7. models of maternity Flashcards
Key features of evidence-informed maternity care
three C’s
- Choice
- Control
- Continuity
Universal access (equity is important)
Early pregnancy care
- Home pregnancy test
- Is a physiological process not a pathology
- GP visits
○ Booking bloods
○ Dating scan
○ First trimester screen FTS
○ Referral for maternity care - Do you have private health insurance
○ Problematic as it limits options (opens and closes doors) and private health insurance is declining as its too expensive - Choice of lead professional
○ Midwife: independent, caseload, teams, group practice, hospital-based
○ Obstetrician
GP obstetrician
Place of birth choice
why does this matter
- Homes
- Birth centre
- Private hospital
- Public hospital (out of pocket or private health care)
- If rural
○ Can be problematic and trick (not universal access)
○ On the side of the road due to bad health care in rural places maternity care plan can be bad, very different to the city sometimes having to travel far and wide which has big negative implications, expensive
Why does place of birth matter
- Must be private and safe
- Must reflect the environment baby was conceived in
- For optimal physiology for birth > large studies of these outcomes depending on the environment. Home > birthing centre > hospital. Less stressful and better outcomes
home birth pros and cons
- 2x demand for home birth during covid some 4 fold increase
Pros: - Labour efficiently (calm, familiar environment)
- Familiar people
- No journey to hospital
- No limitations to visitors/hours
Cons: - Emergency management for morbidity (lower rates for mortality)
Birth centre pros and cons
Pros
- Labour efficiently (calm, familiar environment)
- Home from home
- Emergency services at hand (depending on location of birth centre)
- No limitations to visitors/hours
- Usually caseload/MGP: know your midwife
- No charge
Cons:
- Emergency management (for some areas)
- Need to book in before 16 weeks of pregnancy
- Must have low risk profile
public hospital pros and cons
Pros:
- Collaborative care
- Access to all services (physio, clin psych, US dept, social services)
- Usually roster system for staff so no on-call tiredness
- Emergency care usually on hand
Cons:
- Rarely continuity
- Long waiting times sometimes other emergencies
private hospital pros and cons
Pros:
- Private obstetrician of your choosing
- Posh room and meals
- Longer postnatal stay
Cons:
- Significantly more intervention and higher LUSC rate
- Labour care with an unknown midwife until the time of birth
- Postnatal care variable staffing
lead professionals for maternity care
Midwifes (primary carers)
- Experts in primary maternity care
- Can provide emergency care
- Routine education and health promotion skills
Obstetrician (tertiary care)
- If tertiary care is needed
- More serious state of pregnancy like comorbidities
- Often in collaboration with midwife
- Most urgent needs and medical emergencies
GP’s
- Expertise in general primary care
- Less expert than midwife
midwifery lead models of care
- Private practice
- Birth centre
- Team or group midwifery: individual caseload but also share, continuity of care, also postpartum
- Caseload practice
models of practice pros and cons
caseload
Pros:
- Get to know your midwife; continuity of carer
- No conflicting advice
Cons:
- May not like your midwife
- No other opinions
- Co-dependency
models of practice pros and cons
midwifery group practice
Pros:
- Get to know your midwives; continuity of care
- Less conflicting advice
Cons:
- May not have primary midwife for the birth
models of practice pros and cons
shared GP and hospital
Pros:
- Close to home with family GP
- GP knows your full history
- Standard 7 min appointments
- May have a gap fee
Cons:
- No continuity for the birth
- Conflicting opinions between sharers
- No universal access
models of practice pros and cons
shared midwife and hospital
Pros:
- Close to home
- Bulk billed/ universal access
- Longer appointments 30 mins standard
- Midwifes have full prescription and service access and diagnostics
Cons:
- No continuity for the birth
- Conflicting opinions between sharers
models of practice pros and cons
public hospital and obstetrician
Pros:
- Expert care for high risk cases
- On call team available at all times
- Universal access
Cons:
- Long clinic waiting times
- Conflicting opinions between sharers
- Impersonal care
models of practice pros and cons
private practising midwife
Pros:
- Continuity of carer
- No conflicting advice
- Open choices
Cons:
- No insurance for homebirth
- Need for collaboration
- Possible co-dependency
- Maybe isolating
- Tiredness of midwife
- OOP Costs ~$3 – 5K
