Continuity of midwifery care for rural women through caseload group practice: Delivering for almost 20 years.

OBJECTIVE

To describe the clinical outcomes and sustainability factors of a long-standing midwifery led caseload model of rural maternity care.

DESIGN

Retrospective clinical audit from 1998 to 2011 and autoethnographic narrative of the midwifery program told by the longest serving midwives under three key themes relating to sustainable practice.

SETTING

Regional Health Service with annual birth rate of 500. Maternity care is provided by either public antenatal clinic/GP shared care or midwife-led care.

PARTICIPANTS

Women attending a rural caseload midwifery group practice between the period 1998-2011 and midwives working in the same group practice during that period.

MAIN OUTCOME MEASURES

Antenatal attendance, maternal mortality, infant morbidity and mortality, mode of birth, known midwife at birth, initiation of breastfeeding.

RESULTS

There were 1674 births between 1998 and 2011. Clinical outcomes for women and infants closely reflected national maternity indicator data. The group practice midwives attribute sustainability of the program to the enjoyment of flexibility in their working environment, to establishing trust amongst themselves, the women they care for, and with the obstetricians, GPs and health service executives. The rigorous application of midwifery principles including robust clinical governance have been hallmarks of success.

CONCLUSION

This caseload midwifery group practice is a safe, satisfying and sustainable model of maternity care in a rural setting. Clinical outcomes are similar to standard care. Success can be attributed to strong leadership across all levels of policy, health service management and, most importantly, the rural midwives providing the service.