Midwifery Group Practice

Midwifery Group Practice
A woman centred primary health care model that offers well pregnant
women a care option of partnership with a known midwife.

Aim
 Through the promotion of birth as a natural event for most women, the
MGP model of care aims to increase the onset of spontaneous labour
and decrease labour interventions. The ensuing outcomes will result in
an increased vaginal birth rate, a decreased caesarean section rate
and an increased level of satisfaction for women with regard to their
childbearing journey.
Overview
 Submission for funding arose from the NSW government initiative
Towards Normal Birth
 Principle outcome aimed at reducing Caesarean Section Rate for

women having their first baby.
Overview
 All women will receive antenatal care and education through the
provision of consistent and balanced information, support during labour,
birth and post partum home care from a known midwife.
 Women able to be booked to the MGP will be determined by a ‘low risk’
criteria based on the Australian College of Midwives National Guidelines
for Consultation and Referral (ACMI).

Objectives
 The provision of balanced and consistent information for women and
their families.
 To provide care and facilities which are aligned with each woman’s
unique pregnancy and birthing journey and their subsequent transition to
parenting.
 To provide the option of midwifery evidence based best practice in
promoting optimal maternal and neonatal outcomes

Objectives
 To promote women’s satisfaction during pregnancy and childbirth through
collaborative participation in decision making.
 To offer pregnant/birthing women a choice of service
 To provide continuity of care by a known midwife within a dedicated group
 To implement an affordable and sustainable model of maternity care within

the current budget.
Rostering and On Call
 The MGP midwife will be on 24 hour call, during their rostered shifts. When not
on duty or on call, the MGP midwife will divert her mobile phone to the on call
MGP midwife.

 The MGP midwife will attend booking-in, antenatal and intra-partum care and
postnatal visits as required for her caseload of women according to on call and
prior work loads.

 Scheduled visits that cannot be rearranged for another time will be provided by
the next available MGP midwife on call.
Ongoing Pregnancy Care
 Meeting other midwives – women's’ groups
 Rescheduling Visits

 Continuation of midwifery care in collaboration with obstetric team as
the need arises
Antenatal Admission
 MGP midwife will organise a consultation with senior obstetric medical
officer/Obstetric Staff Specialist for MGP women if medical
management is required.
 On discharge from antenatal ward or DSU, the management plan will

indicate the lead carer and the schedule of planned visits. Ongoing
collaborative care will be between the woman, the MGP midwife and
the Obstetric Staff Specialist with a clear documented management
care plan.
Intra-partum Care
 Midwives contactable by work mobile when on call.
 MGP midwife will contact Birth Unit for admission after ongoing
consultation with the woman and arrangement to meet at Birthing Unit.
 If a woman presents to Birth Unit without contacting the MGP midwives

Birth unit staff will contact MGP midwife on call.
 Midwives work a maximum of 12 consecutive hours

Induction and
Caesarean Section
 Whenever possible, the MGP midwife will conduct pre-induction assessment and
consult with senior medical staff.
 The MGP midwife will retain lead carer role unless induction is complicated by a
‘C’ category risk.

 The MGP midwife will conduct the prostin pre-induction assessment
 Where possible, the MGP will be available for the woman’s care on the day of the
LSCS.
Postnatal Care
 Postnatal discharge is anticipated 4-6 hours after birth.
 The ACMI Consultation and Referral Guidelines for Postnatal Care will
be utilised for determining clinical risk.
 MGP discharge planning will be undertaken by the MGP midwife and
the woman.
 MGP postnatal home and/or phone visiting is available for up to 7 days
with ongoing postnatal contact, parenting and breastfeeding support
for six weeks postpartum.
Clinical Review
 One day per week is scheduled for MGP midwives to attend meetings
and education sessions. This includes note review, case review and
reflection, peer review, clinical supervision and group meeting.
 Adverse outcomes are subject to the usual reporting and review

