Each researcher independently analysed the data, highlighted key terms and assigned their own codes. Risk management assessment indicates the need to identify likely barriers and enablers. The authors declare no conflicts of interest are held in relation to this study. Participants had concerns around costs which may be reflected by decision-makers when examining the rigor in which a business case has been prepared. 2007;45(2):4157. 2019;32(1):35. Aim: To explore what determines optimal management of MGP in Australia, and . The results also demonstrated a moderate level of self-efficacy there were mixed beliefs amongst individuals in their own capabilities to deliver the model of care, while also identifying that the proposed model of care would provide an opportunity for midwives to build their self-efficacy through gaining new skills and expanding their scope of practice. Group interviews included between two and five members based on availability of attendees. Asking women about mental health and social adversity in pregnancy: results of an Australian population-based survey. some with abuse histories dont want to go over those histories over and over. BMC Pregnancy Childbirth. Maternity care in Australia: first national report on models of care, 2021. 2019;148:3242. Such solutions would inform risk mitigation. Continuity of care by a primary midwife (caseload midwifery) increases womens satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. Background: Although there is high-level evidence supporting positive perinatal outcomes for midwifery group practice (MGP) care, not all women can access this model due to a failure to implement or sustain it. Midwifery caseload practice Group pregnancy care Young Mums Privately Practising Midwife Antenatal Shared Care Other links for women preparing to birth at Westmead Westmead midwives understand each pregnancy is unique and our care includes education to help you remain healthy and well throughout your pregnancy Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. Opened at the Tweed Hospital in March, the new model of midwifery care provides women the opportunity to be seen by the same midwife from their first antenatal visit right through their pregnancy, during birth and after they have returned home with their baby. Depla AL, Crombag NM, Franx A, Bekker MN. No additional people contacted the study team to offer their involvement. The diversity and large relative number of stakeholders involved in the study also ensured the qualitative data were reflective of a comprehensive sample from which data saturation was readily achieved. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities . Midwifery group practice is also safe in terms of maternal and neonatal outcomes, is associated with a reduction in maternal risk-taking behaviours, and is a less-costly model of maternity care [24,25,26]. 2018;66:7987. Computer-assisted analysis was undertaken to mitigate the recognised and acknowledged potential inherent bias in qualitative analysis [41]. Women Birth. Feedback on study results at completion of the study was provided to participants who requested follow-up. 2012;52(6):57681. The cost of the proposed model had not been established but was imagined by participants to be higher than both the current model of care and comparative midwifery group practices. The two novice researchers, both dual registered nurses and midwives at senior and middle management levels were known to all participants. Using the CFIR in this study presents results that may guide other Australian maternity services on how to best plan and implement a midwifery group practice for vulnerable women. continuing to have the multi-disciplinary input and multi-disciplinary team meeting is going to be beneficial (Medical Officer, Interview 20). Midwifery. All methods were performed in accordance with the Declaration of Helsinki, in particular the respect for individuals, the right to make informed decisions and the recognition of vulnerable groups. Midwifery Group Practice $75,200 jobs now available in New South Wales. Midwifery Group Practice (MGP) is the common name given in Australia to an evidence based model of care in which women are allocated a primary midwife who provides their care throughout their pregnancy, labour, birth and postnatal period. The identification of this enabler suggests that the initial enthusiasm for the intervention would sustain its implementation over time. For many, the perception from the evidence that a midwifery group practice for vulnerable women is gold standard was the sole driver for supporting the proposed model and was seen as a strong enabler which would enhance a business case for the proposed model. Waltz TJ, Powell BJ, Fernndez ME, Abadie B, Damschroder LJ. View 48 Registered Midwife jobs in Ewingsdale NSW at Jora, create free email alerts and never miss another career opportunity again. Cat. Ongoing postnatal care is then personalised to you and the needs of your baby, and consists of regular home visits in the first few weeks after the birth of your baby. Pregnant women with a history of substance use, mental health challenges and complex social issues have unique care needs during pregnancy, birth and the postpartum period [1] and are estimated to represent over 5% of the approximately 295,000 women who give birth each year in Australia [2]. What will happen when I arrive at the hospital? Implementation Science is Imperative to the Optimization of Obstetric Care. They were predominantly permanent employees (74.2%) and had more than 10 years experience (70.9%) (Table2). A midwife or small team of midwives will provide your primary care with medical practitioner. The continuity of midwives would ensure the deep needs of each woman were met. 2016;40:15361. All times AEST (GMT +10). volume22, Articlenumber:1265 (2022) Smith, P.A., Kilgour, C., Rice, D. et al. "The benefits of this type of midwifery model lie in the continuity of care which enables the development of a relationship between a woman and her midwife throughout the pregnancy journey.. BMC Health Serv Res. 2014;30(4):44755. The midwife researchers reflected on and acknowledged both the potential bias of being midwives investigating a topic they may have a self-interest in, along with the benefits of improved engagement from participants as they were known colleagues. * Your GP will refer you to the Antenatal (Pregnancy) Clinic, but please also fill out a form for the MGP team (Step 2 below). Implementation barriers and enablers of midwifery group practice for vulnerable women: a qualitative study in a tertiary urban Australian health service. Effective processes and strategies used to implement a midwifery group practice for vulnerable women depend on full engagement of stakeholders and a clear picture of the health service context [30, 31]. A cost-consequences analysis of a midwifery group practice for Aboriginal mothers and infants in the top end of the Northern Territory, Australia. Gilkison A, McAra-Couper J, Gunn J, Crowther S, Hunter M, Macgregor D, et al. Vulnerable women may also experience domestic and family violence isolation in addition to poor maternal health, further compromising the fetus and neonate [1]. Midwifery. BMC Health Services Research Midwifery. The dataset supporting the conclusions of this article are available from the corresponding author on reasonable request. A thesis submitted for the Degree of Doctor of . Continuity of care through midwifery group practice is mostly restricted to women with low-risk pregnancies and is not universally available to vulnerable women, despite evidence supporting benefits of this model of care for all women. Dixon L, Neely E, Eddy A, Raven B, Bartle C. Maternal socio-economic disadvantage in Aotearoa New Zealand and the impact on midwifery care. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. 2019;322(2):14552. About us Brisbane: Queensland Government; 2021 [Available from: https://metronorth.health.qld.gov.au/rbwh/about-us. The 1000-bed health service is located in an inner suburb of an Australian capital city, with a diverse population catchment including large numbers of disadvantaged groups. Some questions were adapted for local contextualisation and conversation style. CFIR Research Team. Review submission. Midwifery Group Practice | Northern NSW Local Health District ResetShow/Hide X EMERGENCY In an emergency, always call triple zero (000). Midwifery. Midwifery Group Practice (MGP): Midwifery-led care for low- to medium-risk women from a designated . 2015;52(8):133242. Potential enablers of implementation included perceptions that the model facilitates a relationship of trust with vulnerable women, that clinical benefit outweighs cost and universal stakeholder acceptance. Relationships between women and carers that are grounded in an interdisciplinary continuity of care and carer model increases womens access to services and provide safe spaces for disclosure of sensitive information that guides high quality health care delivery [19]. Don't miss out on the headlines from Tweed Heads. they can build up trust, they can have the tough talk with a familiar face (Nurse, Interview 12). Overall, the most common terms were caseload midwifery (n = 63, 36%), midwifery-led continuity (n = 60, 34%), or team/midwifery group practice (n = 40, 23%). The State of Queensland (Queensland Health) 2023, www.goldcoast.health.qld.gov.au | | _v1_, Gold Coast Health is recognised for quality patient care, nursing and midwifery excellence and innovations in professional nursing and midwifery practice under the, Aboriginal & Torres Strait Islander service, Aboriginal and Torres Strait Islander Health, Services, Emergency Contacts and Resources, Lesson 1 - Using language strategies in everyday routines, Feeding babies for women isolated and quarantined, Partner with the National Centre for Neuroimmunology and Emerging Diseases. The Midwifery Group Practice (MGP) works within the Family Birthing Centre and is for women who choose to be cared for by the same group of midwives throughout their pregnancy and after the birth. BMC Health Serv Res. the midwives would need to be engaged with the multi-disciplinary team more than MGPs (Other role, Interview 17). Midwifery Group Practice (MGP) (also known as caseload midwifery) describes a model where women receive midwifery care from the same midwife or small group of midwives throughout their pregnancy, birth and postnatal period. Need an Interpreter? Themes were then mapped to CFIR domains and constructs within each domain to finalise the analysis. The interdisciplinary team expressed views that to continue safe and effective care, it was important the teams role be maintained. The