University Report: Evaluation of Caseload Midwifery Care in Maternity

This report evaluates the effectiveness of the Caseload Midwifery model in maternity care within the Australian context. The model, which involves a group of midwives providing continuous care from prenatal to postnatal stages, is examined in detail, including its application in remote areas and its impact on Aboriginal and Torres Strait Islander (TSI) women. The report discusses the structure of Midwifery Group Practices, the benefits of continuity of care, and the relationship between midwives and pregnant women. It also evaluates the model's effectiveness based on research findings, including its impact on maternal and infant health outcomes and cost-effectiveness. The report highlights the importance of ICM adaptations and the potential for expanding the model to improve healthcare access and outcomes, particularly for vulnerable populations. The report also discusses the challenges and opportunities associated with implementing caseload midwifery, including the need for supportive leadership and the potential for reducing medical interventions. Overall, the report emphasizes the positive impact of caseload midwifery on women's childbirth experiences and the importance of its expansion throughout Australia.

Running head: CASELOAD MIDWIFERY CARE IN MATERNITY CARE
CASELOAD MIDWIFERY CARE IN MATERNITY CARE
Name of the Student
Name of the University
Author Note

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Abstract
The following section focuses on effectiveness of the Caseload Midwifery model care model
in care program of pregnancy in Australia. This model comprises of a group of midwives
who provide the continuity care in pregnancy from the prenatal stage to the postnatal stage
that is until at least six weeks after the childbirth. The care policies of the midwives of
Australia would be discussed in a detailed manner along with the effectiveness of this model
in providing care to the extremely rural areas where care could not be provided to the
pregnant women or conditioned aboriginal women as well. The relation between midwives
and pregnant women would play a vital role in the whole program as well. Finally, the ICM
adaptation in the context of providing care to the pregnant women also discussed along with a
concluding statement which highlights the effectiveness of this model in maternity care.

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Table of Contents
Introduction................................................................................................................................3
Discussion..................................................................................................................................3
Midwifery Group Practices....................................................................................................3
Brief Description of the Model..............................................................................................5
Evaluation of the model.........................................................................................................5
Caseload Midwifery Model in TSI Women Care..................................................................6
Conclusion................................................................................................................................10
References................................................................................................................................12

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Introduction
In pregnancy, a woman needs intensive care which can be provided by a midwife at the
prenatal period, during childbirth and also in the postnatal period. The Caseload Midwifery
practice is a model which could help the midwives in this context of care planning of the
pregnant women. A group of midwives would support a midwife in the period of pregnancy
of a woman in this model of care. Caseload Midwifery model also considers a number of
factors including the continuity of care along with care in full pregnancy period. The
midwifery group practice also helps a primary midwife at the time of care for pregnant
women in the process of continuity care. In this following discussion, the Caseload
Midwifery model is described and evaluated with the context of care policies and the relation
of this model to the aboriginal cases and with the Torres Strait Island (TSI) women care also
would be discussed. All these factors would be discussed in relation with ICM regulations.
Discussion
Midwifery Group Practices
Midwifery Group Practices also termed as ‘Caseload Midwifery’ and this Midwifery
Group Practice (MGP) creates an opportunity for pregnant women being cared by
same midwife who is primarily assigned to that woman. The primary midwife with the
support of a group of midwives in the pregnancy period of women, childbirth and the period
of post-childbirth time at home along with the new born baby. Midwives prioritizes the
mother's primary needs that are known as the ‘woman-centered care', and it is a group
practice in Australia in the present time frame.
Midwifery Group Practice is growing in number in Australia (Forster et al. 2016). Midwifery
Group Practice offers a range of options to pregnant women; these options are as follows:

