Implementation and upscaling of midwifery continuity of care: The experience of midwives and obstetricians

Problem: Despite high quality evidence supporting midwifery continuity of care, access to this model is limited in many parts of Australia and internationally. Background: The models of care provided to women have a strong influence on their perinatal experience and clinical outcomes. Midwifery Continuity of Care (CoC) is arguably the most significant factor in enhancing women’s clinical outcomes during child-bearing and facilitating a positive childbirth experience. Health system change is required, yet little literature has detailed the actualisation of this in the context of upscaling midwifery CoC. Research question/aim: This study aimed to explore the perceptions and experiences of midwifery and obstetric staff during the implementation and upscaling of midwifery CoC within a regional hospital and health service in coastal Queensland, Australia. Methods: A single-site, qualitative enquiry. Obstetricians and midwives participated in semi-structured interviews or focus groups at two-time points: within 2 months of introduction of the CoC service (obstetricians n = 6; midwives n = 15); and 2-years after implementation (obstetricians n = 5; midwives n = 17). Data were analysed thematically. Findings: Four key themes and several categories were generated from the data: hopes and expectations; clinical and practice changes; organisational and structural change; and, future directions. Discussion: Organisational culture, structural change, communication processes and collaborative relationships can be used to inform future scale-up and sustain midwifery caseload care. Specifically, communication, inter-disciplinary collegial relationships, and managerial support are crucial to the sustainability and ultimate upscaling of caseload midwifery care. Conclusion: System change is challenging, but in order to improve access to midwifery CoC is necessary