Sadly the caesarean section rate in WA has skyrocketed to 37.8% of all births. Leading this disturbing trend are private Hospitals such as St John of God Murdoch and Subiaco at 57.4% and 50.4% ( 2017). I advocate “Continuity of care” and Midwifery group practice as the preferred option for maternity care in low risk women.
To access Midwifery care that is based on a continuity of care model going public is generally your best option. In recent decades “continuity of care” has become an overarching principle in Australianand international models of midwifery and woman centered care. This is thanks to research findings that have consistently validated the benefits of this model for women and their babies. Continuity of care implies that a midwife is the primary health care provider throughout the antenatal period, birth and including the initial phase of parenting. The traditional model of care common in Australia and many developed countries is to see an obstetrician or doctor in a hospital or clinical setting in dispersed with visits to a midwife or nurse that is randomly allocated (Sandall et al., 2016).
Two common continuity of care models are; Team Midwifery and Midwifery Group Practice (MGP). The distinction between team and group midwifery can be blurry however group midwifery tends to imply care from a primary midwife in a smaller group practice with a work schedule that is organized around the needs of women who are part of her caseload (Hartz et al.,2012), in team midwifery women will experience the care of a number of midwives, the intention being that one of the team will then be present at the birth(Biro et al., 2000). In both “continuity of care” models midwives typically work within a woman centred framework with a shared philosophy. The right to respect, dignity, safety empowering women, offering choices, expectant management and the use of interventions only when necessary are some of the commonalities that resonate with my personal philosophy.
In Australia MGP typically operates under the umbrella of a public hospitalwith approximately 30% of hospitals offering MGP or caseload midwifery and servicing around 8% of pregnant woman. In order to access and be eligible for MGP women need to live in or around the metropolitan area and be classified as being at “low risk” (Dawson et al., 2016). Should something go wrong there is scope for MGP practitioners to care for women in collaboration with conventional medical and obstetric care, which is one of many strengths of this model.
Rebecca Tanner BSC, ND, Dip Acu, Masters in Repro Med (UNSW)