Approve Midwifery Group Practice for continuity during pregnancy, birth and postnatal care

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We are asking for the Midwifery Group Practice (MGP) model of care to be made an available service by the Bundaberg Hospital. Currently the hospital only provides fragmented care where women see numerous care givers and birth with the midwife who is rostered on at the time. MGP is an alternative model of care that facilitates continuity of care allowing expectant mothers to build relationship and give birth with a known midwife. Continuity of care is shown to have numerous benefits for the mother and infant. These include though are not limited to the woman being more likely to have a normal birth, have a more positive experience of labour and birth, be satisfied with her maternity care, successfully breastfeed her baby and the baby is more likely to be born healthy and at term.

Midwifery group practice has been implemented across most Hospital Health Services in Queensland because it is in high demand by women and midwives, it meets workforce needs, is cost effective and improves the health and well being of all mothers and babies regardless of risk status. Years of high level evidence clearly shows that midwifery models of care – specifically caseload care – is the safest, most cost effective model for women and their babies. There are improved outcomes for women of any risk and lower intervention rates. Women and babies are healthier with better short and long term outcomes. 

Commencing an MGP model would benefit the community and the health service. Currently MGP is offered in surrounding hospitals of Hervey Bay, Rockhampton, Gladstone and Mackay. The women of Bundaberg and surrounding areas deserve to have the choice to birth in such a model of care. 

It is relatively easy to develop the model and midwives will want to come to Bundaberg to work in this model of care. Midwives provide care to approximately 40 women per year and mostly only come in to the hospital when the woman is birthing. Antenatal and postnatal care including early discharge is done in the community decreasing the demand on the hospital services. 

Strong, healthy families start with a positive birth, we ask for your support to take a step towards improving our community through making MGP model of care available locally here in Bundaberg and ensuring the best model of care is in place for expectant mothers and the most vulnerable members of society to give them the best start at life.



Extensive evidence for Midwifery Group Practice and be reviewed under the folowing studies:

The M@NGO Trial: Does caseload midwifery reduce caesarean section operation rates? Hartz, Donna et al. Women and Birth , Volume 26 , S8 - S9 

Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. 2013 Tracy, Sally K et al. 2013The Lancet , Volume 382 , Issue 9906 , 1723 - 1732 

Comparing satisfaction and burnout between caseload and standard care midwives: findings from two cross-sectional surveys conducted in Victoria, Australia. 2014 Michelle S Newton, Helen L McLachlan, Karen F Willis and Della A Forster. BMC Pregnancy and Childbirth201414:426

Lee YY, Roberts CL, Patterson JA, et al: Unexplained variation in hospital caesarean section rates. Med J Aust. 2013, 348-353. 

Roberts CL, Tracy S, Peat B: Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. BMJ. 2000, 321 (7254): 137-141. 10.1136/bmj.321.7254.137.

Dahlen HG, Tracy S, Tracy M, et al: Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open. 2012, 0: e001723-doi:10.1136/bmjopen-2012-001723.accessed 23/01/2014

Hyde MJ, Mostyn A, Modi N, et al: The health implications of birth by caesarean section. Biol Rev. 2011, doi:10.1111/j.1469-185X.2011.00195.
Tracy SK, Tracy MB: Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data. BJOG. 2003, 110 (8): 717-724. 

Allen VM, O'Connell CM, Farrell SA, et al: Economic implications of method of delivery. Am J Obstet Gynecol. 2005, 193 (1): 192-197..
Commonwealth of Australia: Improving maternity services in Australia: report of the maternity services review. 2009.

Declercq E, Young R, Cabral H, et al: Is a rising cesarean delivery rate inevitable? Trends in industrialized countries, 1987 to 2007. Birth. 2011, 38 (2): 99-104. 10.1111/j.1523-536X.2010.00459.x.

NHS Insititute for Innovation and Improvement UK: Promoting normal birth. 2011, UK: NHS Institute for Innovation and Improvement, UK
New South Wales Health: Maternity - towards normal birth in NSW PD2010_045. 2011, Sydney, Australia: NSW

Sandall J, Soltani H, Gates S, Shennan A, Devane D: Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2013. 

Tracy SK, Hartz DL, Tracy MB, Allen J, Forti M, Hall B, White J, Lainchbury A, Stapleton H, Beckmann M, Bisits A, Homer C, Foureur M, Welsh A, Kildea S: Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. Lancet. 2013, 382: 1723-1732. 

McCourt C, Stevens S, Sandall J, et al: Working with women: developing continuity in practice. The new midwifery. Edited by: Page LA, McCandlish R. 2006, London: Churchill Livingstone Elsevier, 141-167. 2

Page L, McCourt C, Beake S, et al: Clinical interventions and outcomes of one-to-one midwifery practice. J Public Health Med. 1999, 21 (3): 243-248..

Page L: One-to-one midwifery: restoring the "with woman" relationship in midwifery. J Midwifery Womens Health. 2003, 48 (2): 119-125. 

Hartz DL, White J, Lainchbury KA, et al: Australian maternity reform through clinical redesign. Aust Health Rev. 2012, 36 (2): 169-10.1071/AH11012. 175
Knight M, Sullivan EA: Variation in caesarean delivery rates. BMJ. 2010, 341: c5255-10.1136/bmj.c5255.

Australian Bureau of Statistics: Perinatal deaths, Australia, 2009. 2011, Canberra: Australian Bureau of Statistics

Bryant J, Porter M, Tracy SK, et al: Caesarean birth: consumption, safety, order, and good mothering. Soc Sci Med. 2007, 65 (6): 1192-1201. 

Stavrou EP, Ford JB, Shand AW, et al: Epidemiology and trends for Caesarean section births in New South Wales, Australia: a population-based study. BMC Pregnancy Childbirth. 2011, 11: 8-10.