A case study exploring the effect of implementing a caseload midwifery model of care in a Melbourne metropolitan maternity facility

摘要

Caseload midwifery is a new form of maternity care where women are cared for throughout pregnancy, birth and the early postnatal period by a known midwife, with one or two back-up midwives. The major underlying philosophy of the model is to offer women continuity of both care and carer. This form of care was introduced into a maternity facility in metropolitan Melbourne. The current study used an embedded case study design to explore the views and experiences of the women and midwives involved in caseload midwifery. The views of the midwives not directly involved in caseload midwifery were also sought. There were three sub-units of analysis. Sub-unit one: four women receiving caseload midwifery care. Sub-unit two: four midwives involved in providing caseload care. Sub-unit three: midwives not directly involved in caseload care. Of the 68 questionnaires sent to the midwives in sub-unit three, 37 were returned, giving a response rate of 54.4%. Data collection involved semi-structured interviews {subunits one and two), which were audiotaped, and a structured questionnaire for those in sub-unit three. Caseload midwifery was described positively by all three groups, and all considered that it should remain as an option of care at the maternity facility. The key positive aspect of the caseload model mentioned by each group was that the women developed a relationship with a midwife, which provided continuity for both the women and the midwives throughout pregnancy and birth. The negative factor identified by the two groups of midwives was the issue of ‘on call’ work. The other important themes emerging were related to infrastructure, with the caseload midwives concerned about lack of support, lack of remuneration and the negative attitudes of some of their colleagues. The non-caseload midwives were concerned with the effect of the model on core ward staffing, and the cost of the model. The conclusions drawn from this case study are that both women and midwives have a positive view of the value of the caseload midwifery model, however, if the caseload model is to continue as a viable and sustainable option of care for women at the maternity facility then the major concerns as mentioned above need to be addressed.