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 Continuity in care with more than one midwives
 Care in prenatal period
 Standby for the care of pregnant women at their labour and child birth period
 Care in Waterbirth
 Look after the women in Homebirth
 Birth centre births
 Care in the postnatal period for at least six weeks
Maximum number of midwifery group practice can be found in public hospitals;
however, it is now a private practice as well. Public hospitals usually screen women to check
their health risks prior to their access to the midwifery model of care. Geographical
boundaries or limitation in number can be an obstacle for the midwifery model of care.
Private and public group practices work under doctors which includes obstetricians with the
requirement. The main focus of Midwives Australia is to assist midwives and to establish
midwifery group practice for public health care services or as private practitioners
(Midwivesaustralia.com.au, 2019).
Mater's Midwifery Group Practice (MGP) is created to make sure that the pregnant
woman receives proper care with dedication and consistency at the period of pregnancy,
labour and childbirth along with at least six weeks after the birth of the baby (Mater Patient
Information, 2019). The partnership in between the mother and the midwife assigned for her
will mean that they will properly know each other, and also other MGP midwives of the
group.
This program also cares for women with a little amount of risk and complication and
generally in good health condition. If any complications arise, the midwives will co-ordinate

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with Mothers' Hospital's obstetric team, so that the mother and the baby will have the proper
specialist care, along with the support of the midwife.
Brief Description of the Model
The Midwifery Group Practice Caseload Model is a Maternity Care model in which
pregnant women have certain midwives assigned for their care throughout the prenatal
period, labour, birth and also in the postnatal period. Every midwife has to attend a number of
women per year and also acts as back-up midwife for other pregnant women who already
have another midwife as their primary care personnel it is called the caseload of a midwife.
Caseload midwives often work on a 24-hour standby basis and could be employed based on
their annualised salary. Caseload Midwifery program can also be termed as a midwifery
continuity care model and it can be a private or public service. Midwifery caseload managed
by a group of midwives that is a small number of midwives joining together to form a group.
Each midwife has their own caseload and also provide backup for other members in the
group as well. The critical factor of caseload midwifery practice which differentiates this
practice from ‘team midwifery' model where a pregnant women have a certain midwife to
attend their care program. Caseload midwives manage the workload within themselves as
well which also differs from the traditional roster structure and provides continuity to the care
program throughout the maternity period of a pregnant woman.
Evaluation of the model
A good amount of evidence for the effectiveness of caseload midwifery had been
found in the Cochrane systematic review of midwife-led models of care that includes ten
trials of ‘team midwifery' and three trials of ‘caseload midwifery’. This review found
improvement in clinical processes for mothers and babies; as a result increase in maternal
satisfaction also found. Since then two Australian studies have highlighted the safety and

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cost-effectiveness of caseload midwifery in comparison with orthodox care (Tracy et al.
2014). Besides, this analysis of in-depth interviews highlighted that the trust and positivity in
the relationship with the midwife helped the ability of the women to cope up with the labour
pain and birth experience of the baby positively. In Australia, a survey highlighted that the
continuity of care and familiarity with midwives was very much appreciated by women
having pregnancy who had experienced MGP care with home visiting and 24-hour contact
with the midwives. Effectiveness of MGP models in relation with care of Australian women
has been surveyed by many researchers, which gave positive outcomes, especially about the
continuity of care along with the reference of professionalism of Australian midwives.
However, According to Menke et al. (2014), a study on socially disadvantaged and
vulnerable women in South East QLD showed that Midwifery led service was not embraced
at all by the Organization and Medical Staff. A dominating culture of blame and medicine
continuously threatened and undermined the model and pointed out the need of contemporary
midwifery leadership structures which can be able to facilitate and encourage midwives to

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communicate in positive ways within the care team. It may take some time, but eventually,
the medical staff will have to embrace the MGP as it is proven to have many advantages on a
women's childbirth experience (Forster et al. 2016). It is also very cost effective with the high
likelihood of reducing medical intervention if the woman feels supported by the start (Menke
et al. 2014).
Caseload Midwifery helps to motivate the midwives to reach beyond the expectations,
as a result the women cared by them feel safe during pregnancy, labour, birth and also in the
postnatal period (Allen et al. 2017).
Caseload Midwifery Model in TSI Women Care
Australian Aboriginal women and new born babies experience high maternal and
prenatal ill health. Death rates of this kind are higher than the non-Aboriginal ones. While
continuity care led by midwifery group is safe for pregnant women and also benefited the
babies by means of reducing the preterm birth rate. On the other hand this model has limited
access in remote areas remains limited thus the women who could not be able to get the care
faces various problems during the pregnancy period. A Midwifery Group Practice was started
from 2009 in remote city of the Northern Territory, Australia, to give access to women of
midwifery continuity of care (MCC) (Lack et al. 2016).
The establishment of MGP in Alice Springs increased maternity care options for the
pregnant women of Alice Springs. MGP helped the midwives in continuity of care practice
for pregnant women with risks of Alice Springs. It also helped the women who needed to
change location from extremely Aboriginal communities to Alice Springs for giving their
child safe birth. The effectiveness of continuity care gave access to the option of homebirth
for Alice Springs’ low-risk women.

