Providing pregnancy care services

Different women have different needs in relation to pregnancy and childbirth and require access to appropriate levels of care AHMAC 2008. The level of care determines whether the woman is at the right place, at the right time, with the right health professional, for her clinical needs. Models of care should, as far as possible, provide a range of options at the same time as closely matching quality services to clinical needs AHMAC 2008.

7.1 Approaches to antenatal care

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 (Donnolley 2015):

• 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 being responsible for care of a small number of women (team midwifery) or a woman receiving care from one midwife or his/her practice partner (caseload midwifery).

As well as these health professionals, others who may have an integral role in the antenatal care team where available include Aboriginal health workers, maternity liaison officers, bilingual or multicultural health workers and sonographers. Child and family health workers, psychologists, nutritionists and drug and alcohol workers may also play a role in a woman’s antenatal care.

7.1.1 Collaborative practice

Findings from several comprehensive Australian maternity reviews have confirmed the need for maternity services to work within collaborative and consultative frameworks, 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.

7.1.2 Continuity of care and carer

The benefits of midwifery continuity of care when providing maternity services are well documented Sandall et al 2016, Homer 2016. Continuity of care is a common philosophy and involves 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
• adapting approaches to care that are locally successful.

7.1.3 Providing antenatal care for women with complex social needs

For 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.

7.1.4 Antenatal groups

A 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 (Catling et al 2015). 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 and language backgrounds, refugee women and women experiencing social isolation. However, the WHO guidelines on antenatal care WHO 2016 found that further research on the benefits of antenatal groups is required.

7.2 Resources

• NHMRC (2010) National Guidance on Collaborative Maternity Care. Canberra: National Health and Medical Research Council.