Academic literature on the topic 'Midwives Victoria'

Substantial State Government funding has been committed in Victoria for the enhancement of maternity services. The funding is intended to improve the quality of care for women and meet consumer expectations for choice and continuity of care in maternity services. This paper reports on a mid-term review (the 'Review') of the Victorian Maternity Services Program, which was conducted by the authors on behalf of the Victorian Department of Human Services. Documentary analysis was conducted for the review, and workshops and key informant interviews were held throughout Victoria with midwives, medical staff and Department of Human Services staff. The Review found that there had been many gains as a result of the Maternity Services Program and identified directions for further development. Issues of change and facilitators of change processes in maternity services are highlighted in this article.

BACKGROUND:The use of complementary and alternative medicine (CAM) to manage pregnancy-related conditions is becoming increasingly popular. This article draws on a qualitative study that aimed to explain the processes midwives engaged when determining the role of these therapies for pregnancy care.METHODOLOGY:Our study used grounded theory methodology. Twenty-five midwives, who were employed in metropolitan hospitals situated in Victoria, Australia, participated in the study. Data was collected from semistructured interviews and nonparticipant observation of a subgroup over an 18-month period.RESULTS:Midwives’ attitudes and behavior toward the CAM was influenced by their professional ideology and knowledge. When participants considered the role of these therapies, they employed various strategies including aligning CAM with midwifery philosophy, using the therapies to increase women’s options, valuing diverse ways of understanding and seeking out professional knowledge.CONCLUSIONS:Although midwives do not reject conventional medicine, many value the opportunity CAM offers to individualize care and promote natural childbearing.

To address workforce shortages, the Australian Government funded additional nursing and midwifery places in 2009 pre-registration courses. An existing deficit in midwifery clinical placements, combined with the need to secure additional clinical placements, contributed to a serious shortfall. In response, a unique collaboration between Midwifery Academics of Victoria (MIDAC), rural and metropolitan maternity managers (RMM and MMM) groups and Department of Health (DOH) Victoria was generated, in order to overcome difficulties experienced by maternity services in meeting the increased need. This group identified the large number of different clinical assessment tools required to be being completed by midwives supervising students as problematic. It was agreed that the development of a Common Assessment Tool (CAT) for use in clinical assessment across all pre-registration midwifery courses in Victoria had the potential to reduce workload associated with student assessments and, in doing so, release additional placements within each service. The CAT was developed in 2009 and implemented in 2010. The unique collaboration involved in the development of the CAT is a blueprint for future projects. The collaboration on this project provided a range of benefits and challenges, as well as unique opportunities for further collaborations involving industry, government, regulators and the tertiary sector. What is known about this topic? In response to current and predicted workforce shortages, the Australian Government funded additional midwifery places in pre-registration midwifery courses in 2009, creating the need for additional midwifery student clinical placements. Victorian midwifery service providers experienced difficulty in the supply of the additional placements requested, due to complex influences constraining clinical placement opportunities; one of these was the array of assessment tools being used by students on clinical placements. What does this paper add? A collaborative partnership between MIDAC, RMM and MMM groups, and the DOH identified a range of problems affecting the ability of midwifery services to increase clinical placements. The workload burden attached to the wide range of clinical assessment tools required to be completed by the supervising midwife for each placement was identified as the most urgent problem requiring resolution. The collaborative partnership approach facilitated the development of a CAT capable of meeting the needs of all key stakeholders. What are the implications for managers and policy makers? Using a collaborative partnership workshop approach, the development of a clear project focus where all participants understood the outcome required was achieved. This collaboration occurred at multiple levels with support from the DOH and was key to the success of the project. The approach strengthens problem solving in situations complicated by competing influences, a common occurrence in health service delivery, and where unilateral approaches have not or are unlikely to succeed.

