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CASELOADMIDWIFERY  April 2005

CASELOADMIDWIFERY April 2005

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Subject:

Re: caseload midwifery in Ontario

From:

Vicki Van Wagner <[log in to unmask]>

Reply-To:

Caseload midwifery <[log in to unmask]>

Date:

Tue, 5 Apr 2005 00:07:16 -0400

Content-Type:

text/plain

Parts/Attachments:

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text/plain (289 lines)

Thanks Jane. VVW
----- Original Message -----
From: "Jane Kilthei" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, April 04, 2005 11:41 PM
Subject: Re: caseload midwifery in Ontario


Hi Vicki,
I think you mistyped the College of Midwives of Ontario website address -
it's www.cmo.on.ca

Similar information about the framework of caseload-based midwifery practice
in British Columbia cam be found on our website at www.cmbc.bc.ca  Our
Indications for Discussion, Consultation and Transfer of Care are very
similar.
Jane

Jane Kilthei
Registrar
College of Midwives of B.C.
[log in to unmask]
(604) 742-2234 (M-W)
(250) 715-1027 (Th-F)

-----Original Message-----
From: Caseload midwifery [mailto:[log in to unmask]] On Behalf
Of Vicki Van Wagner
Sent: Monday, April 04, 2005 7:31 PM
To: [log in to unmask]
Subject: Re: caseload midwifery in Ontario

In Ontario, midwives generally do not plan to care for women with medical or
obstetrical problems that would require ongoing primary care from an
obstetrician from the onset of pregnancy, as this is seen as a duplication
of services in our system. However, women with medical or obstetrical
problems that require consultation or temporary transfer of care (the
indications for consultation and transfer can be found on the web site of
the College of Midwives of Ontario www.cmo.org.ca ) are cared for by
midwives. If a problem which requires transfer arises after the woman is
under the care of the midwife,  the midwife does continue (and is paid to
continue) to provide care in association with medical staff. There is some
room for the midwife to use judgement here eg. a midwife may or may not
accept the care of a woman who has come into her care but very early it
becomes clear she will need
to be transfered to an OB.

The context here of course is that since midwifery is relatively "new" in
Canada there are far too few of us to meet the demand for our services. It
does not make sense to care for a significant proportion of women who also
need medical care when we turn many women away who could be cared for by
midwives only.

Hope this helps. VVW

----- Original Message -----
From: "Jane sandall" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, April 04, 2005 5:09 PM
Subject: Re: caseload midwifery in Ontario