difficulty in attracting midwives to the proposed model of care was an identified barrier to implementing a high standard of care: attracting the midwives that would have an interest in it, we almost need a mother-like figurewould have to be resilient and have had a few more life experiences (Medical Officer, Interview 13). In this study, we have used the CFIR to identify potential barriers and enablers to implementing a midwifery group practice for vulnerable women, with both local and national relevance. Active labour, normal birth, breastfeeding and early discharge home from the Birthing Unit are important to us. Tarasoff LA, Milligan K, Le TL, Usher AM, Urbanoski K. Integrated treatment programs for pregnant and parenting women with problematic substance use: Service descriptions and client perceptions of care. The integral way in which having a known midwife provides benefit and support for women was repeatedly discussed by participants. These design details can be included in a business case to ensure successful and sustained implementation. In the computer-assisted analysis, five themes were identified from the data: women with complex care: specialty clinic; continuity of care; workforce; and opportunity (Fig. Stakeholders had a positive attitude towards the intervention; they placed a high value on the proposed model of care. This aims to provide continuity of carer . Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. PubMed Participants were also advised their involvement was voluntary and that their responses could be withdrawn at any stage up to two-weeks post-interview. Such antenatal care may facilitate equitable access, high quality health care and the best possible health outcomes during pregnancy, birth and the postpartum period [12]. Easy access for disabled persons at both Hospitals. 2021;21(1):113. Coburger Strasse 31, Grub am Forst, 96271. This belief in the net benefit when costs were also considered was not rooted in available evidence, which contrasts with the desire for evidence for gold standard effectiveness. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Patricia A Smith. 2015;51:116. Of the 40 people invited to an interview, 31 consented to participate (77.5%) with no response received from 9 others. Join Gold Coast Health on social media as we create a more connected health community. J Manage Control. Manage cookies/Do not sell my data we use in the preference centre. In this table it becomes clear what the requirements for successful and sustained implementation of the proposed model might be. 76024 Suite 1/118 Main Street Murwillumbah | 6672 1698. Participants identified that the proposed model is likely to provide health benefits for women due to the rapport built with a small group of care givers including a supportive interdisciplinary team providing continuity of care. Support for the inclusion of an interdisciplinary team in the proposed model of care was identified as an enabler and was particularly supported by non-midwife participants: I would love it, because we felt [from observation of previous staffing arrangements] that when the midwives were staying in the role longer it felt very organised and that we knew the patients very well (Allied Health Practitioner, Interview 9). Many participants expressed empathy for the likely patient cohort and placed the proposed model as a high priority for the health service. Australian maternity services can use our results to compare how the perceptions of local stakeholders might be similar or different to the results presented in this paper. 2019;14(1):42. Participant characteristics generally aligned with that of the Australian health workforce, with most participants being nurses and midwives (Australian Institute of Health and Welfare, 2020). The perception that midwifery group practice for vulnerable women is a high-risk model of care lacking in evidence may have in the past, thwarted implementation planning studies that seek to improve care for these women. You are on ISLHD's test/development site. The structural characteristics of the setting for this research were that it is a mature and large maternity service, with a range of existing and well-supported midwifery group practices already established. Annals of Leisure Research. Vulnerable pregnant women in antenatal practice: Caregivers perception of workload, associated burden and agreement with objective caseload, and the influence of a structured organisation of antenatal risk management. The women can be fearful about opening upthat there may be negative consequences (Midwife, Interview 10). Viveiros CJ, Darling EKJM. Interviews were recorded with participant consent and transcribed verbatim by an administration support officer. Kilgour C, Bogossian FE, Callaway L, Gallois C. Postnatal gestational diabetes mellitus follow-up: Australian womens experiences. 2018;18(1):309. Midwives will actually see this as a positive move and its going to be development for them, and its going to be opportunistic for them (Nurse/Midwife Leader, Interview 4). The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. These Australian models facilitate monitoring of antenatal clinical indicators but may miss an opportunity to establish trusting relationships through continuity of carers during pregnancy and the postpartum period [12]. Midwifery Group Practice Ward Clerk (08) 8161 8406 (Monday - Friday, 9.00am - 3.30pm) Fax (08) 8161 7829 Email Health.WCHNMidwiferyGroupPracticeWdClrk@sa.gov.au Mailing Address Midwifery Group Practice Women's and Children's Hospital 72 King William Road North Adelaide South Australia 5006 Pregnancy Services at the WCH Below is the link to the electronic supplementary material. Implement Sci. 2014;14(1):170. 