mechanisms.
 Each MGP midwife will undertake yearly review and reflection on

practice.
Professional Development
 There is recognition of the increased responsibility, accountability and
competency requirements when midwives become lead carers within
the MGP model.
 All MGP midwives are encouraged and supported to continue their

professional development and develop a professional development
plan based on the ACM Self-assessment tool.
Professional Development
 Adequate professional development and up skilling will be built into the
model. MGP midwives will demonstrate competency in the following
areas.
– Skilled in current antenatal assessment and care
– Skilled in promoting and supporting the use of water in birth
– Skilled in promoting and supporting breast feeding
– Skilled in promoting and supporting development of parenting capacity
– Skilled in completing well mother and baby discharge assessments

The Research
 Clinical Effectiveness of Midwifery Group Practice model of care
 Fewer assisted births
 Fewer labour inductions
 Less epidural analgesia
 Altered Patterns of perineal trauma
 Fewer Caesarean sections
Turnbull, D., Baghurst, P., Collins, C., Cornwell, C., Nixon, A., Donnelan-Fernandez,
R. and Antoniou, G. (2009). An evaluation of Midwifery Group Practice. Part 1:
Clinical effectiveness. Women and Birth, 22; 3-9.
The Research
 Maternal Satisfaction Levels
 MGP is associated with higher level of maternal satisfaction
 Noted by women - better access to quality information

- participation in decision making
- sense of control during labour
- better relationship with caregiver
Williams, K., Lago, L., Lainchbury, A. and Eagar, K. (2010). Mother’s views of
caseload midwifery and the value of continuity of care at an Australian regional
hospital. Midwifery, 26; 615-621.
Midwifery Led Antenatal
Care
For well, healthy women having
their first baby
Schedule of Care
 Based on NICE guidelines
 10 appointments for 1st time

mothers
Early Pregnancy
 Booking visit
 Options of care
 Obstetrix –medical history,

family history, psychosocial
assessment, lifestyle issues
Routine Screening
 Generally attended urine pregnancy test at home & BHcG through GP
 BGA, Hb, MCV, hepatitis B, syphilis, rubella, MSU for C&S, ?Hepatitis C, ?
HIV, ? Varicella
 Dating Scan if LMP unknown or irregular
 Nuchal Translucency offered
 Genetic counseling if appropriate

16 weeks
 Review test results
 BP, FHS
 Organize morphology us for 18-

20wks
25 weeks
 Measure & plot fundal height
 FHS
 BP
 Antenatal Classes
28 weeks
 Hb, MCV, 50gm AGT or 75gm GTT
 Anti D 625 IU if rhesus negative mother
31 weeks
 Review results of tests
34 weeks

Anti D 625 IU
36 weeks
 Check presentation of baby- discuss options of breech
 LV/PA swab for GBS
38 weeks & 40 weeks

 Discuss options of post dates management
41 weeks
 Postdates assessment
What happens when a pregnancy
becomes complicated?
Collaborative Care
The Woman
The Midwife
The Obstetrician
Other Health Care Providers

History
 Miranda
 20 years old, single
 G2P0
 B Neg
 Smoker
 Carer for her mother

Past Medical History
 Hospitalised with pyelonephritis at age 13
 Asthma, ventolin prn
 Miscarriage at 5 weeks gestation 2010

Miranda’s pregnancy journey
 16/02/11 – 9/40 - referred to MGP from ANC Booking in Visit
 06/03/11 – 12/40 – presented to ED with a post coital bleed, given Anti

D and an EPAS appointment was made
 07/03/11 – EPAS - Miranda was sent for an NT scan. Result – low risk
 10/03/11 – 12/40 - presented to ED with PV bleeding, abdominal pain and
lower pelvic pain radiating to right loin.
 Treated 2 weeks prior for a UTI but had not finished the course of antibiotics
 Attended an ultrasound. Findings included a sub chorionic haemorrhage plus a

complex mass 78x32x43mm superior to the right kidney
 Discharged with follow up by GP

