Making the case for Midwifery Caseload Practice

21 January 2021

A new model of care may help alleviate the issue of midwife shortages in regional areas such as Waikerie, ANMF (SA Branch) CEO/Secretary Adj. Associate Professor Elizabeth Dabars AM has told the ABC.

It was revealed this week pregnant women in labour turning up to Waikerie Hospital face being transferred to other sites due to a shortage of midwives and nurses.

Speaking on ABC Radio Riverland today, Ms Dabars said the issue of staff shortages and the retention and recruitment of   staff to regional areas needed a more “overarching, strategic approach’’.

“We are looking at a very significant shortfall of nurses and midwives, particularly specialising ones, into the very close future, over the next 5 to 10 years. That urgency really is building,’’ Ms Dabars said.

“And the concern is if you haven’t got a plan in place, if you don’t have a strategy, and also you’re not necessarily taking into regard changing models and changing educational programs, that eventually it will just wither on the vine.

“The question that needs to be asked in order to get to the solution is what kind of models of care are being used in the region and how does that now connect with modern practice and also the modern education programs and expectations of midwives exiting the system,’’ Ms Dabars told the ABC.

She said a new model of care, Midwifery Caseload Practice,  “involves rather than the woman turning up to the hospital at their time of birth and then seeing whichever midwife is on duty, there is a caseload whereby the midwife is allocated a number of women who are in the process of pregnancy.

“And they really follow that woman, they connect with the women before the birth, provide prenatal care, then they attend at the birth and then they provide all the postnatal care and services.

“It’s a very, very good model and one that is worthy of consideration because it actually means that you can service a community more broadly and potentially with less staff that you would need to actually put on general shifts.

“It’s a model worth considering … particularly when you also understand that there has been a fairly significant change to the educational model, whereas in the past it was a very common thing for a person to undertake their registered nursing qualification and then undertake a postgraduate speciality in midwifery.

“But these days you can actually emerge from the university sector as a singly qualified midwife which means that there are issues in these country regions which are emerging because about half the graduates now simply have a single qualification because that’s their area of passion,’’ Ms Dabars said.

As a consequence specialising graduates are not qualified to work in other areas of nursing outside of midwifery and may find themselves stuck on a rotating roster or being asked to work outside of their scope of practice.

The caseload model - working with multiple women in a regional area - would allow them to concentrate solely on their chosen profession.

“That Midwifery Caseload model, as part of a range of choices for women can be a very good choice for a woman to make when they really want that comfort and care from prebirth, during birth and post-birth with a single midwife working in partnership,’’ Ms Dabars said.

“Your attention is directed very specifically to those women, so in fact rather than stretching people across a system where they are required to do this, that and the other and turn up to shifts on that rotating roster and just wait for whoever turns up, it can actually be more efficient and more effective.’’