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MIDWIFERY-RESEARCH  October 2009

MIDWIFERY-RESEARCH October 2009

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Subject:

Re: team midwifery

From:

Della Forster <[log in to unmask]>

Reply-To:

A forum for discussion on midwifery and reproductive health research." <[log in to unmask]>

Date:

Tue, 13 Oct 2009 14:15:03 +1100

Content-Type:

text/plain

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text/plain (142 lines)

I think that it is important to keep in mind though that the two caselaod trial included in the hatem et al review do not on their on provide evidence of the safety outcomes of caseload models and I we can not say that caseload models are significantly safer than team odels - while this may well be the case we don't have this evidence at the moment
 
Della Forster

________________________________

From: A forum for discussion on midwifery and reproductive health research. on behalf of Sandall, Jane
Sent: Mon 12/10/2009 6:08 PM
To: [log in to unmask]
Subject: Re: team midwifery


Dear Debra
If you look at our Cochrane review midwife-led care vs other models of care, which had a range of positive outcomes, you will see that 2 studies offered caseload and 9 offered team care. No home birth care was offered in any trial in this review. Levels of intrapartum continuity ranged from 63-98% in the midwife led models of care vs 0.3-21% for other models of care. Caseload size was 32-40 women in the caseload models.
So the evidence is there to support team midwifery, although when you compare outcomes between the two models,  there were statistically significantly fewer babies with lower apgar scores,  and fetal loss after 24 weeks in the caseload models. So there might be 'dose response' with the level of continuity.
Hatem M, Sandall, J. (Joint First Author and Contact Author) Devane D, Soltani H. Gates,S. (2008) Midwife-led versus other models of care for childbearing women, Cochrane Database of Systematic Reviews 2008, Issue 4.
 
We also did some work in London, assessing the implementation and impact of a move to caseload midwifery.
http://www.kcl.ac.uk/projects/1to1caseload
You can see the women's views about this model here. 

Finlay, S. Sandall,J. (in press online ) "Someone's rooting for you": Continuity and Advocacy in Bureaucratic Maternal Health Care Systems, Social Science and Medicine, doi:10.1016/j.socscimed.2009.07.029

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4X26XPX-4&_user=10&_coverDate=10%2F31%2F2009&_alid=1044081259&_rdoc=2&_fmt=high&_orig=search&_cdi=5925&_sort=r&_docanchor=&view=c&_ct=7&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=14c392461040fbe84f3538bc5d8f327e

 

Three community based group practices working in deprived areas offered total midwifery care to women at all risk levels. Six midwives were in the groups and ended up doing 35 births a year each. They booked more women than this and this varied by level of mobility of women. The midwives carried their own caseload, and did the majority of births in home or hospital and antenatal and postnatal care in office hours but shared on call for out of hours in different ways. The outcomes -  more home births, more births in MW led unit, higher breastfeeding and reduction of DNA rates. Access and experience  and some safety issues improved. See attached poster.

 

So lessons- women want to know who their midwife is, who to contact and to feel that the midwife knows them. teams larger than 8 have very little evidence to support them and plenty against in terms of very fragmented care. Most caseloads are around 40 women booked per midwife depending on level of complexity, It is possible for midwives to carry responsibility for their own caseload of women, provide care during office hours and share out of hours care with the team. It is better for women to develop a relationship with a midwife in the antenatal period rather than try to get her to see a different midwife each time. Expectations have to be managed about what can be offered in the intrapartum period. caseload size has to be managed otherwise they tend to creep up. Sticky areas to be addressed are - managing inductions, still having to cover GP clinics, making sure performance is audited and monitored by process and outcome rather than time sheets, training of midwives (see our web site for some audit and training assessment materials), managing on call incl different methods of payment.

 

Hope this is helpful

Jane

 
Professor Jane Sandall 
Professor of Social Science & Women's Health
Programme Director (Innovations) NIHR King's Patient Safety and Service Quality Research Centre


Department of Public Health Sciences

King's College London School of Medicine, 

Floor 7, Capital House, 42 Weston St 

London SE1 3QD, UK

Tel: +44 (0)20 7848 6261/6604
e-mail:[log in to unmask]
http://www.kingspssq.org.uk/
http://myprofile.cos.com/sandall
<http://www.kcl.ac.uk/about/campuses/guys.html>  
 
________________________________

From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] On Behalf Of Maggie Banks [[log in to unmask]]
Sent: 12 October 2009 05:19
To: [log in to unmask]
Subject: Re: team midwifery


Hello Deborah. Caseloads when midwives are employed by District Health Boards in NZ tend to be 40-50 women a year per midwife too - usually 40 - and they tend to work in pairs with someone from another pair providing the relief for holidays. I know when midwives work in shifts there are 4.5 midwives needed to cover 3 midwives for relief, holidays, education etc  and 1.5 do not carry a caseload. As far as I know large teams have been abandoned in NZ because continuity of carer is so hit and miss and women are dissatisfied with large teams. 

kind regards 
Maggie Banks 
  

Check out Birthspirit Midwifery Journal <http://www.birthspirit.co.nz/BirthspiritMidwiferyJournal/Issue2.php> 


15  Te Awa Road, RD 3, Hamilton, New Zealand 3283
Ph  64 7 8564612
Fax 64 7 8563070
www.birthspirit.co.nz <http://www.birthspirit.co.nz/> 
[log in to unmask] <mailto:[log in to unmask]>  

 

________________________________

From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Della Forster
Sent: Monday, 12 October 2009 2:31 p.m.
To: [log in to unmask]
Subject: Re: team midwifery



We go on 40 women per eft for teams of about 8 - that covers antenatal, most birth suite shifts and some postnatal coverage on shifts (at least one per day) with some ability to do dom care

 

So not that dissimilar to caseload numbers

 

Della Forster (Victoria, Australia)

 

________________________________

From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Debra Kroll
Sent: Monday, 12 October 2009 10:05 AM
To: [log in to unmask]
Subject: team midwifery

 

We are reconfiguring out community teams. Does anyone have up to date numbers on how many women should be allocated per midwife if the midwives:

a) work in teams  

b) and provide antenatal, intrapartum (on shifts) and postnatal care

 

I do not appear to find this information for teams (only for caselaoding) 

 

Thanks

 

Debra Kroll
Midwifery Lecturer in Practice UCLH /City University
Supervisor of Midwives



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