> Dear Vicki
> Could you clarify whether midwives carrying a caseload look after women
> with
> obstetric and medical complications and attend their births or whether
> they
> look after women with no complications. When women transfer care in your
> system, do midwives continue to provide midwifery care in association with
> medical staff?
>
>
> PS you can download the evaluation report of the Albany Practice in SE
> London from our web site here
> http://www.kcl.ac.uk/nmvc/research/project/moreinfo.php?id=4&the_group=1
>
> bw
>
> Dr Jane Sandall
> Professor of Midwifery and Women's Health
> Women & Family Health Research
> Health and Social Care Research Division
> King's College, Waterloo Bridge Wing,
> 150 Stamford Street,
> London, SE1 9NH
> Tel: 020 7848 3605
> Fax: 020 7848 3764
> e-mail:[log in to unmask]
> http://www.kcl.ac.uk/nursing/research/women.html
>
>
>
> ----- Original Message -----
> From: "Vicki Van Wagner" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, April 04, 2005 8:39 PM
> Subject: caseload midwifery in Ontario
>
>
>> Chris - what you have reported below is very relevant to/confirms the
>> experience of and the evaluation results of the Ontario government's
>> review
>> of our midwifery system (not published but I will try to get you an
>> official
>> source). As many of you may know the Ontario system (and midwifery in
>> most
>> of Canada) is currently organized and funded based on "caseload
>> practice".
>>
>> Midwives are currently paid "full time" compensation for providing care
>> to
>> a
>> caseload of 40 births as primary midwife and 40 births as second midwife
>> (some of which are not  actually attended if there is a transfer of care)
>> as
>> we have a system where normally there are two midwives from the group
>> practice at each birth. Midwives can choose to provide care to a
>> part-time
>> caseload if they wish.
>>
>> We are also given an "overhead" fee per course of care to run our
>> practices -ie to rent a clinic, hire support staff, buy supplies and
>> equipment etc.
>>
>> All of this is currently under renegotiation so more specific details re
>> compensation levels etc may change soon.
>>
>> Vicki Van Wagner, RM, PhD(c)
>> [log in to unmask]
>> Associate Professor
>> Ryerson University
>> Midwifery Education Programme
>>
>> ----- Original Message -----
>> From: "Christine McCourt" <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Friday, April 01, 2005 1:18 PM
>> Subject: Re: Beg, borrow and steal
>>
>>
>> Hi Folks
>>
>> We have a general evaluation of caseload midwifery report which includes
>> economic analysis, and also a specific economic report - both from our
>> eval of the implementation of caseload midwifery at QCCH in London. Both
>> can be posted to anyone who wants them. if interested please contact
>> [log in to unmask]
>>
>> A later report (2001) evaluating the service several years down the
>> line, including economic evaluation, can be downloaded from our website
>> but it is just being re-jigged so I will post the web address when the
>> new site is live, next week.
>>
>>
>>
>> The important message from these studies (admittedly in one context) is
>> that caseload midwifery is not necessarily more expensive than
>> conventional care. This may seem counter-intuitive because people
>> perceive it as a more personal service, a bit of a luxury perhaps, but
>> there are inbuilt 'inefficiencies' in conventional hospital services.
>> For example, having women spend less time in hospital overall, or less
>> time with medics, can free up resources for midwifery input and
>> community-based services. If interventions are reduced, this may also
>> save resources, which are needed for one-to-one support in labour or
>> similar. whether such potential savings can be realised in practice may
>> depend on the local service configuration, cultural issues, ability to
>> tap into ongoing changes etc. It may require a lot of collaboration,
>> leadership and imagination, to facilitate the change.
>>
>> In these studies, we calculated that a caseload of 40 in an urban
>> context should be manageable. this means births per year for a WTE - mws
>> may pick up slightly more women given that some will have miscarriages
>> or move away.
>>
>> We also - from research on midwives' experiences, suggested that
>> midwives' with personal/partnership caseloads should not be used as a
>> back up cover for labour ward or similar, as the flexibility demanded of
>> them to cover for births on the caseload means they must have the
>> flexibility and autonomy to manage their work to ensure they take rest
>> time and are not overloaded. although caseload midwives might be
>> 'on-call' more frequently than with a team system, they should not be
>> expected to be called out for much of that time. The inevitable
>> occasional bad week should be balanced by the quiet ones
>>
>> Chris
>>
>>
>>
>>
>> -----Original Message-----
>> From:   Caseload midwifery on behalf of Forrester, Mandy
>> Sent:   Fri 4/1/2005 3:12 PM
>> To:     [log in to unmask]
>> Cc:
>> Subject:        Re: Beg, borrow and steal
>> Hi Chris,
>> Could you also send me the same?
>>
>> Thanks,
>> Mandy
>>
>>> -----Original Message-----
>>> From: Caseload midwifery [SMTP:[log in to unmask]] On
>> Behalf
>>> Of Christine McCourt
>>> Sent: 17 December 2004 10:58
>>> To:   [log in to unmask]
>>> Subject:      Re: Beg, borrow and steal
>>>
>>> Joy
>>>
>>>
>>>
>>> If you contact me, I can let you have some info on economic issues
>>>
>>>
>>>
>>> [log in to unmask]
>>>
>>>
>>>
>>> Dr. Christine McCourt
>>>
>>> Reader in Maternity, Health and Social Sciences
>>>
>>> Faculty of Health and Human Sciences
>>>
>>> Thames Valley University
>>>
>>> 32 Uxbridge Road
>>>
>>> London W5 2BS
>>>
>>>
>>>
>>> Tel: (44) 208 280 5287
>>>
>>>
>>>
>>> -----Original Message-----
>>> From: Caseload midwifery [mailto:[log in to unmask]] On
>>> Behalf Of Joy Kemp
>>> Sent: 14 November 2004 23:29
>>> To: [log in to unmask]
>>> Subject: Beg, borrow and steal
>>>
>>>
>>>
>>> Dear caseload list
>>>
>>>
>>>
>>> We (myself and a small group of colleagues) are shortly hoping to
>> begin
>>> work on writing a proposal for a caseload midwifery practice, targeted
>>> towards the most disadvantaged women in our local area (Maidstone and
>>> Tunbridge Wells in Kent).  There are a group of midwives committed to
>> such
>>> a way of working, but no financial support available from our trust.
>>> Unfortunately we are not eligible for sure start funding.  I hope to
>> get
>>> funding from the PCT and/or any other pots of cash anyone is aware of.
>>>
>>>
>>>
>>> I have read fairly widely, and we have done a workshop with the Albany
>>> midwifery practice in London.  However, we are keen not to re-invent
>> the
>>> wheel, so would be very grateful to hear from any of you who have been
>>> involved in setting up such a scheme.  I would be interested in copies
>> of
>>> any plans, proposals, etc - anything that would help us, and any
>> general
>>> tips on what to do/not to do.  Also, any literature which you would
>>> consider to be essential reading to get us started.  Also, if there
>> are
>>> other practices which are not too far away from us which would be
>> helpful
>>> to visit, we would love to hear from you.
>>>
>>>
>>>
>>> Many thanks
>>>
>>>
>>>
>>> Joy Kemp
>>>
>

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