Opportunities of Midwife-led Continuity-of-care (MLCC) Models
Increase in the level of satisfaction
The main opportunities for the Midwife model of care it has a continuity care models. Under this, a known midwife or a small group of trained midwives assists the pregnant women through the process of the antenatal care, intrapartum care, postnatal care or postnatal continuum care. This is considered as a well practiced midwifery programmes (Perriman, Davis and Ferguson 2018). Daemers et al. (2017) stated that proper MLCC helps in improving the overall clinical outcomes for the women who are pregnant or has recently gave birth to their child. The midwives helps to increase the degree of satisfaction for the women who are passing through the antenatal care. The majority of the women who are from the poor socio-economic background value this model of relationship. This kind of relationship helps in improving the degree of trust with the pregnant women with the process of care and at the same time helps in increasing the overall access of care. The systematic review and meta-analysis conducted by Daemers et al. (2017) highlighted that the proper MLCC helps in increasing the scope of the personalised care plan and this is considered as the central aspect of the care for the child bearing woman. According to the principle of the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (2014), it is the duty of the nursing professionals to provide Quality of Practice (principle 3) and at the same time increase the overall trust and confidentiality of the process of care (principle 4) (Nursing and Midwifery Board of Ireland 2015).
ABC care is safe as it promote normality to decrease risk of interventions
ABC care is delivered by trained midwives and thus help in avoiding the chances of the still birth and premature delivery. This goes in association with the Ireland’s First National Maternity Strategy, Creating A Better Future Together (2016 to 2026) (Government of Ireland 2016). This strategy helps in reducing the mortality and morbidity while increasing the degree of normality via the help of interventions. The strategy also helps in identification that the some women have higher care needs and this must be followed by Supported Care, assisted Care and Specialized Care (Government of Ireland 2016). This care need is supported by the trained midwives as they have underwent CLU-Personal development for midwives. This coincides with principle 2 and principle 3 professional responsibility and accountability and quality of care (NMBI 2015). Principle 2 states that nurses must work in an accountable manner and delivering proper interventions to normalize the birth process helps in indicating the accountability of the nurses. Principle 3 emphasize towards improving the quality of care and normalizing helps in improving the normality of care.
Challenges associated with Midwife-led Continuity-of-care (MLCC) Models
The healthcare service users look puzzles
One of the challenge of the MLCC is certain cases, the pregnant women are not satisfied with the overall personal level of support they are receive during the process of the care. The condition of childbearing and the overall transition of the process of birth becomes an extremely sensitive period in someone’s life and during this one must have the required opportunity to receive the proper level of the personal support. The degree of the professional support given under the MLCC not always correspond to the needs of the pregnant women (Bäckström et al. 2016). There is gap between the understandings of the women’s customised need by the midwives. The women mainly perceive the professional support in midwifery care to be a factor reassuring as well as emotional. However, the midwives are at times are unable to understand the emotional need for the pregnant women during the process of child care and child delivery as MLCC has limited scope to indulge into a collaborative practice with other stakeholders like the nurses, psychologists, mental health professionals, physiotherapists, nutritionists and other directions. There is also a gap in the pedagogical creativity (Bäckström et al. 2016). This gap in pedagogical creativity decrease the level of satisfaction of the women. The women at times looks puzzle regarding the access of care as the majority of the section of MLCC is fragmented and this challenge both the midwives and the healthcare service users (Bradfield et al. 2019). This further decrease the scope of decreasing the healthcare access and at the same time increasing the risk of post-delivery complications and during the time of birth (Bradfield et al. 2019). The principle 5 of the Code of Professional Conduct for Ethics for Registered Nurses and Registered Midwives 2014 states that it is the duty of the nurse to work in proper collaboration with others (Nursing and Midwifery Board of Ireland 2015). Aquino (2018) are of the opinion that in order to increase the pedagogical creativity the midwives must take help from other nursing professionals and other allied healthcare professionals and this might help in streamlining the process of care and while increasing the degree of satisfaction of the service users. Hanafin and Dwan O’Reilly (2015) stated that the presence of the multiple stakeholders towards the process of the care delivery helps in increasing the safety of care.
Poor investigation of and management of the late fatal intrauterine death and still birth
The role of the trained midwives who have under-went CLU-Personal development provide enough support to improve the quality of care while reducing the degree of still birth, but they lack the required skills and investigation mechanism to track back the underlying reasons behind the failed in the domain of the intrauterine death and still birth. Thus creating gap in trouble shooting and designing more refined interventions (Khumujam and Podder 2019). Institute of Obstetricians & Gynaecologists (2013) stated that it must fall under the ABC of care that the nursing professionals and the trained midwives must come forward and conduct the necessary investigation of the still birth or delivery at the time of death under the guidance of the gynaecologists and thus helping to refine the process of care.
References
Aquino, M.R.J.V., 2018. Studies of midwives’ and health visitors’ interprofessional collaborative relationships (Doctoral dissertation, City, university of London).
Bäckström, C.A., Mårtensson, L.B., Golsäter, M.H. and Thorstensson, S.A., 2016. “It’s like a puzzle”: Pregnant women’s perceptions of professional support in midwifery care. Women and birth, 29(6), pp.e110-e118.
Bradfield, Z., Hauck, Y., Kelly, M. and Duggan, R., 2019. Urgency to build a connection: midwives’ experiences of being ‘with woman’in a model where midwives are unknown. Midwifery, 69, pp.150-157.
Daemers, D.O., van Limbeek, E.B., Wijnen, H.A., Nieuwenhuijze, M.J. and de Vries, R.G., 2017. Factors influencing the clinical decision-making of midwives: a qualitative study. BMC pregnancy and childbirth, 17(1), p.345.
Government of Ireland. 2016. National Maternity Strategy – Creating a Better Future Together 2016-2026. Access dare: 14th December 2020. Retrieved from: https://www.gov.ie/en/publication/0ac5a8-national-maternity-strategy-creating-a-better-future-together-2016-2/
Hanafin, S. and Dwan O’Reilly, E., 2015. Multiple stakeholder views on changes in delivery of public health nursing services in Ireland. British journal of community nursing, 20(8), pp.389-393.
Institute of Obstetricians & Gynaecologists. 2013. Investigation And Management Of Late Fetal Intrauterine Death And Stillbirth Access dare: 14th December 2020. Retrieved from: https://www.hse.ie/eng/about/who/acute-hospitals-division/woman-infants/clinical-guidelines/4-investigation-and-management-of-late-fetal-intrauterine-death-and-stillbirth.pdf
Khumujam, M. and Podder, L., 2019. Knowledge regarding fetal well-being among the Staff Nurses working in obstetrics and Gynecological wards.
Nursing and Midwifery Board of Ireland. Or NMBI 2015. Practice Standards for Midwives. Access dare: 14th December 2020. Retrieved from: https://www.nmbi.ie/nmbi/media/NMBI/Publications/Practice-Standards-for-Midwives-2015.pdf?ext=.pdf
Perriman, N., Davis, D.L. and Ferguson, S., 2018. What women value in the midwifery continuity of care model: A systematic review with meta-synthesis. Midwifery, 62, pp.220-229.
