Service ‘game-changer’

Wimmera Health Care Group leaders are working to introduce a new model of care they believe will be a ‘game-changer’ for maternity services in the Wimmera-southern Mallee.

Yandilla nurse-midwife unit manager Michelle Coutts is heading up a project to design and implement a new model of care as part of a complete overhaul of maternity services in Horsham.

Mrs Coutts said Wimmera Base Hospital was committed to implementing a new model as part of a revision of its maternity service to ensure it was ‘safer, efficient, cost-effective and sustainable for the future’.

She said what that would ultimately look like would depend on the outcome of six months of extensive research, stakeholder and community feedback and planning.

“First and foremost, Wimmera Base Hospital should be a place where women want to birth – and not just birth here because they have to,” she said.

“We provide good care but we need to provide a much more contemporary, evidence-based maternity service.”

The hospital provides obstetric services in Horsham Rural City, Hindmarsh, West Wimmera, Northern Grampians and Yarriambiack municipalities, primarily on a ‘shared care’ basis between midwives and obstetric doctors.

Mrs Coutts said the new model of care would most likely be based on the ‘caseload’ model, which she said was the ‘gold standard’ of maternity care.

Caseload involves one midwife – and back-up midwives – taking care of a woman throughout pregnancy, labour, birth, postnatal stay and home visits.

The assigned midwife would be oncall to provide care during labour and birth as well as available to answer any queries.

Mrs Coutts said the caseload model was primarily focused on the principle of ‘continuity of care’.

“At the moment, unless a woman comes to Yandilla to get checked out, when she goes into labour she is usually cared for by people she doesn’t know,” she said.

“With a caseload model, the patient forms a relationship with a midwife in a clinical setting, who works collaboratively with a doctor.

“Caseload is first and foremost about women and their families, and we know that continuity of care leads to much better antenatal and obstetric outcomes.

“Evidence demonstrates that women experience better outcomes when midwives are the primary maternity care providers and work collaboratively with other providers to coordinate maternity care.”

Mrs Coutts said an important aspect of the caseload model was improving communication between midwives and doctors.

“This project is absolutely about improving the collaboration between the obstetric, midwifery and allied health workforce and each discipline working to their full scope and areas of expertise,” she said.

Mrs Coutts said the project also involved creating an antenatal clinic, separate from the Yandilla maternity ward.

“At the moment our services are squashed into a little space and we can do so much better,” she said.

Mrs Coutts said project leaders would work on determining the most appropriate location for the clinic.

She said if the hospital adopted a caseload approach, all women who birthed in Horsham would be cared for within the model.

“It’s quite different from how we provide care on Yandilla at the moment,” she said.

“As part of the project we will also be completely overhauling all the birth education we deliver.

“We also want to redecorate and repurpose areas of Yandilla.

“Our new model of maternity care is all about providing not only continuity of care for women and their families – it is also about providing care that is accessible, equitable, culturally safe and absolutely woman-centred.

“What we implement at Wimmera Base Hospital will also be contemporary.”

Under the caseload model, midwives would work in the antenatal clinic, on the ward and out in the field.

The hospital’s midwives are currently required to have dual qualifications and must be Registered Nurses, RNS.

“Many of our midwives would prefer to work solely in midwifery, rather than sharing their time between midwife duties and general patients,” Mrs Coutts said.

“At the moment, we can’t hire anyone who isn’t an RN as well as a midwife, but if we offered a standalone service, we would be able to.

“This would enable midwives to work within their scope of practice and not lose their skills due to working in other areas as well.”

Mrs Coutts said attracting more midwives to the service – a difficulty many organisations throughout the country are also experiencing – would decrease reliance on agency staff, who were expensive.

She said introducing a new model of care would create long-term cost savings, including in regard to staffing.

She said freeing up beds for general patients, with women cared for postnatally in their homes, would also save money long-term.

Mrs Coutts said extensive community consultation, via formal working groups and informal focus groups, would help inform the process.

“I want to give women an opportunity to share their stories and opinions in a very safe and informal space,” she said.

“I know what I think, but I want to know what the community thinks as well. At the moment, nothing is set in stone and there is plenty of scope for change – that’s what this project is all about.”

• For more on the community consultation process, see next week’s The