Women's and staff views: an evaluation of maternity care at Barwon Health
Additional Document Info
Executive summary and recommendations
In 2008 Barwon Health (a regional hospital in Victoria with approximately 2000 births per year) implemented major changes to the provision of maternity care, with new approaches being taken in postnatal care and in models of maternity care provision.
Postnatal care changes commenced in January 2008 and comprised a more flexible, individualised approach to care, with a focus on normalising the postnatal period. The changes were in response to the growing evidence from Australia and overseas that the care provided in hospital in the early postnatal period may be less than optimal for both women and care providers. That is, that the care may not meet the individual needs of the women in the limited time they spend in postnatal wards in hospitals, and at the same time, many midwives have reported that postnatal care provision is challenging.
A caseload midwifery model of care – known as the ‘Midwifery Group Practice’ (MGP) commenced in July 2008. MGP is a one to one midwifery model of care in which women are cared for by a primary midwife throughout pregnancy, birth and the early postnatal period. Women receiving MGP care receive antenatal, intrapartum and postpartum care from a primary midwife with one or two antenatal visits and other care as necessary conducted by a ‘back-up’ midwife, and consultation with and referral to other care providers as required.
An evaluation of these changes (known as ‘WAVE - Women’s and staff views: an evaluation of maternity care at Barwon Health’) was undertaken by Mother and Child Health Research (MCHR), La Trobe University, in collaboration with Barwon Health. The evaluation was multi-faceted, evaluating both the postnatal changes and the introduction of the MGP. It included three cross-sectional surveys of women (251 women who gave birth before any changes (time point one, TP1), 230 women who gave birth after the changes to postnatal care (time point two, TP2) and 289 women who gave birth after the implementation of MGP (time point three, TP3); surveys of midwives at two time points (50 following introduction of the postnatal changes and immediately prior to the introduction of MGP and 50 two years later); and key informant interviews with eight women, five midwives and 13 other key stakeholders. Four focus groups were undertaken with midwives involved in postnatal care provision. The health outcomes of women (and their babies) were explored comparing all births in 2007 with all births in 2009, and an economic evaluation of the changes undertaken.