Midwifery Models of Care - Essay Example

Midwifery models of care Author’s name Institutional Affiliation Introduction Continuity of care is an ongoing therapeutic relationship between the client and one or more health providers. It involves a manner in which a gravid mother and the fetus or the newborn is taken care of before, during and after birth (Gibbs, 2004). This is done by providing the mother with personal advice regarding parturition process, comprehensive antenatal care whereby the mother is examined intensively to detect any defect that may complicate delivery and immediately intervening to avoid endangering the life of the mother and the baby. Continuity of care is important as personal association between the pregnant mother and the obstetrician or midwife leads to increased competency at work and perception of the importance of gestational care to both the mother and the fetus (Brook, 2012). There are better outcomes and prevention of many uncertainties. Comparison between case load midwifery model and shared care with GP model According to Gibbs, 2004 in his book; Achievements in Nursing, in caseload midwifery a pregnant mother is assigned one or a group of midwives who offer her perinatal care in the health facility and community follow-ups for at least six weeks following discharge from the clinical area. This model allows mothers and their relatives to be included in interventions regarding childbearing. In shared care model the mother is attended to by various staff in each meeting in certain setting which include midwives and physician who is normally a general practitioner, therefore there is no chance of providing personalized care to each mother. There is no mother or family involvement in intervention of care and the mother may develop anxiety due to provision of the same information over time to different health personnel when giving personal history. Antenatal services are brought near the mother’s community with delivery and postpartum services being offered within the facility in case load model. The mother is able to communicate with the case load health care provider about the onset of labor before being admitted in the labor ward. This reduces the duration of stay in the hospital and allows early intervention in case of any emergency. On the other hand shared care model the mother interacts with the midwife whom they have never met before which doesn’t provide proper interaction and timely management of labor. Mothers are encouraged to go home soon after delivery and are visited by their caseload care providers few days postpartum up to six to ten weeks after delivery at their homes while in shared care model the mothers are encouraged to stay at the postnatal ward to receive postpartum care and community follow up is made by a community assigned midwife incase of early discharge before 48 hours post spontaneous vaginal delivery and 72 hours post surgical delivery. In case load model antenatal assessments are directed to meet the needs of the mother at home while in the shared care model the mothers attend regular antenatal clinic according to the hospital protocols. Midwives match the amount of work to need such that a midwife takes care of predictable specific number of mothers per year in caseload model. In shared care model, midwives are assigned duties in respect to expected amount of work in the ward. Therefore, there is no defined number of midwives to be allocated in each shift. Women experience with caseload midwifery practice and woman experience with shared care with the GP model. Case load model encourages the use of less pain relief since there is less physical stress, reduced caesarean section risk, instrumental births, episiotomy and vacuum deliveries and perineal tears due to close monitoring and evaluation in antenatal period unlike in shared care with GP model where there may be unexpected complications and increased pain relief requirement due to lack of continuous assessment of the mother to rule out any risks that may lead to obstetric emergencies during antenatal period (Dawson, 2015).In case load, there are increased better breastfeeding rates due to continuous provision of knowledge through the gestation period using the same approaches while in shared care the quality of breastfeeding is comparatively poor since the mother may not get adequate education on breastfeeding. There is great satisfaction experienced by mothers who receive care using caseload model as their expectations and needs are holistically met. They have a chance to contact the healthcare providers that are assigned to them any time even by use of phone call. They can make more antenatal visits with no appointments with any issue they want addressed. Comparatively, in shared care with GP, the satisfaction level is lower as the contact time of the mother with healthcare providers is limited; they have no developed relationship with any of them and openness to seek information. The number of antenatal visits are also few and adhere to the institutional guidelines therefore there is no adequate preparation for delivery. In caseload model, there is enough preparation on the expected outcomes leading to proper preparation of the mother during and after delivery. This reduces the incidences of postnatal delivery and other postnatal mental conditions such as puerperal psychosis. On the other hand, the shared care model does not allow adequate maternal preparation for delivery experience due to the limited antenatal visits and contact with healthcare providers. This predisposes the mother to uncertainties that may lead to postnatal depression and puerperal mental disorders. Due to the adequate preparation of the mother with clear expected outcomes during labor in caseload midwifery model, there is reduced instrumental vaginal births, obstetric emergencies, perineal trauma and induction of labor while in shared care with GP, the mother is prone to obstetric emergencies, trauma to both mother and the baby and subsequently increased hospital stay which may not be cost-effective.. Woman experience with the shared care model with GP The continuity of care that is provided to the mother through this model by one career general helps the mother to receive specialized care. The care is individualized rather than generalized. The patient satisfaction is enhanced due to the closeness with one career GP with whom they develop a therapeutic relationship along. The good relationship with the general practitioner whom she is familiar with and who know their medical history make the mother more satisfied. There will be ease of understanding between each other and can arrange the specific issues that need to be addressed in the antenatal meetings. There is comfort, mutual trust, confidence and openness of the mother towards the GP as they get to know each other better and more issues are addressed before the expected day of delivery in preparation for perinatal period. The GP helps the mother make informed choices regarding their care and evidently the outcome will be better. Impact of the caseload midwifery model and shared case model on the midwifery practice. In caseload model the relationship development over time improves communication between midwife and the client, the mother feels good companionship through the antenatal period, receives increased attention and support from the health providers while the nurse feels at ease handling specified patients whose histories and progress is already known. It makes the care provision experience enjoyable and fulfilling. Contrary to that, in the shared care model the mother feels having inadequate attention as the nurse’s experience is tiresome as it involves providing service for different mothers daily. There is increased job satisfaction to the midwife due to the positive contribution and therapeutic relationship developed in the process of caseload management as there are more positive outcomes. In the shared case model, the nurse’s sense of satisfaction is poor as there may be more obstetric emergencies and uncertain outcomes. In caseload model the midwife who is on call may not have a pleasant experience as they are compelled to serve the allocated patients even when they are out of duty. This affects their personal life with the reduced time to attend to personal commitments. The shared case model gives the midwife chance to attend to their personal issues out of duty and change the environment. Prolonged time spent in caseload model as the midwife is on call throught leads to frustration, burning out, and goes through physical and psychological stress which may affect quality of their service delivery. Sharing care and GP model provides midwife with enough time off duty and therefore less stress and frustration experiences. Gradual development of midwife-client relationship in caseload model leads to more enjoyment by the midwife in delivery of satisfactory service as there is increased confidence and high expectations from the mother. In shared case model the high expectations from the midwife by the client might not be met and that leads to reduced interaction and enjoyment of the short term relationships developed. Bibliography Bale, B. (2012). Report on comparative trial of caseload managed midwifery care and team midwifery. Pontypridd: University of Glamorgan. Brook, C. (2012). The woman-midwife relationship in caseload midwifery in a birth center. St.Lucia: Qld. Dawson, K. &. (2015). Exploring midwifery students' views and experiencesof caseload midwifery:A cross section survey conducted in Victoria,Australia. Midwifery.31 , 7-15. Elliot-Cannon, C. &. (2005). Building a partinership. London: ENB and CCETSW. Fleming, A. (2016). Caseload midwifery:How teamwork makes familylife possible. Br J Midwifery.14(6) , 360-360. Gibbs, J. &. (2004). Achievements in nursing. Sydney: St.George Hospital and community service nursing and midwifery research council. King, T. &. (2014). Varney's midwifery. McGee, P. (2009). 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