Following a successful application for a Florence Nightingale Foundation travel scholarship, I completed two observation visits one to New Zealand and one to Denmark to explore models of midwifery care. My focus consisted of three main elements: exploration at a clinical level and lessons we can learn to improve our clinical model of continuity; exploration at a strategic level to learn lessons about sustainability of continuity models, monitoring and regulation exploration at researcher level to explore research priorities and interests and consider topics for further research and potential collaboration. The purpose of the paper is to provide insight into the models of care as observed in my trip to inform discussion and debate within clinical, educational and strategic midwifery fields in relation to continuity of care and future design of midwifery models in the UK.
The New Zealand model is based on a philosophy of trust in both women as consumer and midwives as skilled professionals. At all levels there was a commitment to the value of autonomy; a feeling of safety in people holding the responsibility for their decisions. I was interested that in New Zealand, despite a full commitment to continuity and partnership working with women, the decisions women were making were not necessarily reflective of an increase in normality. The Danish model had adapted the New Zealand philosophy to include continuity of carer models into main stream maternity care and explore making these models of care sustainable for midwives. To maximise benefit from lessons learnt in practice it seems prudent to work together internationally on improvement, innovation and research. I have used the lessons learned from my travels to influence the way we model our maternity care in Powys for a remote and rural population and developed a pilot quality improvement project to test out new ways of working in the community.
The trips have reaffirmed my belief in continuity and the importance of building trusting relationships with women. Shared decision making based on a mutual understanding would appear to be important rather than a blind commitment to a woman’s choice even when that choice has implications for systems, resources or other women. What seems important is being able to understand each other and choose a midwife with whom a woman can form a connection. What is important when transferring the principles to the UK is to be mindful of sustainability and realistic support for midwives’ work life balance and resilient cultures. Powys Maternity Services will explore and evaluate an eighteen month pilot group practice model, working in pairs with women as part of a four midwife group practice type approach. The 18 month pilot will be evaluated. At the same time it is possible that New Zealand will explore a similar model of employed midwives within one Health Board and some collaboration around researching the two pilots could be explored. It would interrest me to visit San Sabastian and extend my exploration of midwifery models of care.