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Women
accessed care from the MGP of Alice Spring had reported That they
experience positive care for example early access to prenatal care, lower rates of premature
birth and of low weight birth compared to other data found from other populations. This
model gave access to prenatal care and decreased the prematurity rate and birth of low weight
babies are main priority factors in terms of infant health and the health of the mother in
global context. The midwives also recommended considering the motivational conversations
with the pregnant women as for the reason of that it could be helpful in the process of
childbirth as it could help the woman sustaining against the pain of labour (Allen et al. 2017).

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Closing the Gap is dependent on the health care services and this is also found to be
one of the critical factors. Betterment of access to primary health care service is able to give
over time care so that can provide a healthy outcome to the Aboriginal people (Lack et al.

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2016). Changing in the way of delivering maternal care in rural and extremely remote areas
can be recommended to improve the outcomes for Aboriginal mother and their new born
infants. Kildea et al. (2018), stated the recommendation for establishment of rural and
remote-based Midwifery Group Practices that can provide MCC to contribute in Closing the
Gap phenomena. It would be helpful in assisting the reduction of ill health factors of the
mother and the baby for Aboriginal and TSI women. The findings which have highlighted
that MCC can possibly be adopted in all remote location. This single care model satisfies
expectations of the National Maternity Services Plan and recommended for Closing the Gap

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phenomena of care policies. MCC in this field can help in Closing the Gap at the remote
locations and look after the fact of Aboriginal babies having a healthy start to life.
It has been recommended to expand the use of this care model throughout Australia in
order to provide improve health care thus mothers in all far areas have the access to MCC
from prenatal period until first few weeks of postnatal period as well. The expansion of this
model as a practice of pregnancy care in Australia would be most effective in the remote
areas of the country, and this program would help many women to deliver a healthy child and
provide proper care for their health as well (Nursingmidwiferyboard.gov.au, 2019).
There has been a vast amount of research relating to the Aboriginal and TSI Women.
If an Aboriginal or TSI Women attends the GP in the first trimester of her pregnancy, she will
be given the highest priority be in the MGP Caseload Team (Menke et al. 2014). Midwifery
Group Practice and Continuity Midwifery Care can be adequately provided to remote areas
comprising of Aboriginal women and helps to improve outcomes for women and their
infants. Additionally, Australian researchers have found some evidences that highlighted the

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MGP model of care provides more cost-friendly care than the standard ones. This model of
care is helpful for the Australian Aboriginal women and low-risk women.
Most studies completed were mainly Caucasian, and supported with living in affluent
areas, so it was difficult to get good reviews on the Aboriginal population which
demonstrates the need even more of MGP in areas they reside. This amount to a lower rate of
pre-term births which is experienced a lot in the Aboriginal Community.

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The Maternity care model used in Western Countries such as Australia, Canada, the
United Kingdom (UK) and the United States (US) usually led by medical department and can
be divided into several groups (Allen, Kildea and Stapleton 2015).
Caseload Midwifery focuses on giving all the cares a pregnant woman need. A
woman can have all the care she needs from the trusted and familiar midwife along with the
other members of the group of a midwife. A primary midwife is the leading care personnel
for a caseload of women across the continuity of pregnancy, labour, child birth, and first few
weeks after birth (Dahlberg et al. 2014). A Midwifery Group Practice generally consists of at
least four midwives providing prenatal care to a pregnant woman through a series of
individual appointments whether that in the home, hospital or community. Midwives in MGP
are always standby for labour and birth and also work as a backup midwife for each other in
the event of a rostered day off or period of leave.
Australian Women provided with the opportunity of contacting their primary or back-
up midwives any time of a day for all kinds of health concerns and the postnatal care for the
mother and baby is usually provided at home for at least six weeks which depends on the
mother and baby’s needs (Gray et al. 2016). Midwives need to prioritise the physical and
mental health factors of the mother they are responsible for despite her own needs to provide
effective care to the pregnant woman and her baby as well. The Midwife can work to her/his
full scope of Practice in this setting. As ICM states, support, necessary care and advice during
the span of pregnancy, child birth and in the postnatal period would be provided to the
pregnant women primarily by the midwives in order to conduct healthy births and to provide
care for the newborn infant. Midwifery care comprises of preventative measures for the
mother along with the promotion of normal delivery. They are also responsible for detecting
complications in mother and child’s health conditions; they also have access to the medical

