Differential access to continuity of midwifery care in Queensland, Australia
Roslyn E. Donnellan-Fernandez
A B F , Debra K. Creedy A B , Emily J. Callander A B C D , Jenny Gamble A B and Jocelyn Toohill A B E
+ Author Affiliations
- Author Affiliations
A School of Nursing and Midwifery, Griffith University, Logan Campus, Meadowbrook, Qld 4131, Australia. Email: d.creedy@griffith.edu.au; j.gamble@griffith.edu.au; j.toohill@griffith.edu.au
B Transforming Maternity Care Collaborative, Griffith University, Logan Campus, Meadowbrook, Qld 4131, Australia.
C School of Medicine, Griffith University, Southport, Qld 4215, Australia.
D Present address: Monash Health, School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia. Email: emily.callander@monash.edu.au
E Office of the Chief Nursing and Midwifery Officer, Queensland Health, Herston, Qld 4006, Australia.
F Corresponding author. Email: r.donnellan-fernandez@griffith.edu.au
Australian Health Review - https://doi.org/10.1071/AH19264
Submitted: 25 November 2019 Accepted: 17 April 2020 Published online: 28 August 2020
Abstract
Objective To determine maternal access to continuity of midwifery care in public maternity hospitals across the state of Queensland, Australia.
Methods Maternal access to continuity of midwifery care in Queensland was modelled by considering the proportion of midwives publicly employed to provide continuity of midwifery care alongside 2017 birth data for Queensland Hospital and Health Services. The model assumed an average caseload per full-time equivalent midwife working in continuity of care with 35 women per annum, based on state Nursing and Midwifery Award conditions. Hospitals were grouped into five clusters using standard Australian hospital classifications.
Results Twenty-seven facilities (out of 39, 69%) across all 15 hospital and health services in Queensland providing a maternity service offered continuity of midwifery care in 2017 (birthing onsite). Modelling applying the assumed caseload of 35 women per full-time equivalent midwife found wide variations in the percentage of women able to access continuity of midwifery care, with access available for an estimated 18% of childbearing women across the state. Hospital classifications with higher clinical services capability and birth volume did not equate with higher access to continuity of midwifery care in metropolitan areas. Regional health services with level 3 district hospitals assisting with <500 births showed higher levels of access, potentially due to additional challenges to meet local population needs to those of a metropolitan service. Access to full continuity of midwifery care in level 3 remote hospitals (<500 births) was artificially inflated due to planned pre-labour transfers for women requiring specialised intrapartum care and women who planned to birth at other hospitals.
Conclusions Despite strong evidence that continuity of midwifery care offers optimal care for women and their babies, there was significant variation in implementation and scale-up of these models across hospital jurisdictions.
What is known about the topic? Access to continuity of midwifery care for pregnant women within the public health system varies widely; however, access variation among different hospital classification groups in Australian states and territories has not been systematically mapped.
What does this paper add? This paper identified differential access to continuity of midwifery care among hospital classifications grouped for clinical services capability and birth volume in one state, Queensland. It shows that higher clinical services capability and birth volume did not equate with higher access to continuity of midwifery care in metropolitan areas.
What are the implications for practitioners Scaling up continuity of midwifery care among all hospital classification groups in Queensland remains an important public health strategy to address equitable service access.
Additional keywords: health equity, maternal health services, pregnancy, vulnerable populations.
References
[1] Kildea S, Tracy S, Sherwood J, Magick-Dennis F, Barclay L. Improving maternity services for Indigenous women in Australia: moving from policy to practice. Med J Aust 2016; 205 374–9.| Improving maternity services for Indigenous women in Australia: moving from policy to practice.Crossref | GoogleScholarGoogle Scholar | 27736626PubMed |
[2] Yelland J, Riggs E, Small R, Brown S. Maternity services are not meeting the needs of immigrant women of non-English speaking background: results of two consecutive Australian population based studies. Midwifery 2015; 31 664–70.
| Maternity services are not meeting the needs of immigrant women of non-English speaking background: results of two consecutive Australian population based studies.Crossref | GoogleScholarGoogle Scholar | 25823755PubMed |
[3] Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, Silva DR, Downe S, Kennedy HP, Malata A, McCormick F, Wick L, Declercq E. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet 2014; 384 1129–45.
| Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.Crossref | GoogleScholarGoogle Scholar | 24965816PubMed |
[4] Koblinsky M, Moyer C, Calvert C, Campbell J, Campbell O, Feigl A, et al Quality maternity care for every woman everywhere: a call to action. Lancet 2016; 388 2307–20.
| Quality maternity care for every woman everywhere: a call to action.Crossref | GoogleScholarGoogle Scholar | 27642018PubMed |
[5] WHO Reproductive Health Library. WHO recommendation on midwife-led continuity of care during pregnancy. Geneva: World Health Organization; 2016. Available at: https://extranet.who.int/rhl/topics/improving-health-system-performance/implementation-strategies/who-recommendation-midwife-led-continuity-care-during-pregnancy [verified 3 January 2020].