2015;42(5):53344. Corsi DJ, Walsh L, Weiss D, Hsu H, El-Chaar D, Hawken S, et al. Beasley S, Ford N, Tracy SK, Welsh AW. The Tweed Hospital runs an extensive Rehabilitation Outpatient Service for a range of health issues including fracture clinic, gynaecological needs, paediatric services, and pre-surgery. Last modified 21/7/2021. Flinders University . Royal Brisbane and Womens Hospital. The service design would need to ensure that midwives can be changed across groups. Other studies in New Zealand, Belgium and the Netherlands demonstrated low antenatal care attendance by women with social and other vulnerability [8, 9]. The Midwifery Group Practice (MGP) is a free service offered by Gold Coast Health and is located within the Birth Centre at the Gold Coast University Hospital. Attention to these key themes, barriers and enablers will assist with identification of strategies to aid successful implementation. . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. The MGP model of care provides continuity of maternity care by a known midwife throughout pregnancy, labour and birth, and the early weeks following the birth of your baby. Our MGP program offers you one midwife (who works in a team) who will care for you through your pregnancy, through your birth and at home for 2 weeks after your baby is born. If material is not included in the articles Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The study was deemed by the hospitals and universitys Human Research Ethics Committees as a quality assurance or quality improvement activity and thus not requiring formal ethics approval (Exemption number: LNR/2019/QRBW/54,360). While this second barrier is contradictory to the initial workforce enabler identified in this theme, participants became solution focussed in the interviews, which is reflected in the theme reported below The interdisciplinary team. 2012;28(6):e874-9. Participants saw the proposed new model as an opportunity for midwives to gain new skills and expand their scope of practice which was identified as an enabler: There are a few midwives out there currently upskilling themselves and are really passionate and interested and already preparing for being part of the team (Nurse/Midwife Leader, Interview 3). The context assessment was conducted early in the planning stages of the intervention and the strong engagement suggested interest in the intervention and acceptance of the planning methods. 8:30am-12:00pm on Fridays. 2023 BioMed Central Ltd unless otherwise stated. Participants believed that the health benefits of the proposed model of care would outweigh the perception that a midwifery group practice for vulnerable women was a more expensive model of care. 2020;56:2634. The belief amongst participants of strong, quality evidence in favour of the proposed model was identified as an enabler, and there were no barriers highlighted by participants in terms of available evidence. If we can offer you a place on the program a midwife will contact you by phone. the midwife would need to be capable of referring to those that can help (Midwife, Interview 16). Sydney; 2014. Midwifery Group Practice. This belief was a clear enabler of the proposed model: the cost would come with great reward (Nurse/Midwife Leader, Interview 3). Mater Doc Num: PI-CLN-430006. de Groot N, Venekamp AA, Torij HW, Lambregtse-Van den Berg MP, Bonsel GJJM. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Our research suggests that stakeholders naturally seek evidence for both costs and effectiveness, and in the absence of evidence, local costs should be examined. To enable such an intervention to be implemented in other Australian maternity services, stakeholders would need to have confidence in their ability to seek and interpret the evidence and have an awareness of the strengths and limitations of the workforce capabilities to execute the proposed model of care. Instead, our interpretation of results for Australian maternity services should prompt services to identify which of our results mapped to the CFIR domains are relevant, and how they might be similar or different to the local context. Some MGPs in certain states also provide public-funded homebirth programs. Where it is not possible to be seen by your own midwife, another midwife from MGP will see you. Agreed key words and phrases were organised into barriers and enablers as determined by consensus amongst the researchers and then coded in vivo using participants own words. A thorough consideration of potential experiences for the woman, the workforce and costs when preparing a business case, will be a determinant of model implementation success. Most participants were female (87%) and between 41 and 50 years of age (35.5%). Dos Santos JF, de Melo Bastos Cavalcante C, Barbosa FT, Gita DLG, Duzzioni M, Tilelli CQ, et al. Roslyn Donnellan-Fernandez . If complications arise during or after the birth, you and your baby will be admitted to our Maternity Inpatient Unit (MIPU). Themes