Providing Continuity of Care during Antenatal Period for High-Risk Pregnancy

PROVIDING CONTINUITY OF CARE DURING ANTENATAL PERIOD FOR HIGH-RISK PREGNANCY 9

Providing Continuity of Care during Antenatal Period for High-RiskPregnancy

Providing Continuity of Care during Antenatal Period for High-RiskPregnancy

Policy scope

In Australia, just as it is in most parts of the world, the models ofmidwife care provision for pregnant women exists while there areareas where the models of family physicians and obstetricians providethe care required by pregnant women. Notably, not all women requirespecialized care due to pregnancy complications. Small percentagesdevelop pregnancy-related complications and are perceived, ashigh-risk cases hence require close attention. While all pregnantwomen require close observation and prenatal care, there are thosecases, which do not require any form of special attention. InAustralia, however, care for pregnant women is compulsory sincebooking in until delivery (Australian Collage of Midwives, 2011).Good midwifery according to research requires that a pregnant womanbe assigned to one midwife who will be testing and observing thewellbeing of the woman throughout pregnancy unlike having to meet adifferent and new midwife, any instance the pregnant woman requiresmedical attention. Structural as well as policy weakne&shysses areblamed on complicating this model of midwifery and, therefore, exposepregnant women to higher risks because of a lack of appropriate andspecialized care by one caregiver throughout the pregnancy. Thepurview of the policy paper is to evaluate and recommend policyguidelines through the philosophy of provision of continuityantenatal care to women at all health institutions and at all levelsof health provision within Australia.

Aims and objectives

The paper provides a significant a clear-cut policy framework throughwhich continued antenatal health care can be delivered to all womenwithin the country, regardless of the health care facility visited,the social, economic class as well as the stage of pregnancy. If thepolicy guidelines to be proposed would be rightly implemented, theAustralia would realize a complete shift of effectiveness in theantenatal care service delivery as has been experienced. Policyrecommendations will be directed towards the primary caregivers, thegovernment, and pregnant women. Thereby initiating a holisticparadigm shift in the manner, the topic has been handled previouslyas well as improving antenatal service care delivery in the country.The rationale and aim of this policy are to provide access to qualitymaternal care to all women while keeping the health of the pregnantwoman and the newborn baby on priority. Thereby preventingunnecessary deaths by either or both the expectant woman and or thechild.

Policy philosophyrecommendation: The philosophyemphasized by this policy is on having perpetual care provision by aknown person or a team in order to ensure safe and healthy delivery.It is worth noting that continuity antenatal care can be offered byteams or assigned to a particular person who will take allcorrespondence to all cases regarding the woman during pregnancy andafter birth. In the case reviews provided, this paper identifiesvarious literatures through which the continuity models have beenimplemented. Through the analysis of these cases, this paper developspolicy recommendations by which the continuity model can be betterexploited in Australia.

Midwifery literaturereview

According to the article ‘Australian Collage of Midwives’ (2011)there are various literatures which focus on the role of a midwifeand best practices to be adopted for guidance in practice. Through areview of a continuing care model, the literature highlights thatsuch a model becomes more efficient and optimum results are realizedwhen one midwife is assigned to a particular case. The focus istherefore on the importance of such specialized care for all womenduring pregnancy in order to minimize the occurrence and fataleffects of such complications as are uncommon. The emphasis isequally on enforcing such a policy as would guide continuity careprovision by a team of experts or a person work together but in thesame case. Another study conducted by Menke and the team (2013)sought to evaluate the perceptions of caregivers to vulnerable casesespecially to the socially disadvantaged persons. The paper notesthat antenatal care should be basic and accessible to all personsregardless of their social class. The paper also evaluates theperceptions of midwives on structures and processes observed inhealth care facilities and the possible means through which theyinfluence care delivery.

Another report by the ‘Department of Health and Social Services’by the Northwest Territories government (2012) focused on the role ofprimary care providers in ensuring that antenatal care is availableto all families in the region. Therefore, recommend the increase ofmidwives of effectiveness in service delivery. In a 2010 policydirective from the health ministry in South Wales, a comprehensiveprimary care assessment model was established where policies to carefor all identified vulnerable families are outlined. This packagealso highlights the strategies, equality and clinical practiceprinciples that include working in partnership with families. Teate(2010) outlines a pilot study through which he talks aboutimplementing Centering pregnancy in Australia. The conclusion of thisstudy highlights the facts that by centering the pregnancy, itenables midwives to enhance their antenatal care model by developinga relationship between the women and their midwives as necessary forprofessional fulfillment and the satisfaction of a relationship basedcare.

Turnbull et al (2009) authored a paper that talked about the caseloadmidwifery model of antenatal care. The paper outlined variousstrategies that community-based hospitals in Australia have embracedin the past and had great success. A caseload midwife model couldhave had great success in the country prior to the continuity modelthat proves more profitable. Another policy directive from Queenslandgovernment (2008) enhances the primary maternity service models asthe preferred method of providing maternity services to women withuncomplicated pregnancies. This policy also highlights the safety andeffectiveness of primary maternity services that underpins thecollaborative provision of services framework to the care providers,which ensures effective assessment, access to secondary services, andtimely referral In 2012, the Queenslandhealthcare department drafted a policy implementation guideline to beenforced within the entire population but targeting the pregnantwomen. The aim of this policy implementation was to provide acontinuity model because they are highly popular with women as wellas there is high-quality evidence of improved outcomes.

Implementation processes

The policy guideline supported by this paper is about having thegovernment enforce the law that all pregnant women attendingantenatal clinical care be assigned a particular caregiver. Unlikebeing assigned to any caregiver whenever they come for the services.According to Berg (2005), the childbearing women have been consideredto be at high risk. However, conditions that hindered women fromhealthy pregnancy are now being dealt with because of the medicaldevelopments that have taken place in the last decades. Nevertheless,it must be appreciated that the implementation process may facevarious challenges as explained by various levels of health caredelivery and the fact that there are public facilities of serviceprovision while others are private institutions. However, this policybrief recommends implementation of the policy through three stages asshown below.

First stage:involves thegovernment

In this stage, the role of government is to make clear communicationof the policy to all service providers, as well as the public. Thegovernment would then ensure that the structural frameworks andenough service providers (midwives) are available within each levelof antenatal health care provision.Second stage: involvesthe caregivers

Midwives are the main component of this policy and they have theresponsibility for ensuring effective and efficient services areaccorded to the pregnant women. Proper training, as well asprofessionalism, is the prerequisite to the implementation of thepolicy. Therefore, this implies that health care institutions mustensure that the midwives hired are up to the task of ensuring thatantenatal services are provided through high standards ofprofessionalism and integrity. Through training, the midwives shouldbe empowered on the importance of having one mother assigned to onemidwife for continuity until the woman gives birth.

Third stage: involves the pregnant women

The public should be enlightened on their rights to free and qualitymidwifery services across the entire country. Nevertheless, foreffectiveness, pregnant women should be educated on the importance ofobserving discipline while attending antenatal care and the need toidentify with the assigned midwife in order to ensure quality servicedelivery and continuity.

Conclusion

In conclusion, the policy ofproviding continuity health care during antenatal period,especially for high-risk pregnancy cases can be implementedeffectively and efficiently through the three stages the governmentstage, the service provider stage as well as the pregnant womenstage.

References

AustralianCollage of Midwives (2011). Know Your Midwife. TheBenefits of Continuity of Care.Retrieved on 02/03/2015 fromhttp://www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccm

Berg. M. (2005). A Midwifery Model of Care for Childbearing Women atHigh Risk: Genuine Caring in Caring for the Genuine. The journal ofperinatal education. 14(1): 9–21. Doi: 10.1624/105812405X23577

Department of Health and Social Services Government of the NorthwestTerritories (2012). Midwifery Program review and ExpansionAnalysis. Midwifery Options Report. Retrieved on the02/03/2014.fromhttp://www.hss.gov.nt.ca/sites/default/files/midwifery-options-report.pdf

Menke. J, Fenwick. J, Brittain. H and Creedy. D, K. (2013). Midwiferygroup practice for socially disadvantaged and vulnerable women:Midwives perceptions of organizational structures and processesinfluencing care. Midwifery.http://dx.doi.org/10.1016/j.midw.2013.12.015

New South Wales Health Policy Directive (2010). Ministry of Health.Maternal &amp Child Health Primary Health Care Policy. Retrieved onthe 03/03/2015, fromhttp://www0.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_017.

Queensland Government Policy Directive (2008). Queensland Health.Clinical Governance for Midwifery Models of Care. Retrieved onthe 03/03/2015, fromhttp://www.health.qld.gov.au/qhpolicy/docs/pol/qh-pol-074.pdf

Queensland health (2012). Delivering continuity of midwifery care toQueensland women. A guide to implementation. Retrieved on the03/03/2015. Fromhttp://www.qcmb.org.au/media/pdf/Midwives%20Imp%20guide_web.pdf

Teate. A, J. (2010). The experiences of midwives involved with thedevelopment and implementation of Centering-Pregnancy at twohospitals in Australia. Retrieved on the 02/03/2014 fromhttps://opus.lib.uts.edu.au/research/bitstream/handle/2100/1005/02

Turnbull D, Baghurst P, Collins C, Cornwell C, Nixon A,Donnelan-Fernandez R, et al. (2009). An evaluation of Midwifery GroupPractice. Part I: clinical effectiveness. Women &amp Birth: Journalof the Australian College of Midwives. 22(1): 3-9.

Berg. M. (2005). A Midwifery Model of Care for Childbearing Women atHigh Risk: Genuine Caring in Caring for the Genuine. The journal ofperinatal education. 14(1): 9–21. Doi: 10.1624/105812405X23577