Additional questions from the community Here are answers to questions that have been asked by the community. The questions and answers have been grouped to make it easier to follow the topics. 1. Philosophy and environment a. Exactly how is the hospital going to maintain Family Birth Centre philosophy in the new model of care? b. In earlier questions you stated that you will maintain the home like environment of the Family Birth Centre and mentioned a number of aspects. Can you confirm that the double beds will stay also, so that partners can sleep overnight, should the mother’s stay extend beyond the normal 6-12 hour stay? A: We assure the community that the Maternity Group Practice model of care shares a low intervention philosophy. There is published evidence that this model results in low intervention rates and high patient and staff satisfaction and we are very excited to be able to offer this care to women and their families. The comfortable, safe environment that the Family Birth Centre is known for will remain the same, including the double beds. Overall, we expect that this model of care will enable more women and their partners to stay in their Family Birth Centre room. As has always been the case, some interventions will need to occur in birth suites to ensure the safety of women and our staff. 2. Doctors and guidelines a. Under the Maternity Group Practice (caseload model), will midwives work autonomously from doctors? If so, how will this be ensured? b. Under the current Family Birth Centre model of care, doctors are called on to intervene in a labour according to clinical guidelines regarding complications and at the midwife’s discretion. This is what many consider central to the family birth centre model – that it is truly midwife led. Under the new model, how will you ensure that doctors only intervene in births when midwives see the need? Will the clinical guidelines that enable this be maintained in the new model? c. Will clinical guidelines that relate specifically to the Family Birth Centre within the broader maternity services clinical guidelines be maintained? Are they being reviewed? When will the new guidelines be made available to staff? d. The existing Family Birth Centre has obstetricians as part of the team. Maternity Group Practice will also have obstetricians as part of the team. The primary care will be provided by a midwife, as is currently the case, and other support will be sought as needed. A: Mercy Hospital for Women builds all care models around trust, respect and collaboration between clinicians to provide the best possible care to women and their babies. We have a range of skilled clinical specialists on staff. Mercy Hospital for Women also promotes patient centred care. This means that patients are closely involved in decision making about their own care. Consistent with current Family Birth Centre practice, Maternity Group Practice midwives will communicate with the rest of the clinical team once a woman is admitted in labour. This is to ensure that a collaborative and professional approach is taken to ongoing care. Obstetricians will continue to be part of the clinical team at the Family Birth Centre as they always have, and will continue to be available as our midwives see fit. There are currently no specific clinical guidelines relating to pregnancy or labour care in the Family Birth Centre. We have standard clinical guidelines that apply across our various models of care. All Mercy Hospital for Women guidelines are based on evidence and best practice. Our clinical teams are continually developing new and updating existing procedures and guidelines to ensure a high standard of care. All guidelines and procedures are made available to all staff as they are developed. Maternity Group Practice means that a primary midwife will be coordinating care of the woman. There will be a broader team that includes obstetricians who are available for consultation and review as required. The vast majority of the care will usually be provided by the midwife. Collaborative care means that a team of professionals including midwives, obstetricians, physicians, allied health (eg physiotherapy) etc are available when they are needed. Cases will be discussed with the broader team as is considered best practice. Again, this doesn’t mean that everyone becomes involved but they are aware of the patient’s history if they are required. 3. Currently, women in Family Birth Centre model have one standard doctor’s review appointment to clear risk and if the pregnancy remains low-risk, there is no need to be seen by the doctor again. What is the minimum number of doctor appointments women will have in Maternity Group Practice? A: A medical consultation is provided to most women booked to birth at Mercy Hospital for Women, including the Family Birth Centre. Recently, a number of our midwives have been trained in advanced antenatal assessment, which will reduce the need for a routine medical consultation. All midwives working in the Maternity Group Practice model will be expected to complete advanced antenatal assessment training. We therefore anticipate that medical appointments will progress to an as-needed basis rather than the current routine appointment schedule. As has always been the case, the Maternity Group Practice midwife will be able to assess if a medical consultation is required. The midwife will also be able to discuss any issues with an obstetrician and plan a medical consultation if required. 4. Maternity Group Practice model, research and breastfeeding a. Has Mercy Hospital for Women done any research comparing outcomes, obstetric interventions, breastfeeding rates and patient satisfaction between the Maternity Group Practice (caseload model) and Family Birth Centre model? If so, what did it find? b. Would the hospital consider introducing the Maternity Group Practice (caseload model), while also maintaining the Family Birth Centre model, providing women with the choice of both models of care? c. What is the reason behind replacing the Family Birth Centre model of care? A: Mercy Hospital for Women has not directly compared Maternity Group Practice and the current model practised in the Family Birth Centre as we have not had Maternity Group Practice in place. We did, however, conduct a two year review of our maternity models of care and found there is a better model for low intervention care. The team who led this work included midwives and an obstetrician. This team visited other hospitals around the country to see the various models in practice and to learn about current best practice. Maternity Group Practice has been researched and there is published evidence about the efficacy of the model. This is a contemporary model and is well supported by women, midwives, obstetricians, maternity advocacy groups, professional associations and peak bodies. We are not considering running both models as we are now aware that there is a best practice low intervention model of care, which has proven low intervention, high satisfaction and high breastfeeding rates. We are replacing the previous model as only a limited number of women were able to access it, and also due to the model’s high transfer rate. The new model will mean more women will not only be able to access the Centre, but will also remain in the Centre during the birth. 