[6] Renfrew M, Ateva E, Dennis-Antwi J, Davis D, Dixon L, Johnson P, Powell Kennedy H, Knutsson A, Lincetto O, McConville F, McFadden A, Taniguchi H, ten Hoope Bender B, Zeck W. Midwifery is a vital solution - what is holding back global progress? Birth 2019; 46 396–9.
| Midwifery is a vital solution - what is holding back global progress?Crossref | GoogleScholarGoogle Scholar | 31270851PubMed |
[7] Moore T, Arefadib N, Deery A, West S. The first thousand days: an evidence paper. Parkville, Victoria: Centre for Community Child Health, Murdoch Children’s Research Institute; 2017.
[8] Homer C. Models of maternity care: evidence for midwifery continuity of care. Med J Aust 2016; 205 370–4.
| Models of maternity care: evidence for midwifery continuity of care.Crossref | GoogleScholarGoogle Scholar | 27736625PubMed |
[9] Rolfe M, Donoghue D, Longman J, Pilcher J, Kildea S, Kruske S, Kornelsen J, Grzybowski S, Barclay L, Morgan G. The distribution of maternity services across rural and remote Australia: does it reflect population need? BMC Health Serv Res 2017; 17 163
| The distribution of maternity services across rural and remote Australia: does it reflect population need?Crossref | GoogleScholarGoogle Scholar | 28231830PubMed |
[10] Callander E, Fox H. Changes in out-of-pocket charges associated with obstetric care provided under Medicare in Australia. Aust N Z J Obstet Gynaecol 2018; 58 362–65.
| Changes in out-of-pocket charges associated with obstetric care provided under Medicare in Australia.Crossref | GoogleScholarGoogle Scholar | 29327343PubMed |
[11] Australian Institute of Health and Welfare (AIHW). Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Canberra: AIHW; 2016.
[12] Moore T, McDonald M, McHugh-Dillon H. Early childhood development and the social determinants of health inequities: a review of the evidence. Parkville, Victoria: Centre for Community Child Health, Murdoch Children’s Research Institute and the Royal Children’s Hospital; 2014.
[13] Saunders M, Barr B, McHale P, Hamelmann C. Health Evidence Network (HEN) synthesis report 52: key policies for addressing the social determinants of health and health inequities. Copenhagen: WHO Regional Office for Europe; 2017.
[14] Rigg E, Schmied V, Peters K, Dahlen H. Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study. BMC Pregnancy Childbirth 2017; 17 99
| Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 28351344PubMed |
[15] Thornton C, Dahlen H. Born before arrival in NSW, Australia (2000–2011): a linked population data study of incidence, location, associated factors and maternal and neonatal outcomes. BMJ Open 2018; 8 e019328
| Born before arrival in NSW, Australia (2000–2011): a linked population data study of incidence, location, associated factors and maternal and neonatal outcomes.Crossref | GoogleScholarGoogle Scholar | 29695386PubMed |
[16] Ireland S, Wulili Narjic C, Belton S, Kildea S. Niyith NiyithWatmam (the quiet story): exploring the experiences of Aboriginal women who give birth in their remote community. Midwifery 2011; 27 634–41.
| Niyith NiyithWatmam (the quiet story): exploring the experiences of Aboriginal women who give birth in their remote community.Crossref | GoogleScholarGoogle Scholar | 20965625PubMed |
[17] Australian Institute of Health and Welfare (AIHW). Australia’s mothers and babies 2016—in brief. Canberra: AIHW; 2018.
[18] Peters L, Thornton C, de Jonge A, Khashan A, Tracy M, Downe S, Feijen-de Jong E, Dahlen H. The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: a linked data population-based cohort study. Birth 2018; 45 347–57.
| The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: a linked data population-based cohort study.Crossref | GoogleScholarGoogle Scholar | 29577380PubMed |
[19] Fox H, Callander E, Lindsay D, Topp S. Evidence of overuse? Patterns of obstetric interventions during labour and birth among Australian mothers. BMC Pregnancy Childbirth 2019; 19 226
| Evidence of overuse? Patterns of obstetric interventions during labour and birth among Australian mothers.Crossref | GoogleScholarGoogle Scholar | 31272397PubMed |
[20] Australian Government Department of Health. National strategic approach to maternity services - consultation and submissions 2019. Canberra: The Department of Health, 2019. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-pdb-maternity [verified June 2019].