 15/03/11 – 13/40 - first visit with MGP, saw GP same day for referral
to gastrointestinal specialist, discussion with O&G consultant and
appointment made for High Risk Clinic
 08/04/11 – 16/40 - MGP visit, seen by GIT specialist prior and

awaiting MRI results
High Risk Clinic
 20/04/11 – 18/40 - High Risk Clinic visit with Consultant and Midwife –
Provisional diagnosis by GIT specialist following discussion at medical
oncology case meeting – angiomyolipoma plus abnormal right kidney
with cystic component. Uncertain of pathology but feel the mass is
benign and long standing. Surgical management deferred until after
birth. GIT specialist requiring monthly scans of mass and follow up.
Miranda’s Care Plan
 MGP care in consultation with High Risk Consultant
 Regular ultrasounds – morphology scan and then growth scans at

28/32/36 weeks gestation
 04/05/2011 – scan reviewed by O&G Consultant – morphology scan
NAD, mass unchanged, mild dilatation of right renal pelvis. For review
at high risk clinic at 28/40 following growth scan
 15/05/2011 – presented with UTI, treatment commenced

The Journey Continues……..

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Midwifery Group Practice

women a care option of partnership with a known midwife.

MGP model of care aims to increase the onset of spontaneous labour

and decrease labour interventions. The ensuing outcomes will result in

an increased vaginal birth rate, a decreased caesarean section rate

and an increased level of satisfaction for women with regard to their

 Principle outcome aimed at reducing Caesarean Section Rate for

provision of consistent and balanced information, support during labour,

birth and post partum home care from a known midwife.

 Women able to be booked to the MGP will be determined by a ‘low risk’

criteria based on the Australian College of Midwives National Guidelines

for Consultation and Referral (ACMI).

unique pregnancy and birthing journey and their subsequent transition to

 To provide the option of midwifery evidence based best practice in

promoting optimal maternal and neonatal outcomes

 To offer pregnant/birthing women a choice of service

 To provide continuity of care by a known midwife within a dedicated group

 To implement an affordable and sustainable model of maternity care within

 Meeting other midwives – women's’ groups

 On discharge from antenatal ward or DSU, the management plan will

 If a woman presents to Birth Unit without contacting the MGP midwives

 Midwives work a maximum of 12 consecutive hours

 Adverse outcomes are subject to the usual reporting and review

 Each MGP midwife will undertake yearly review and reflection on

 All MGP midwives are encouraged and supported to continue their

– Skilled in current antenatal assessment and care

– Skilled in promoting and supporting the use of water in birth

– Skilled in promoting and supporting breast feeding

– Skilled in promoting and supporting development of parenting capacity

– Skilled in completing well mother and baby discharge assessments

 Fewer labour inductions

 Less epidural analgesia

 Altered Patterns of perineal trauma

 Fewer Caesarean sections

 Noted by women - better access to quality information

- sense of control during labour

- better relationship with caregiver

 10 appointments for 1st time

 Obstetrix –medical history,

 Dating Scan if LMP unknown or irregular

 Nuchal Translucency offered

 Genetic counseling if appropriate

 Organize morphology us for 18-

 Anti D 625 IU if rhesus negative mother

 LV/PA swab for GBS

38 weeks & 40 weeks

Other Health Care Providers

 20 years old, single

 Carer for her mother

 Asthma, ventolin prn

 Miscarriage at 5 weeks gestation 2010

 16/02/11 – 9/40 - referred to MGP from ANC Booking in Visit

 06/03/11 – 12/40 – presented to ED with a post coital bleed, given Anti

 Attended an ultrasound. Findings included a sub chorionic haemorrhage plus a

 Discharged with follow up by GP

 08/04/11 – 16/40 - MGP visit, seen by GIT specialist prior and

 Regular ultrasounds – morphology scan and then growth scans at

 15/05/2011 – presented with UTI, treatment commenced