Call the midwife: Study highlights maternity care model's success

Mothers have described feeling "empowered" and "respected" during their labor and birth at a small rural hospital in Victoria's Goldfields region that has adopted a midwifery continuity of caregiver model, labeled as "gold standard" by La Trobe University experts.

This is amid a decline of more than 200 birthing suites across rural and remote locations over the past two decades, with estimates that only 19% of Australia's population has access to this continuity of caregiver model known as Midwifery Group Practice (MGP).

The MGP model provides personalized support and enables a woman to be cared for by the same (or a backup) midwife throughout their entire pregnancy, labor and birth, and postnatal journey.

In May 2020, Dhelkaya Health (previously called Castlemaine Health) suspended its maternity service following an extensive review and concerns midwives were not utilizing their full scope of practice under the hospital's GP obstetric-led model at the time.

The one-year closure had an immense impact on the small community, located about 40 kilometers from the regional center of Bendigo. A review recommended the development of the MGP model of midwifery care and in May 2021 the ward reopened, with the first birth occurring in early June.

"[For] the birth of my first child … the care was very impersonal. At Castlemaine, it was the opposite; I felt as though my midwife took the time to get to know me and my family, took the time to discuss any concerns and respected my decisions and preferences," said one study participant.

Researchers from La Trobe's Judith Lumley Center evaluated the first 12 months of the MGP operation at Dhelkaya Health. The results are published in the journal Women and Birth.

"Women's experiences were overwhelmingly positive in demonstrating the impact it had on them, on their birthing experience, the transition to motherhood and their whole family," Dr. Laura Whitburn said.

"We know this type of care can lead to reduced rates of cesarean section and have better outcomes for the baby and the mother.

"The success is a testament to this service and how important continuity of care is for women and their birth experiences."

The evaluation shared the experiences of 44 women, including 22 women who birthed at Dhelkaya Health, 18 women who were transferred to birth at Bendigo Health and two women who birthed before arrival, from its reopening until May 2022.

Women particularly valued the continuity of care by a known midwife, the tailored care to their individual needs and circumstances, and the ability to access the service locally. They reported low levels of anxiety during labor and birth and felt that they coped physically and emotionally better than they anticipated.

"Empowering experience because of my freedom to make decisions that were based on clear and unbiased information from midwives," said one study participant.

"All the midwives and doctors were so supportive and positive and made me feel completely free to be vocal and move how I needed to. At no point did I feel judged or rushed," said another study participant.

"Every staff member that I crossed paths with during my pregnancy was absolutely fantastic. My wishes were always respected, and they made me feel heard and supported," claimed another study participant.

April Jardine, Dhelkaya Health's Maternity Unit Manager, works with a committed team of MGP midwives, core midwives and nurses from their Maternity Unit in Castlemaine. She said the key to the service's success is its ability to leverage consumer insight to ensure the focus stays firmly on what's most important to women and families.

"Dhelkaya Health continues to place a high value on the feedback and experiences of the women who experienced our continuity of caregiver model," Jardine said.

"We collect ongoing data through a maternity consumer survey, with the results used to guide and shape the service to meet evolving community needs."

The importance of continuity of caregiver was also highlighted by mothers who felt their experience was negatively affected when continuity was lost during transfer to another service.

The overall success of the MGP model at Dhelkaya Health has informed other rural maternity services across Victoria to introduce similar models, including Maryborough and Cohuna, which developed a model based on Castlemaine.

"I feel deeply, deeply honored to have had the experience I had. I would give so much for every woman to have the sort of care and experience I had. I am beyond grateful Castlemaine opened up again," said a study participant.

Dr. Whitburn said the findings support and expand on existing research regarding the value of midwifery continuity of caregiver models.

"Castlemaine's success has become a catalyst and blueprint for how other rural services can create positive impacts on women and families," Dr. Whitburn said.

"We hope this is another piece of evidence that points to more resourcing into supporting rural services to provide maternity care."