School of Nursing and Midwifery, Griffith University, Logan Campus, Meadowbrook, Qld 4131, Australia. Email:
Aust Health Rev. 2021 Feb;45(1):28-35. doi: 10.1071/AH19264.
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.
确定澳大利亚昆士兰州公立妇产医院中产妇获得助产士连续性护理的情况。
通过考虑公共医疗机构中提供助产士连续性护理的助产士比例，并结合昆士兰州医院和卫生服务机构 2017 年的分娩数据，对昆士兰州产妇获得助产士连续性护理的情况进行建模。该模型假设，在连续性护理工作中，每位全职等效助产士的平均病例数为 35 例，这是基于州级护理和助产士薪酬条件。根据澳大利亚医院的标准分类，将医院分为 5 个组。
在昆士兰州所有 15 家提供产科服务的医院和卫生服务机构中，有 27 家（占 39 家的 69%）在 2017 年提供了助产士连续性护理服务（在现场分娩）。应用假设的每位全职等效助产士 35 名产妇的病例数进行建模发现，产妇获得连续性助产士护理的比例存在很大差异，全州约有 18%的育龄妇女能够获得连续性助产士护理。临床服务能力和分娩量较高的医院分类并不能等同于大都市地区获得连续性助产士护理的比例更高。具有 3 级地区医院并协助分娩量少于 500 例的区域卫生服务机构，其获得连续性助产士护理的水平更高，这可能是由于满足当地人口需求的额外挑战，而不仅仅是大都市服务的需求。由于需要特殊产时护理的妇女和计划在其他医院分娩的妇女计划进行产前转移，3 级偏远地区医院（分娩量少于 500 例）的连续性助产士护理的完全连续性的获得情况被人为夸大。
尽管有强有力的证据表明，连续性助产士护理为妇女及其婴儿提供了最佳护理，但在医院管辖范围内，这种模式的实施和推广存在很大差异。
在公共卫生系统中，孕妇获得连续性助产士护理的情况差异很大；然而，澳大利亚各州和地区不同医院分类组之间的获得情况差异尚未得到系统的描绘。
本文确定了昆士兰州根据临床服务能力和分娩量分组的医院分类中，连续性助产士护理的获得情况存在差异。结果表明，在大都市地区，较高的临床服务能力和分娩量并不等同于更高的连续性助产士护理获得情况。
在昆士兰州所有医院分类组中扩大连续性助产士护理仍然是一项重要的公共卫生策略，旨在解决服务获取的公平性问题。