This modified Grounded Theory study explored the experiences of midwives working in a rural Victorian setting during a period of maternity service redesign. Changes to the local maternity service under study were block funded by the Rural Maternity Initiative, Victoria, Australia (Edwards & Gale, 2007). The Rural Maternity Initiative, along with the release of the maternity service review report (Commonwealth of Australia, 2009), incorporated women’s requests for continuity of care provision, demedicalised care, choice in care, and accessibility of services across the pregnancy, birth and postnatal period. Midwifery workforce shortages and maternity unit closures in rural Australia have been identified by the government, maternity service users and other stakeholders as factors reducing options, and increasing travel requirements, and social and emotional costs for women (Hoang, Le, & Ogden, 2014). Australian state and territory governments encouraged the redesign of maternity services with continuity models of care, more often caseload care or team midwifery, in an effort to combat workforce deficits and rural inequities (Commonwealth of Australia, 2009). A review of literature was undertaken to frame key points associated with Australian health and maternity provision, recent policy developments, health workforce strategies, models of continuity care and rural maternity care accessibility. Significant gaps were noted, relating to the experience of the maternity service restructure in the rural setting, and the relationship between the health services undergoing maternity redesign and local communities. A modified Grounded Theory methodological approach was undertaken, using symbolic interactionalism as the theoretical perspective to frame the study. The work of seminal theorists Glaser and Strauss (1967) informed the design methods employed, particularly that of constant comparative analysis, coding and memoing. A modified approach was taken, however, influenced by constructivist concepts. Charmaz asserts that rather than ‘discovering’ theory, data is socially constructed by study participants with reference to their individual circumstances (Charmaz, 2006). Developmental work by Blumer (1986) significantly influenced the theoretical perspective of this study, as an inquiry based on the lived experiences of a small group of midwives who were affected by maternity service redesign in one locality. In line with symbolic interactionism, this study seeks to understand the meaning these midwives placed on changes and the social interactions they attributed to their work environment. The research setting was a small, rural maternity service, with a select sample population of fifteen. Participants were theoretically sampled and semi-structured interviews were the primary method of data collection. Constant comparative analysis was employed throughout the study, during which time the researcher became increasingly and thoroughly immersed in the data. Coding and categorisation was completed using OneNote Microsoft software to demonstrate thematic saturation and emerging theoretical concepts. It was during this rigorous analysis of data that a deep appreciation and understanding of Grounded Theory methodology was achieved. Constant comparative analysis enabled repeated interaction with data, comparative assessment of literature in conjunction with further data collection, and self-examination by the researcher. Themes that emerged from the midwives’ experiences of maternity service redesign in the rural Victorian context reflected known elements such as midwifery retention rates and burnout (Mollart, Skinner, Newing, & Foureur, 2013), and change planning, change leadership and interprofessional relationships associated with sustaining continuity models of maternity care (Monk, Tracy, Foureur, & Barclay, 2013). Two key themes related specifically to the rural context were communication of maternity service change, and change preparedness inclusive of women, families and interwoven rural communities.

This study aimed to explore the current professional lives, roles and experiences of homecare midwives providing postnatal domiciliary care. The changing environment of maternity care in Australia, with limited resources, has resulted in a continual decrease in postnatal hospital length of stay. Early discharge has resulted in an increased number of clients requiring home visits and domiciliary midwives are attending to mothers and babies who are experiencing increased acuity. A literature review revealed there is a paucity of research pertaining to postnatal care in the home and postnatal care is marginalised in terms of the broader context of midwifery care. There were no available studies that specifically addressed domiciliary midwives’ experiences of care in the home environment. The research design for the study was critical ethnography. There were four ethnographic methods utilised: participant observation, critical conversations, field notes and reflective journalling. Seven domiciliary midwives participated in the study. Data analysis was comprised of three aspects: qualitative content analysis—summative, deep data immersion and qualitative thematic analysis—conventional. The results revealed the role of domiciliary midwives was embedded in their experiences and participants were expert practitioners. Seven themes exemplified their role: relating with intention, autonomy, assessment, prediction, management, education and advocacy. The experiences were characterised by three themes: role complexity and negotiation, personal validation and satisfaction, and professional undervaluing. This study has contributed to the existing body of knowledge by exposing the juxtaposed position of expert practitioners who are personally satisfied yet professionally undervalued. Domiciliary midwives are dedicated to excellent service provision, operating with a vast array of knowledge, skill and experience. Despite limited resources and a changing healthcare context the safety, health and well-being of mothers and babies was not compromised.

The importance of the role of the midwife in providing safe, quality care for women has until recently, been underrated in Victoria, Australia. Acknowledgement of the need for midwife-led models of care in state maternity service policies provided opportunities for midwives to become recognised within the healthcare system and the wider community. This professional doctorate aims to examine the ways in which the role of the midwife and her practice has been impacted on by organisational renovations of midwifery care. It identifies the complexity of the factors that affect the midwife’s ability or choice to work in midwife-led models of care. Furthermore this doctorate highlights the need for ongoing debate into midwifery in Australia. Concepts related to midwifery practice are examined as they form the foundations for the research and policy components of the portfolio. This includes an exploration of midwifery philosophy, the antecedents to autonomous practice and the experience midwives have of midwife-led care. An examination of the concepts of continuity of care and woman-centred care provides a platform upon which to review models of midwifery care. This review highlights the development of an ongoing relationship as a source of satisfaction for midwives and women. The second part of the doctorate reviews policies that guide the provision of maternity services in Victoria. Analysis of these policies using Kingdon’s multiple streams framework identifies the problems, the political actors and the policy developed, establishing the context for organisational change in maternity care. The antecedents for successful integration of organisational change are explored through a review of change theory and leadership. A case study approach utilised for the research component of the doctorate provides insights into organisational change that occurred at two maternity sites in Victoria. The findings of the study suggest there was a dichotomy between those midwives desiring autonomous practice and wanting to work in midwife-led care and those wishing to remain in one specialised area. Recommendations stemming from these findings include the need for sufficient education and support during change, a review of terminology used to describe midwifery models of care and research into the use of integrated maternity units. Complexity science is examined in order to bring the different strands of the doctorate together, providing an explanation for the different outcomes that occur despite the implementation of similar models. The connective leadership model was suggested as the means to provide leadership that is inclusive of providing direction, mentoring new leaders and providing support and opportunities for midwives to become empowered to practice autonomously. Attention to the complexity of organisational change is vital to ensure the future of midwifery.