Midwifery-led Care

A midwife is a health professional specifically qualified to provide the full range of care to healthy women and babies during pregnancy, birth and the postnatal period (first 6 weeks). Midwives are trained to recognise when a woman or baby's progress lie outside of the range of normal. In these circumstances, midwives will refer the woman to an obstetrician or paediatrican. Midwifery- led care has been shown to support women to achieve normal vaginal birth, more than any other model of care.

Midwives are qualified medical professionals who are trained to provide you with the full range of maternity care if you are experiencing a low-risk pregnancy. In Australia, registered midwives have either completed a bachelor degree course specifically in midwifery, or are registered nurses who have done postgraduate study to become midwives.

Midwives are trained to care for you when pregnancy, labour and birth proceed as normal, without any significant health issues. Generally speaking, midwives anticipate that everything will actually be normal unless their clinical observations show a developing health concern. A midwife will consult with you to:

• supervise, care for and advise you during pregnancy;
• support you during your baby's birth;
• care for you and your baby after the birth;
• monitor your progress to ensure that everything remains normal;
• obtain specialist assistance if anything changes from what is normal;
• when no specialist is available, carry out some emergency measures if necessary.

Public Health Care

Midwife-led care in the public system is delivered through a number of different programs or services which you have to book in to speciifically, in order to access them. These programs include Birth Centres, Public Homebirth Services and Caseload Midwifery Programs. Some programs involve care by a small team of midwives and other programs include access to a known midwife throughout your pregnancy, who attends you during the birth and will come to your home for postnatal care. This is called Caseload Midwifery.

Appointments with midwives in midwifery-led programs, tend to last around 30 minutes and include an opportunity to discuss the emotional as well as the physical aspects of your pregnancy. Appointments might include taking your blood pressure, checking your urine for protein and glucose, and checking that your baby's growth is on track. Your midwife might invite you to discuss how you are going with the ups and downs of pregnancy; how your partner is adjusting to things; and how you are feeling about the birth and becoming a parent.

You can access midwifery-led care in the the public health system. These options tend to be very popular with women, so if you think that you might be interested in this form of care, start phoning around your local hospitals as early in your pregnancy as you can.

Midwifery-led care models in the public health system include: Birth Centres, Public Homebirth Services, Caseload Midwifery Programs.

Private Health Care

You can access midwifery-led care by hiring an independent or privately practicing midwife who is registered with the Nursing and Midwifery Board of Australia. Some private midwives ('eligible' midwives) now have Medicare provider numbers in the same way that doctors do. This means that Medicare rebates are available for antenatal care, birth in a hospital/birth centre (where the Eligible Midwife has visiting rights) and postnatal care. However, there may be a 'gap' which you have to pay, as with doctors. A private midwife is able to provide care for you throughout your pregnancy and birth and after the baby born. Your midwife will be able to refer you to a doctor at any time in your pregnancy, labour or birth if the need arises. Women who choose this model of care, plan to birth at home. Antenatal check up appointments happen in your own home and tend to be fairly long (2 hours). Appointments focus not only upon the physical aspects of your pregnancy such as taking your blood pressure, and checking your urine for protein and glucose and checking your baby's growth is on track, but also upon the emotional aspects of your pregnancy which are important to you.

You can also hire an independent midwife to accompany you into a hospital setting to act as an additional support person. In the future, it is expected that you will be able to book into your local public hospital under the care of your private midwife, enabling you to receive your pregnancy, labour and birth care in hospital and your postnatal care at home.

You can find the details of Midwives in Private Practice at this link http://www.midwivesaustralia.com.au/?page_id=68.

For listings of Eligible Midwives in your community, follow this link: http://www.eligiblemidwives.com/victoria.html

Midwifery-led care models in the private health system include: Planned Homebirth, independent midwifery support in public or private hospital.

What does the research say about midwife-led care?

If you are hoping to have a normal vaginal birth with minimal intervention, midwifery-led care has been shown to support these outcomes for birth more than other models of care.

The researchers from the Cochrane Pregnancy and Childbirth Editorial Group, the research group that the majority of maternity professionals refer to, suggest that most women should be offered midwifery-led continuity models of care and that women should be encouraged to ask for this option.

When we look at the results of the large reviews that are done of all the related research, we find that women who had midwife-led continuity models of care during pregnancy and birth, were less likely to experience:

• a pre-term birth;
• an intravenous drip of artificial oxytocin to speed labour up;
• an epidural or any form of drug use during labour or birth;
• an episiotomy;
• or a vacuum or forceps assisted birth.

And were more likely to experience:

• a spontaneous vaginal birth;
• care by a midwife whom they knew before labour began;
• a longer labour;
• breastfeeding at six to eight weeks or longer;
• and very positive views of their care.

Midwifery-led care didn't seem to make a difference to a woman's risk of

• having a caesarean birth;
• or, her baby dying during pregnancy, labour or after the birth.

(Sandall et al. 2013 and Hodnett et al. 2012).

References

• Hodnett ED, Downe S, Walsh D. (2012). Alternative versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD000012. DOI: 10.1002/14651858.CD000012.pub4.
• Sandall, J., Soltani, H., Gates, S. et al (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, Issue 8. Available online at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004667.pub3/abstract [accessed on 31 October 2013].