An overview of the first 'no exit' midwifery group practice in a tertiary maternity hospital in Western Australia: Outcomes, satisfaction and perceptions of care

Abstract

Background: Midwifery group practice (MGP) is a care model offered by a primary midwife in a small team. Evidence confirms MGP is acceptable to women, safe and cost effective.

Methods: We aimed to provide a systematic overview of the first 'no exit' MGP in a Western Australian (WA) tertiary maternity hospital, using a mixed methods approach, involving four phases. Between July 2013 and June 2014: phase one assessed MGP characteristics, obstetric and neonatal outcomes by parity; phase two examined women's satisfaction by mode of delivery; and phase three qualitatively explored perceptions of care. Phase four compared the proportion of MGP women and the 2012 WA birthing population.

Findings: Phase one included 232 MGP women; 87% achieved a vaginal birth. Phase two included 97% (226 of 232) women, finding 98% would recommend the service. Phase three analysis of 62 interviews revealed an overarching theme 'Continuity with Midwives' encompassing six sub-themes: only a phone call away; home away from home; knowing me; a shared view; there for me; and letting it happen. Phase four compared the MGP cohort to 33,393 WA women. Intrapartum MGP women were more likely than the WA population to have a vaginal birth (87% vs 65%, P≤0.001) and intact perineum (49% vs 36%, P≤0.001) and less likely to use epidural/spinal analgesia (34% vs 59%, P≤0.001), or have a caesarean (13% vs 35%, P≤0.001).

Conclusions: Mixed methods enabled systematic examination of this new 'no exit' MGP confirming safety and acceptability. Findings contribute to our knowledge of MGP models.

Keywords: Caseload midwifery; Childbirth; Continuity of care; Midwifery group practice; Women's experiences.