Midwifery Group Practice: A necessary step forward for rural Victorian maternity care

  • Cohuna District Hospital patients
By
Caitlin Fehring
Midwifery Group Practice Unit Manager
Cohuna District Hospital
Issue
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The landscape of rural maternity care in Victoria has been changing dramatically since 1992. Along with the rest of Australia, close to 50% of the country’s maternity services have faced closure, with safety, finance, and workforce shortages the main rationale.

In 2020 Cohuna District Hospital (CDH) also faced the possible closure of maternity services, with retirement of the sole practicing General Practice Obstetrician (GPO). This provided a catalyst to find a new way that delivered on the organisational principles of care, accountability, respect, and equality.

Recent research published by Fiona Faulks in the British Journal of Obstetrics and Gynaecology concluded that women able to access maternity care in their own community from a known midwife are more likely to engage with care, maintain contact with carer and disclose sensitive information, safeguarding the health of not only herself, but also her unborn baby – attributing to the well documented benefits of MGP such as increased incidence of spontaneous vaginal birth at term and reduced incidence of preterm birth and fetal or neonatal death.

Cohuna, located within the Loddon Mallee region of Victoria, services not only the local population of 2,428 individuals, but also a larger reaching population of approximately 7,000 including the shires of Campaspe, Buloke, Loddon, and Murray, with an estimated 105 babies born within this catchment each year. The nearest subregional maternity service is 45min away via road and the next regional maternity service is 1.5hrs away via road. There is a complete lack of direct public transportation between Cohuna and these maternity service providers.

A co-design approach with key stakeholders and consumers alike, determined a strong desire within the community to continue to access care as close to home as possible and leverage upon the documented benefits of continuity of carer to disadvantaged women such as those living in rural areas. The Midwifery Group Practice (MGP) was born from this co-design process.

Implementation of the MGP program at CDH was built upon the needs of the community, a willing and available workforce, and a determined executive team. A phased process to implementation was established to ensure sustainability and long-term feasibility, delivery of quality evidence-based care, and the ability to develop and support collaborative relationships across the region.

But what does this all mean for Cohuna? CDH has implemented a non-birthing MGP model of care, providing pregnancy and postnatal care to women as close to home as possible, be this onsite at the hospital or within the woman’s own home. When it comes to the provision of labour care the Cohuna MGP midwives also travel and support women under their care whilst birthing their baby at the sub-regional maternity service supported through collaborative care pathways across the region.

The Cohuna MGP team is in its infancy. We have 3 midwives working permanently within the program, able to care for 52 women each year. There is also an early career midwife providing contractual leave relief, whilst being given the opportunity to safely delve into the world of caseload care, which often requires a midwife to have more than 5years postgraduate experience. There has been a 96% increase in women receiving postnatal care within their own home by a known midwife, and a 120% increase in pregnancy care appointments delivered locally. These numbers correlate to individual women! Women who have been able to receive care locally, who have not had to travel countless hours and kilometers to the sub-regional or regional birthing service, and women who deserve the gold standard of maternity care in the world.

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