[21] Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016; CD004667
| Midwife-led continuity models versus other models of care for childbearing women.Crossref | GoogleScholarGoogle Scholar | 27121907PubMed |
[22] Queensland Government. Rural Maternity Taskforce Report - June 2019. Brisbane: Queensland Health - Clinical Excellence Queensland, Department of Health: Patient Safety and Quality Improvement Service, Clinical Excellence Queensland, Department of Health; 2019.
[23] Toohill J, Chadha Y, Nowlan S. An interactive decision making framework (i-DMF) to scale up maternity continuity of carer models. J Res Nurs 2020;
| An interactive decision making framework (i-DMF) to scale up maternity continuity of carer models.Crossref | GoogleScholarGoogle Scholar |
[24] Donnolley N, Butler-Henderson K, Chapman M, Sullivan E. The development of a classification system for maternity models of care. Health Int Manag 2016; 45 64–70.
| The development of a classification system for maternity models of care.Crossref | GoogleScholarGoogle Scholar |
[25] Donnolley N, Chambers G, Butler-Henderson K, Chapman M, Sullivan E. A validation study of the Australian Maternity Care Classification System. Women Birth 2019; 32 204–12.
| A validation study of the Australian Maternity Care Classification System.Crossref | GoogleScholarGoogle Scholar | 30166115PubMed |
[26] Australian Institute of Health and Welfare (AIHW). Midwifery caseload identifying and definitional attributes. Canberra: AIHW; 2015. Available at: https://meteor.aihw.gov.au/content/index.phtml/itemId/562448 [verified 28 March 2019].
[27] Queensland Government. Queensland open data portal: 2017 births by hospital. [updated 10 July 2019]. Brisbane: Queensland Government; 2018. Available at: https://www.data.qld.gov.au/dataset/births-by-hospital/resource/1585e886-3037-4874-8353-754f271bc226?inner_span=True. [accessed 3 January 2020].
[28] Queensland Government. Office of the Chief Nursing and Midwifery Officer - Year in Review 2017–18. Brisbane: Queensland Health; 2018.
[29] Australian Institute of Health and Welfare (AIHW). Australian hospital peer groups. Health services series no. 66. Cat. no. HSE 170. Canberra: AIHW; 2015.
[30] Queensland Industrial Relations Commission. Nurses and Midwives (Queensland Health) Award – State. 2015. Brisbane: Queensland Industrial Relations Commission; 2016. Available at: https://www.qirc.qld.gov.au/sites/default/files/nurses_and_midwives_swc18.pdf?v=1542538772 [accessed 3 January 2020].
[31] Nurse and Midwives (Queensland Health and Department of Education and Training) Certified Agreement. (EB9) 2016 [Internet]. Brisbane: Queensland Industrial Relations Commission; 2016. Available at: https://www.health.qld.gov.au/__data/assets/pdf_file/0024/440961/eb9-proposed-agreement.pdf [verified 3 January 2020].
[32] Australian College of Midwives. Delivering midwifery continuity of care to Australian women. A handbook for hospitals and health services, 3rd edn. Canberra: Australian College of Midwives; 2017.
[33] Tyler S, Kinnear A, Simpson J. Chapter 9. Skilled, motivated and engaged: do we have the midwifery workforce to deliver continuity? In Homer C, Leap N, Brodie P, Sandall J, editors. Midwifery continuity of care, 2nd edn. Sydney: Elsevier; 2019. pp. 183–206.
[34] Ryan P, Revill P, Devane D, Normand C. An assessment of the cost-effectiveness of midwife-led care in the United Kingdom. Midwifery 2013; 29 368–76.
| An assessment of the cost-effectiveness of midwife-led care in the United Kingdom.Crossref | GoogleScholarGoogle Scholar | 22565064PubMed |
[35] Queensland Nurses and Midwives’ Union (QNMU). Safe workloads in midwifery standard. Brisbane: QNMU; 2017. Available at: https://www.semanticscholar.org/paper/Safe-workloads-in-midwifery-standard/8d84291e962e20325057f2c8c09c95b79b0c36aa [accessed 3 January 2020].
[36] McLachlan H, McCourt C, Coxon K, Forster D. Chapter 1. Is midwifery continuity of care better for women and babies? What is the evidence? In Homer C, Leap N, Brodie P, Sandall J, editors. Midwifery continuity of care, 2nd edn. Chatswood, NSW: Elsevier; 2019. pp. 1–20.
[37] COAG Health Council. Woman-centred care: strategic directions for Australian maternity services. Canberra: Department of Health; 2019.