were compared and mapped to the Framework. Factors influencing the utilisation of free-standing and alongside midwifery units in England: a qualitative research study. its an addition to the multi-disciplinary teams, so it doesnt take anything away but theyve got some-one they can trust that follows them through all the way (Medical Officer, Interview 8). BMC Pregnancy Childbirth. If you cannot be seen by the MGP program, we have other pregnancy clinics that may suit you. Stakeholders perceived that there was high quality and valid evidence supporting midwifery group practice for vulnerable women as gold standard care (Midwife, Interview 2). An interdisciplinary team that is already part of the organisational structure and engaged in planning the model is likely to be essential. Referrals to the service can be made through a general practitioner or by self-referring by calling the Tweed Hospital Women's Care Unit on (07) 5506 7490. Midwifery continuity of care statement 2019 [Available from: https://www.pretermalliance.com.au/Alliance-News/Latest-News/Midwifery-Continuity-of-Care. A retrospective cohort study. Midwives support the woman during the antenatal, labour and birth of the baby and the immediate post-natal period. Continuity of midwifery care (Midwifery Group Practice)your care is provided by a midwife during your pregnancy, when have your baby and for up to 6 weeks after the baby is born. Gilbert P, Herzig K, Thakar D, Viloria J, Bogetz A, Danley DW, et al. You will give birth at the Gold Coast University Hospital in the Birth Centre or Birth Suite, and you will be supported to go home soon after birth. Participants were mostly clinicians with more than 10 years experience and so were likely able to make accurate assumptions around the number of workforce hours required to build rapport with women, discuss the care being delivered with the women and amongst colleagues, and deliver the volume of care required to optimise health outcomes. Midwifery group practices have been established for Torres Strait Islander women and women carrying Aboriginal and Torres Strait Islander babies in recognition of the importance of continuity of carers for this vulnerable group [27, 28]. Our research may expedite the implementation of such a model of care in other Australian maternity services. Quality evidence drawn from Australian studies [10, 13] builds confidence amongst stakeholders, which is a strong enabler. For the midwife dealing with only these women, it could over time be mentally challenging potentially exhausting and tiring (Midwife, Interview 6). Australian Preterm Birth Prevention Alliance. BMJ Open. Patients and visitors Our services The Tweed Practice The Tweed Practice Details and latest news from The Tweed Practice can be found on the Hay Lodge Health Centre website. An absence of continuity of care has been identified as a barrier to seeking help for mental illness [18, 23]. View on Google maps. 2016;16:337. Midwifery. Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia, Womens and Newborn Services, Royal Brisbane and Womens Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia, Catherine Kilgour,Deann Rice&Leonie K Callaway, School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, 4072, Brisbane, QLD, Australia, Faculty of Medicine, The University of Queensland, Herston Road, 4006, Herston, Brisbane, QLD, Australia, Mater Research Institute, Faculty of Medicine, University of Queensland, Raymond Terrace, 4101, South Brisbane, Brisbane, QLD, Australia, You can also search for this author in 2:00pm-7:30pm on Wednesdays and Thursdays You will then need to choose another option of care for your pregnancy. Australian Institute of Health and Welfare. Holiday rental platforms like Stayz and Airbnb have come out swinging against a recommended 60-day cap on Byron holiday rentals - while council is thrilled. Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives. You can also call the Translating and Interpreting Service on131 450if you need to speak to us before your appointment. Quicklinks. NZCOM J. Walsh D, Spiby H, McCourt C, Grigg C, Coleby D, Bishop S, et al. Midwifery Group Practices (MGPs) provide care to pregnant women in a group of (4-6) midwives. CK: Methodology (Leximancer), Formal analysis, Data curation, Writing Original Draft, Review and Editing. Not a magic bullet: Byron holiday rental cap backlash, NRRRL: massive grand final rematch, huge comeback victory. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Midwifery Group Practice (MGP) continuity of care is where the woman and her family know the midwives who provide her care through pregnancy, labour, birth and at home after the baby is born. Google Scholar. 2019;32(1):e111. There was recognition that the proposed model of care is supported by research and a view that clinical benefits will outweigh costs, however supervision and support is required for midwives to manage and limit vicarious trauma. Benefits of caseload midwifery to prevent fetal alcohol spectrum disorder: A discussion paper. BJOG. As patterns emerged in the reassembling of data and coding, recurrent themes were identified to enable thematic analysis [38]. However, more people aged 41 and over participated in the research, whereas the comparable Australian workforce is mostly aged 20 to 34 years.

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