Does model of maternity care make a difference to birth outcomes for young women? A retrospective cohort study

Allen, Jim; Gibbons, Kristen; Beckmann, Michael; Tracy, Mark; Stapleton, Helen; Kildea, Sue

doi:10.1016/j.ijnurstu.2015.04.011

Cited by 35 publications

(44 citation statements)

References 28 publications

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“…Midwifery models of care have been implemented for a range of specific groups, especially young women and women from minority or marginalised groups. For example, a retrospective cohort study in Queensland showed that women younger than 21 years of age who were allocated to midwifery continuity of carer (caseload care) were less likely to have a pre‐term birth or to have their baby admitted to a neonatal intensive care unit than those receiving standard care 32 …”

Section: Midwifery Models Of Care For Specific Groupsmentioning

confidence: 94%

“…For example, a retrospective cohort study in Queensland showed that women younger than 21 years of age who were allocated to midwifery continuity of carer (caseload care) were less likely to have a pre-term birth or to have their baby admitted to a neonatal intensive care unit than those receiving standard care. 32 In Australia, Aboriginal and Torres Strait Islander women and babies experience higher maternal and perinatal morbidity and mortality rates than their non-Indigenous counterparts. 1 Several models that provide midwifery continuity of carer have been specifically designed and evaluated for Aboriginal and Torres Strait Islander women.…”

Section: Midwifery Models Of Care For Specific Groupsmentioning

confidence: 99%

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Models of maternity care: evidence for midwifery continuity of care

Homer

2016

Medical Journal of Australia

157

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There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects. Non-randomised studies have shown benefits of midwifery continuity of care for specific groups, such as Aboriginal and Torres Strait Islander women. There are also benefits for midwives, including high levels of job satisfaction and less occupational burnout. Implementing midwifery continuity of care in public and private settings in Australia has been challenging, despite the evidence in its favour and government policy documents that support it. A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.

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Section: Midwifery Models Of Care For Specific Groupsmentioning

confidence: 94%

Section: Midwifery Models Of Care For Specific Groupsmentioning

confidence: 99%

Models of maternity care: evidence for midwifery continuity of care

Homer

2016

Medical Journal of Australia

157

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“…Midwife-led continuity models of care have shown a reduction in PTB (of 24%), 22 including for at risk groups like teenagers 51 through early engagement with women in pregnancy and providing opportunities' for early health and social support interventions that impact positively on birth outcomes. 51 Indeed this was one of the drivers for the intervention (the clinical redesign) that was developed through the introduction of the MGP, however we found it mainly impacted services and care provision in the regional hospital around the time of birth (which was also a priority of the project) but the team had limited ability to impact on early engagement or early intervention which may have been a contributing reason to why we did not see a difference in PTB between the cohorts.…”

Section: Sv Kildea Et Al / Women and Birth XXX (2016) Xxx-xxxmentioning

confidence: 99%

“…51 Indeed this was one of the drivers for the intervention (the clinical redesign) that was developed through the introduction of the MGP, however we found it mainly impacted services and care provision in the regional hospital around the time of birth (which was also a priority of the project) but the team had limited ability to impact on early engagement or early intervention which may have been a contributing reason to why we did not see a difference in PTB between the cohorts. Further research is needed to adapt these models, and an appropriate clinical governance structure to flow into the remote communities where women reside during the entire antenatal period.…”

Section: Sv Kildea Et Al / Women and Birth XXX (2016) Xxx-xxxmentioning

confidence: 99%

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

et al. 2017

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Objective: To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women. Methods: The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004-2006 (retrospective cohort) and 2009-2011 (prospective cohort). Demographic, pregnancy characteristics, labour and birth outcomes were described. Multivariate logistic regression analysis was conducted and adjusted odds ratios were reported. Results: The preterm birth rate was 19.4%, low birthweight rate was 17.4% and small for gestational age rate was 16.3%. Risk factors for preterm birth were teenage motherhood, previous preterm birth, smoker status not recorded, inadequate antenatal visits, having pregnancy-induced hypertension, antepartum haemorrhage or placental complications. After adjusting for gender and birth gestation, the only significant risk factor for low birthweight was first time mother. The only significant risk factor for small for gestational age baby was women having their first baby. Conclusions: Rates of these events are high and have changed little over time. Some risk factors are modifiable and treatable but need early, high quality, culturally responsive women centred care delivered in the remote communities themselves. A different approach is recommended.© 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved. Statement of significance Problem or IssueAustralian Aboriginal population has significantly higher rate of preterm birth, low birthweight and small for gestational age birth, especially in rural and remote areas. What is Already KnownRisk factors of preterm births, low birthweight and small for gestational age births include social and demographic factors and medical factors. What this Paper AddsCompared to non-Aboriginal women or Aboriginal women in urban areas, similar risk factors for these events were identified in the remote dwelling Aboriginal women.

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“…We found that midwifery students had experienced a range of approaches identified in the literature as defining elements of models of maternity care including [32]: who provides the care (obstetricians, midwives, allied care providers), whether the providers are known to the woman, where the care occurs (at home, in hospital, community venue), when the care occurs (gestation at booking, frequency and length of visits, after hours contact), and how the care is provided (one-to-one or group visits) and as described as possible future maternity care models for Dutch practice [23]. Students identified shifts away from the original ‘echelon model’ and indicated openness to such change (theme 1).…”

Section: Discussionmentioning

confidence: 99%

Student midwives’ perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study

Warmelink

Cock

Combee

et al. 2017

BMC Pregnancy Childbirth

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BackgroundA major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives’ perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care.MethodsThis qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed.ResultsStudents felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care.ConclusionsFinal year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth.The graduating midwives are motivated to undertake an expanded intrapartum skill set. It can be important to involve students’ views in the discussion, because they are the future maternity care providers.

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Does model of maternity care make a difference to birth outcomes for young women? A retrospective cohort study

Cited by 35 publications

References 28 publications

Models of maternity care: evidence for midwifery continuity of care

Models of maternity care: evidence for midwifery continuity of care

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

Student midwives’ perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study

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