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Why graduate midwives should work in continuity of care models

University of Technology Sydney midwifery lecturer
Photo: University of Technology Sydney midwifery lecturer Allison Cummins (right)
Only a small number of new graduate midwives are working in continuity of care maternity models across Australia despite universities educating students to work in the ‘gold standard’ of care, research shows.

Allison Cummins, a University of Technology Sydney midwifery lecturer and PhD candidate, says new graduate midwives are prepared and eager to work in one-to-one midwifery care, midwifery group practice and team midwifery - yet only about 30 newly graduated midwives are estimated to be working in continuity of care across the nation.

A practising midwife of 26 years and a former hospital clinical educator, Ms Cummins says graduates have limited opportunity to work in the renowned midwifery-led model.

Instead, most graduates complete the transition to professional practice programs in hospitals, where they often rotate through antenatal clinics, birth suites and postnatal wards.
“They lose their skills in the transition to professional practice program - they work in one area for three to six months and by the time they finish one placement, and they are rotated to another, they forget their skills,” Ms Cummins says.

“When you work alongside the woman and provide care throughout pregnancy, you care for around four women a month, so some will be pregnant, some will have given birth and some they will be on-call for, so you are using all of your skills all of the time, and your work is around the needs of women rather than around the needs of the organisation.

“In the transition to practice program, the midwives work around rostered shifts - whether there’s women in the ward or not.

“When they work in midwifery-led continuity of care models, they work when the woman needs them. It’s more woman-centred and they use all of their skills.”

Continuity of care, also known as caseload midwifery or one-to-one midwifery, is care provided throughout the pregnancy, birth and early parenting period from one midwife or a small group of midwives.

The model has been shown to reduce interventions, such as epidural anaesthesia, episiotomy and caesarean section operations, and Australia is experiencing a gradual shift in maternity services towards the midwifery-led models.

Ms Cummins, who has examined the experiences of new graduate midwives in continuity of care models, says an essential part of midwifery curriculum at university is for students to ‘follow through’ a number of women.

Yet, when job positions are advertised for continuity of care models, the criteria often lists a minimum of two years’ experience, which prevents new graduates from applying.

Ms Cummins says midwives are becoming frustrated with working in the fragmented hospital model of care, prompting some to exit the profession.

“When midwives provide continuity of care they are highly satisfied, they have good job satisfaction,” she says.

“There’s also a lot of fear mongering that midwives don’t have enough experience to work in continuity of care - what if something happens, what if the woman dies or the baby dies, you’re going to be held responsible.

“There’s a lot of fear mongering that’s not true. Nothing bad has happened as far as I know but bad things happen all of the time in the fragmented model because the midwives don’t know the women, they don’t know their history.”

In her qualitative descriptive study, Ms Cummins interviewed 13 new midwifery graduates working within continuity of care, who listed the benefits of the model as the relationship with both the woman and with the midwifery group.

“All of the midwives said they felt more confident and consolidated skills better when they know the woman, they know her history,” she says.

“They’ve known her since the beginning of the pregnancy, so by the time she goes into labour they know everything about her - her physiological requirements, her blood group, any problems she’s had in her pregnancy, how she’s going to manage labour - it’s really important.

“It’s like if you go to a hairdresser who knows what colour your hair is, what highlights and cut you want, and you don’t have to explain - it’s continuity.

“When you’re pregnant, you don’t want to turn up every visit and tell your story. Women really like continuity and midwives find it better to work in - it’s highly satisfying, it’s all about the relationships.”

Ms Cummins' other research into graduate midwives found mentoring support helps build their confidence in transitioning from student to practising midwife.

She says visionary leadership and managing myths that mothers and babies may be placed at risk with graduates working in continuity of care is critical to breaking down the barriers to employing new graduates into the models.

Ms Cummins says it's time health services began employing new graduates straight into continuity of care models.

“I would like to see the opportunity for all midwives to work in continuity of care - not midwives with two years’ experience - all midwives,” she says.

“We need more continuity of care models, and then to place graduates straight into those models with a skill mix, so the more experienced with the newer midwives, working together in the models.”

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords