TITLE Providing Continuity of Care during Antenatal Period for High-risk Pregnancy

TITLE: Providing Continuity of Care during Antenatal Period for High-risk Pregnancy

Date 3/10/215

Policy Issue

For quite long, the discussions regarding distinct methods of maternity care have been far above the ground. It is worth noting that, these discussions emerges as a result of quality and safety of midwifery distinct methods of care they undertake. On other hand, the government have tried to dilute the debate by introducing several reforms to improve maternity care, especially the high risk pregnancy. However, these interventions haven’t fully diluted the debate regarding the antenatal pregnancy care policy. Some of the reasons for continuity debates

  • There are only few trials or evidence to show the best possible outcome of continuity-of-care regardless of risk factors.

  • Women who are experiencing certain issues during their pregnancy are faced with additional anxiety of having to meet different midwives throughout their antenatal care.

  • The charges for midwife are not universal, and only few people can access it.

What does the evidence say?

As noted by Menke et al (2013), it is approximated that 25 percent of maternal deaths normally take place during the antenatal care. Additionally, almost a third or half of maternal deaths emerges as a result of diseases like antepartum haemorrhage and hypertension (pre-eclampsia and eclampsia), which are definitely correlated to insufficient antenatal care. Cost is another red tape hindering women from accessing antenatal care. The following studies were conducted by distinct researchers (Teate, 2010 and Loretta et al 2014) in order to determine anxiety, trust, cost and the quality of midwife services as well as their availability.

Teate (2010) conducted a study in the health care experiences that impact patient trust among women. The focus groups were carried out with 33 postpartum and prenatal women, who were aged between 18 and 45 years. All those participants were selected from community-based public as well as private prenatal care programmes. The data was collected by audio-recording, transcribed and thereafter coded by independent readers. All factors affiliated with trust were categorized on distinct major thematic. On their result, they noted some factors impacting trust in between patient and providers are, effective communication, continuity of the provider and patient relationship, perceived competence and demonstration of caring.

It was noted that, majority of women possessing less trust or with anxiety with their midwife reported an unwillingness to adhere their advice. Other women had more trust with nurses or doctors than midwife due to greater contact with these nurses or doctors. On other hand, there were some women who indicated less trust due to discrimination experience as they lack health cover (insurance).

In July 1st 2009 to December 31st 2010,there was a comprehensive study conducted by Loretta et al (2014) across Australia in order to determine the cost and quality of antenatal care. The study involved 1,379 women (participants), whereby they had significant distinct in birth outcome. In their findings, the first time ‘high risk’ mothers who had undergone through caseload care were more likely to possess a unstructured onset of labor as well as an unassisted vaginal birth 58.5% in MGP when done comparison with 30.8% with Private obstetric care (p &lt 0.001) and 48.2% for Standard hospital care. When comes to cost, the average cost of antenatal care for the standard primipara in MGP was found to be $3903.78 per woman.

Another serious issue found by another study conducted Loretta et al (2014) in Australia is inadequate midwife availability. From study, a lot of women responded that their care suffered as a result of midwife being busy or insufficient numbers of midwifes. Some key issues emerged such as not being ‘listened to’ or medical files or record disappearing, all triggered by lack of enough numbers of midwifes. Some women responded that they were left alone at home, and they felt nervous or afraid by the limited contact with midwifes. There were some other women who didn’t receive their medication on time as a result of midwife shortages or long delays before they receive assistance during their antenatal care period.

For instance, Respondent 117: “My medication was not given at the correct times as the midwives were ‘too busy’. I was not helped with the baby which made me feel afraid and nervous”.

What is the quality of the evidence available?

When comparing studies in other health care units, it is noted that maternity care has only few studies conducted recently. The facts provided regarding given techniques of antenatal pregnancy care is very limited. As a result, it is not easier to come out with an ultimate conclusion regarding providing continuity of care during antenatal care period for high-risk pregnancy.

It is worth noting that, findings conducted by randomised controlled trials (RCTs) are regarded as the most credible source in the health care. Forlornly, it isn’t practicable to undertake RCTs in antenatal care. Women are the ones to decide their method of care during antenatal, and they don’t reveal their decisions to researchers. Now, the only available option is a retrospective cohort. When comes to this study, expectant mothers have to decide on the kind of care they want during pregnancy and where they are going to get it. There are many places where this service is provided, depending on where the person resides, and through that, researchers are able to conduct a comparison from distinct methods of antenatal care.

The advantage of applying cohort studies in continuity care is it uses diverse data from fundamental registries, such as birth registries and among others. It’s very crucial to gather data from fundamental registries in order to obtain the figures required to conduct statistical analysis of fairly rare events, like continuity care. However, there are always two sides in a coin. Despite the merit for this method sounding more promising, there is a limitation to this method. A researcher may not obtain an accuracy or reliable data from aggregated fundamental registries data.

In addition, there is a limitation to many studies, as they have failed to come out with enough risk factors. For instance, women without enough education or have low education levels might not be able to secure a good-paying job that can enable them to afford health care visits. Moreover, those women with low income might reside in places far from health care providers. Therefore, it is not easier to determine exact factors affecting women deeply or how they interrelate.

What does this mean for Policymakers?

Pregnant mothers experiencing more complications can have their antenatal care provided by midwives (Menke et al, 2013). During the visits with midwifes, you will be served by one or more midwifes at different stages. Another option for pregnant women is to see their general practitioners instead of the usual midwives. However, in this arrangement, you will still be required to visit the midwives in the hospital where you are scheduled for delivery. According to Menke, Fenwick, Brittain and Creedy (2013), this arrangement is called shared care. Not every general practitioner can offer shared care. Before a general practitioner is allowed to offer this care, they need to undergo additional training. Private care options also exist for people who can afford to pay the cost. This allows you to select a midwife to offer the care to you. If you are using your insurance cover to make the payments, confirm that the service is covered. You can also hire a private doctor who works with midwives to assist in the delivery of their services.

When your time for delivery comes, you can chose to deliver in a public or private hospital. As noted by Menke et al (2013), this will depend on where your midwife will be available. The midwife will be there to help manage your situation and during your delivery (New South Wales Health Policy Directive, 2010).

It is important to have a midwife who will take care of you during pregnancy, at delivery and even after. There are many midwifes who can provide the service you want. If you do not know anyone, there are various ways through which you can identify the right option. According to Teate (2010), you can ask your general practitioner to recommend someone you can work with. Another option is to visit hospitals near you and ask about the doctors working there. Women with high risk pregnancies are the ones who need to find a midwife to work with. However, this kind of care may be in a limited number of hospitals (Queensland health, 2012). You need to establish if there is one with such facilities in your location. If you have a special case, you need to locate a midwife who will give you the care and attention you require.

Antenatal care is very important. As noted by Menke et al (2013), many mothers lose their lives and babies too, due to poor care. Proper antenatal care for mothers should be extended in rural areas too. If managed properly, even high risk mothers will deliver safely. The government ought to create awareness to the public about the importance of seeking antenatal care as soon as women become pregnant. Doctors will evaluate your situation and determine the kind of care that is suitable in your case (Department of Health and Social Services Government of the Northwest Territories, 2012).

Policy Recommendations

In light of these research results, several practicable policy recommendations can be stipulated with the aim of enhancing continuity of care during antenatal period for high-risk pregnancy.

  • The state government ought to come out clear on their position regarding the antenatal care period for high-risk pregnancy through a devoted policy approach. If the state government pledges support for antenatal care, it must fund it and provide legislative means, which will effectively transform antenatal care.

  • The government ought to introduce new polices to include an obligatory antenatal care assessment. This will widen the antenatal care coverage as well as assisting other policies on implementation.

  • Enhancing financial aid to unprivileged women who cannot access antenatal care due to its high cost. Getting rid of financial barriers is one key element to enhance the equity of access to antenatal care. Additionally, the government ought to provide a free antenatal care to all women, since majority of women cannot fully afford the cost of antenatal care as well as delivery. The government can do so by partnering with insurance companies or private companies who will decrease the premium for antenatal care cover or waived it fully as part of CSR (social corporate responsibility). Also, the government can also implement a free antenatal care for women from disadvantageous position, so as to allow all women to have a quality care during antenatal period. The merits of implementing free antenatal care will outweigh demerits by far in the long run. For example, the government will be able to creates more jobs, reduce the cost of fighting against diseases and boosting the economy though productive peoples.

  • The government needs to improve the quality of antenatal care by increasing the number of midwifes so as to enable them to handle the ever increasing number of women who requires antenatal care services.

  • The government should implement policy for mothers with high risk pregnancies to avoid lifestyle behaviours that put their babies at risk. Smoking, drug and alcohol use are some of the habits that complicate pregnancy

References

Australian Collage of Midwives (2011). Know Your Midwife. The Benefits of Continuity of Care. Retrieved on 02/03/2015 from http://www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccm

Menke. J, Fenwick. J, Brittain. H and Creedy. D, K. (2013). Midwifery group practice for socially disadvantaged and vulnerable women: Midwives perceptions of organizational structures and processes influencing 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 on the 03/03/2015, from http://www0.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_017.

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

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

Loretta C McKinnon et al, (2014). What women want: qualitative analysis of consumer evaluations of maternity care in Queensland, Australia. BMC Pregnancy and Childbirth , 14:366.

Department of Health and Social Services Government of the Northwest Territories (2012). Midwifery Program review and Expansion Analysis.Midwifery Options Report. Retrieved on the 02/03/2014.fromhttp://www.hss.gov.nt.ca/sites/default/files/midwifery-options-report.pdf

Annotated Bibliography

Australian Collage of Midwives (2011). Know Your Midwife. The Benefits of Continuity of Care. Retrieved on 02/03/2015 from http://www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccm

Focus: The AMC constitutes the midwifery practices and provides evidence guidelines and reports to midwives. This report presents the evidence based reviews on continuity-care-model with a known midwife has optimum outcome for women and their families.

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

Focus: This study relives the midwives belief in proving an excellent service to socially disadvantaged and vulnerable pregnant women, and midwives gaining satisfaction from working in partnership with women and working across their full scope of practice.

Department of Health and Social Services Government of the Northwest Territories (2012). Midwifery Program review and Expansion Analysis.Midwifery Options Report. Retrieved on the 02/03/2014.fromhttp://www.hss.gov.nt.ca/sites/default/files/midwifery-options-report.pdf

Focus: This report projects on primarily to provide recommendation to help enhance the quality of antenatal care available to NWT families by increasing access to midwifery services.

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

Focus: The policy was endorsed in 2010 as part of the NSW health and families support package. The package contains polices and guidelines for the early dictation of vulnerable families through comprehensive primary care assessment model. This package also highlights the strategies, equality and clinical practice principles that includes working in partnership with families.

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

Focus: In this pilot study the author talks about implementing Centering pregnancy in Australia. The conclusion of this study highlights the facts that by centering the pregnancy enables midwives to enhance their antenatal care model by developing a relationship between the women and their midwives that was necessary for professional fulfillment and the satisfaction of relationship based care.

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

Focus: The aim of this policy implementation is to provide continuity model, because they are highly popular with women as well as there is high quality evidence of improved outcomes.