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care and other appropriate assistance and also carry out different emergency measures (West,
Dawson and Homer 2017). The midwife educates and consults with the pregnant woman and
also with the family member and the community about the care priorities. A midwife can be
able to practice in any kind of facilities such as in hospitals, communities, home, health units
and others.
As a result of ICM, Adopted at Brisbane Council meeting, 2005 belief of midwives
were focused on their achievement of providing almost best care for the socio-economically
disadvantaged women and also the unsafe mothers. They successfully gained the satisfaction
of the pregnant women of Australia with whom they work as partners throughout their
practice by making a prominent change in the birth journey of Australian women (Menke et
al. 2014). A Midwife practicing in this setting will adopt all essential competencies for
Midwifery Practice which embodies general skills, pre-pregnancy and antenatal, care during
labour and birth and ongoing care of women and newborns (Internationalmidwives.org,
2019).
In addition to all these findings, Australian researchers also found that the care
provided by the MGP model is more cost-friendly than other care models. They also found
that, this care model is more effective for the Aboriginal women and the low-risk women of

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Australia. Effectiveness of MGP model in terms of meeting the expectations of Australian
women has been highlighted by the researchers which positively evaluated the continuity care
along with the professionalism of the midwives (Tracy et al. 2014).
Conclusion
Based on the above discussion it can be concluded that the Caseload Midwifery model is one
of the beneficial care model in the context of the pregnant women care. It also found that
pregnant women are very much satisfied with the midwives. The midwives even with the
help of other midwives can provide continuity care in the period of prenatal and postnatal
pregnancy which is the main decisive factor of this model. The other positive factors are
giving attention to the rural and aboriginal pregnant women of the TSI which could be gained
with the help of this model of care as well. These midwifery group practices are also useful in
the home birth as well as in the birth centre birth. The midwives also give support to the
pregnant women by standing by the mother and the relationship between the mother and the
midwife is one of the main factors in this continuity care facility. Thus it can be said that the
Caseload Midwifery model is needed to be practiced as the primary care model for the
pregnant women in Australia.

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References
Allen, J., Kildea, S. and Stapleton, H., 2015. How does group antenatal care function within a
caseload midwifery model? A critical ethnographic analysis. Midwifery, 31(5), pp.489-497.
Allen, J., Kildea, S., Hartz, D.L., Tracy, M. and Tracy, S., 2017. The motivation and capacity
to go ‘above and beyond’: qualitative analysis of free-text survey responses in the M@ NGO
randomised controlled trial of caseload midwifery. Midwifery, 50, pp.148-156..
Dahlberg, U., Persen, J., Skogås, A.K., Selboe, S.T., Torvik, H.M. and Aune, I., 2016. How
can midwives promote a normal birth and a positive birth experience? The experience of
first-time Norwegian mothers. Sexual & Reproductive Healthcare, 7, pp.2-7.
Forster, D.A., McLachlan, H.L., Davey, M.A., Biro, M.A., Farrell, T., Gold, L., Flood, M.,
Shafiei, T. and Waldenström, U., 2016. Continuity of care by a primary midwife (caseload
midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care:
results from the COSMOS randomised controlled trial. BMC pregnancy and
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Gray, M., Malott, A., Davis, B.M. and Sandor, C., 2016. A scoping review of how new
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S., Kruske, S., Tracy, M. and O’Hara, M.W., 2018. Continuity of midwifery carer moderates
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Arundell, M.J. and Homer, C.S., 2016. Narrowing the Gap?
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