[38] Dawson K, Forster D, McLachlan H, Newton M. Operationalising caseload midwifery in the Australian public maternity system: findings from a national cross-sectional survey of maternity managers. Women Birth 2018; 31 194–201.
| Operationalising caseload midwifery in the Australian public maternity system: findings from a national cross-sectional survey of maternity managers.Crossref | GoogleScholarGoogle Scholar | 28964707PubMed |
[39] Dawson K, Newton M, Forster D, McLachlan H. Caseload midwifery in Australia: what access do women have? Women Birth 2015; 28 S12
[40] Australian Health Ministers’ Advisory Council. National survey of the availability of access to a midwifery carer for postnatal care outside of the hospital setting. In Council Maternity Services Inter Jurisdictional Committee. Canberra : Commonwealth of Australia; 2015.
[41] Toohill J, Nowlan S, Nunan S, Clarke J, Chadha Y. An interactive decision making tool to improve continuity of carer in maternity health service re-design. Women Birth 2018; 31 S29
| An interactive decision making tool to improve continuity of carer in maternity health service re-design.Crossref | GoogleScholarGoogle Scholar |
[42] Queensland Health. Maternity and neonatal care. Brisbane: Health Innovation, Investment and Research Office; 2018.
[43] Australian Bureau of Statistics. Australian Statistical Geography Standard 2016: remoteness structure/remoteness area boundaries. Canberra: ABS; 2018. Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202016?OpenDocument [verified 3 January 2020].
[44] Barclay L, Kornelson J. The closure of rural and remote maternity services: where are the midwives? Midwifery 2016; 38 9–11.
| The closure of rural and remote maternity services: where are the midwives?Crossref | GoogleScholarGoogle Scholar | 27046265PubMed |
[45] Australian Institute of Health & Welfare (AIHW). Child and maternal health in 2014 - 2016 - Data Tables - My Healthy Communities. Canberra: AIHW; 2018.
[46] Kruske S, Schultz T, Eales S, Kildea S. A retrospective, descriptive study of maternal and neonatal transfers, and clinical outcomes of a Primary Maternity Unit in rural Queensland, 2009–2011. Women Birth 2015; 28 30–9.
| A retrospective, descriptive study of maternal and neonatal transfers, and clinical outcomes of a Primary Maternity Unit in rural Queensland, 2009–2011.Crossref | GoogleScholarGoogle Scholar | 25458610PubMed |
[47] Wilkes E, Gamble J, Adam G, Creedy D. Reforming maternity services in Australia: outcomes of a private practice midwifery service. Midwifery 2015; 31 935–40.
| Reforming maternity services in Australia: outcomes of a private practice midwifery service.Crossref | GoogleScholarGoogle Scholar | 26092305PubMed |
[48] Queensland Government - Queensland Health. Rural and remote health facilities. Brisbane: Queensland Government; 2018. Available at: https://www.health.qld.gov.au/clinical-practice/engagement/networks/rural-remote/rural-facilities [verified 3 January 2020].
[49] Longman J, Morgan G, Rolfe M, Donoghue D, Kildea S, Kruske S, et al. Australian Regional Birthing Index Toolkit: a resource for planning maternity services in rural and remote Australia. Lismore: University Centre for Rural Health North Coast; 2015.
[50] Kildea S, McGhie A, Gao Y, Rumbold A, Rolfe M. Babies born before arrival to hospital and maternity unit closures in Queensland and Australia. Women Birth 2015; 28 236–45.
| Babies born before arrival to hospital and maternity unit closures in Queensland and Australia.Crossref | GoogleScholarGoogle Scholar | 25845486PubMed |
[51] Hickey S, Roe Y, Gao Y, Nelson C, Carson A, Currie J, Reynolds M, Wilson K, Kruske S, Blackman R, Passey M, Clifford A, Tracy S, West R, Williamson D, Kosiak M, Watego S, Webster J, Kildea S. The Indigenous Birthing in an Urban Setting study: the IBUS study. A prospective birth cohort study comparing different models of care for women having Aboriginal and Torres Strait Islander babies at two major maternity hospitals in urban South East Queensland, Australia. BMC Pregnancy Childbirth 2018; 18 431
| The Indigenous Birthing in an Urban Setting study: the IBUS study. A prospective birth cohort study comparing different models of care for women having Aboriginal and Torres Strait Islander babies at two major maternity hospitals in urban South East Queensland, Australia.Crossref | GoogleScholarGoogle Scholar | 30382852PubMed |
[52] Queensland Government- Metro South Health. Logan maternity and child health hubs. Logan: Queensland Government; 2018. Available at: https://metrosouth.health.qld.gov.au/news/maternity-outcomes-lifted-in-logan [verified 25 October 2019].
[53] Donnolley N, Chambers G, Butler-Henderson K, Chapman M, Sullivan E. More than a name: heterogeneity in characteristics of models of maternity care reported from the Australian Maternity Care Classification System validation study. Woman Birth 2017; 30 332–41.
