review and post natal home visits.

Designed through a consultative process with stakeholders, including local Nursing Management, Midwives, GP/Obstetricians, community representatives, MLHD Clinical Midwifery Consultant (CMC) and the Rural Group Manager. SSCM has enabled local women to continue to register antenatal with the service, give birth outside the local area, return home and be followed up at home by the local midwives within 24 hours of discharge. The SCCM provides continuity of care throughout the antenatal and postnatal phase, prior to being followed up by the Child and Family Health Nurse at two weeks after birth. 

A six month trial to be undertaken within existing FTE and a steering committee was established to oversee the development of the model.

The midwives, in their day to day operations would develop appropriate forms, an information brochure, visit birthing facilities to promote the service trial and identify and collect appropriate statistics for evaluation of the program at the conclusion of the six month trial. 

The Narrandera GP VMO/Obstetricians have actively supported the SCCM and work one antenatal clinic per month, providing clinical support for the midwives and enabling clinical review.

Results 

There has been an improvement in breastfeeding rates and benefits to MLHD through early transfer of care and shorter lengths of stay in the birthing hospitals.

The SCCM model has been very well received in the community, with positive feedback from parents. 

Positive clinical outcomes have included: 

  • improvement in breastfeeding rates
  • nil readmissions of mothers during the trial. This trend should continue as the service has enabled women to suitably adjust to managing in the home with the support of the midwives
  • early discharge was taken up by 17 of the 32 women referred to the program, which enables improved bed management for the birthing hospital.

There are also cost benefits to the organisation through savings due to early transfer  home and nil readmissions to hospital. 

Antenatal visits, which were decreasing prior to commencement of the SCCM trial, have increased and the antenatal clinic has strong bookings for the first six months in 2014 with strong positive feedback from antenatal class attendees. Home visiting is a significant part of the service and midwives have received positive feedback from mothers at the postnatal visit. 

This is a low risk model in which liaison with birthing hospitals is a significant and important element.

Lessons Learnt 

Narrandera Health Service successfully managed to pilot a new maternity service model of care. 

Narrandera now offers a sustainable and safe maternity service to the Narrandera community, using the current available skilled midwives to care for women upon early discharge from surrounding birthing hospitals. 

The Narrandera SCCM trial has provided a model of care that is adaptable to any similar district health service unable to sustain adequate human resources to continue with a birthing model of care. 

References

  • Rossiter, C., Fowler, C., McMahon, C. & Kowalenko, N. 2012. Supporting depressed mothers at home: Their views on an innovative relationship-based intervention. Contemporary Nurse:Vol.41, Advances in Contemporary Community & Family Health Care- Third Edition, pp-90-100
  • Wagga Wagga Health Service Pregnancy Care & Community Midwifery Service, and Griffith Health Service Maternity Unit

Contact

Pauline Hatherly
Deputy Nurse Manager
Narrandera Health Service
Murrumbidgee Local Health District
Phone: 02 69510200
Email: pauline.hatherly@gsahs.health.nsw.gov.au

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