“A highly trained, qualified and effective primary maternity service workforce, working collaboratively, to use increasingly scarce respective skills efficiently, is the key to developing and sustaining quality primary maternity services.” (AHMAC 2008)
Australian women are likely to receive antenatal care in primary and hospital settings and to see a range of health professionals. Existing models of care include:
- public hospital care — the woman attends the hospital for all aspects of her antenatal care and receives care from hospital doctors and midwives;
- GP care — the woman sees her GP throughout her pregnancy;
- private obstetrician or private midwife care — the woman sees her private obstetrician or midwife throughout her pregnancy;
- private obstetrician and private GP — the woman sees her GP regularly during the antenatal period with specific visits to an obstetrician;
- shared care — several health professionals are involved in the care of a woman during pregnancy, often in the context of a formal arrangement; health professionals involved may include GPs, midwives, other primary care health professionals, specialist obstetricians and hospital practitioners;
- midwife care — midwives are the primary providers of care for the woman; this may be through a team of midwives sharing a caseload (team midwifery) or a woman receiving care from one midwife or his/her practice partner (caseload midwifery).
5.1.1 Collaborative practiceFindings from several comprehensive Australian maternity reviews have confirmed the need for maternity services to work within collaborative and consultative frameworks, in order to more closely match services to women’s needs, preferences and expectations (AHMAC 2008). Midwives, obstetricians and GPs can all make valuable contributions to collaborative antenatal care (AHMAC 2008).
In maternity care, collaboration is a dynamic process of facilitating communication, trust and pathways that enable health professionals to provide safe, woman-centred care. Collaborative maternity care enables women to be active participants in their care (NHMRC 2010). It includes clearly defined roles and responsibilities for everyone involved in the woman’s care, especially for the person the woman sees as her maternity care coordinator (NHMRC 2010).
Collaboration also involves working within established clinical networks and systems to facilitate timely referral and transfer to appropriate services when required (AHMAC 2008). Collaborative networks within these systems are critical for enabling access to safe effective quality services (AHMAC 2008).
5.1.2 Continuity of care and carerThe benefits of continuity of care and carer when providing maternity services are well documented (Homer et al 2008). Continuity of care is a common philosophy and shared understanding of care pathways by all professionals involved in a women’s care, with the aim of reducing fragmented care and conflicting advice. Continuity of carer is when a health professional who is known by the woman provides all her care, thus enabling the development of a relationship.
Factors that may improve continuity of care include:
- sharing of information (eg through documenting of all assessments) — this reduces the need for a woman to repeatedly “tell her story”;
- collaborative development of management plans — this ensures that they are matched to locally available resources;
- developing linkages and networks; and
- adapting approaches to care that are locally successful.
5.1.3 Providing antenatal care for women with complex social needsFor women with complex social needs, maternity care may be provided in partnership with other agencies including children’s services, domestic violence teams, illegal substance use services, drug and alcohol teams, youth and adolescent pregnancy support services, learning disability services and mental health services (UK Dept Health 2007; cited in Homer et al 2008).
5.1.4 Antenatal groupsA model of antenatal education and support where women set the agenda (as opposed to being told what their health professionals decide they should know) can provide women with the opportunity to learn from each other and build their own support network (Homer et al 2008). Women may learn and retain knowledge more readily through hearing other women’s stories or experiences.
Antenatal groups may provide a sustainable alternative to the delivery of antenatal care for health services experiencing significant demand and limited resources. Antenatal groups can also be used to meet the needs of specific groups of women, such as adolescent women, Aboriginal and Torres Strait Islander women, women from specific cultural backgrounds, refugee women and women experiencing social isolation.