5. Has a cost comparison been done between Maternity Group Practice (caseload model) and the Family Birth Centre model? If so, what did it find? A: This is not a financially driven change, and has been made on the basis of improving the clinical care we provide to mothers and their babies as based on their feedback. We believe operational costs in Maternity Group Practice will be similar to the existing model. 6. Transfer and medical Intervention a. One of the concerns identified by Mercy Hospital for Women with the current Family Birth Centre model is the number of women transferring to the conventional birth suites to get intervention, including minor interventions. Why has Mercy Hospital for Women chosen to replace the model rather than reviewing the transfer criteria in the Family Birth Centre clinical guidelines to allow more women to receive minor interventions? b. Another concern identified by the hospital was that when women are transferred to the conventional birth suites when in labour due to complications, they lose access to their midwife carer. Did the hospital consider increasing the number of staff rostered on at the Family Birth Centre to enable midwives to be able to go with the woman to the conventional birthing suites when transferred out? A: Maternity Group Practice addresses both the transfer out rate and also the number of women who can access the low intervention birth model that the Family Birth Centre is dedicated to. This means that a larger number of women will be able to book and stay in low intervention care. We considered all reasonable options for transfers and continuity of care. Maternity Group Practice allows midwives to stay with mothers as they are transferred and has the added significant benefit of one to one care. Many women pay a high fee for this type of care and we will be able to provide this free of charge in a public hospital. This is a significant advance in patient centred care. 7. Will medical inductions and epidurals be offered in Family Birth Centre rooms under the new model of care? A: As has always been the case, the double beds in the Family Birth Centre make it unsafe for our staff to administer epidurals so women choosing epidural pain relief would need to be moved to a birth suite room while remaining under the primary care of their midwife. Discussions are ongoing regarding which interventions will be safe, possible and appropriate in the Family Birth Centre rooms. 8. Length of stay a. If women need to stay longer than the 6-12 hours postnatally on a medical basis, will they remain in Family Birth Centre rooms or will they be transferred to the postnatal ward on the fifth floor? If they are transferred, will partners be accommodated? b. The hospital has said that under the new model of care women who have uncomplicated births will have a 6-12 hour stay after birth. On what basis was this length of time selected, when the current Family Birth Centre and many other hospitals offer at least a 24 stay (of course, women can leave earlier than this if they choose)? c. How many women do you realistically expect to be discharged in the 6-12 hour time frame and will there be criteria for women to meet prior to discharge? A: The amount of time women stay will be dependent on their individually assessed clinical need. We do anticipate that some women will choose a shorter postnatal length of stay (6-12 hours) as women will have had the opportunity to individually prepare in advance for discharge with their midwife. Their midwife will also be on call and visit them in their home in the postnatal period. If women require a longer stay, they will usually be cared for on the postnatal floor. If women are clinically well, a partner package room will be offered if available. This is the same process currently used for women who require postnatal transfer from the Family Birth Centre area. Several interstate hospitals offer this program with a comparable length of stay. It is a very popular model of care for women with demand continually exceeding the hospital’s ability to provide care for women in this way. Given the duration of stay varies between women, it’s impossible to speculate about the number of women who will be discharged within specific periods. 9. The Family Birth Centre currently is available to women statewide. Women come from all over for this model of care. Under the new proposal, the service will only be available to the region. Where will women seeking this model of care, who don’t live in the northern region now go? A: Mercy Hospital for Women is a statewide provider for high risk pregnancy and neonatal care. We are also a local provider of low risk pregnancy care. The Family Birth Centre has accepted bookings from other areas. The Maternity Group Practice model is available now at a range of hospitals and women seeking low intervention care will be able to access this care closer to home. 10. Staffing and industrial relations a. Currently the hospital is proposing to offer Maternity Group Practice midwives the options of a 4 day week (0.8 EFT) or more. How are the current Family Birth Centre midwives (working lower EFT or not interested in taking up the Maternity Group Practice model) going to be affected? How will they be accommodated to keep up the spectrum of skills utilised in Family Birth Centre if the current Family Birth Centre model no longer exists? b. Is it proposed to cease operating a separate Family Birth Centre roster? When is this likely to occur? If this occurs, will the Family Birth Centre birth suites be staffed from the conventional birth suite roster? c. When will Mercy Hospital provide the Australian Nurses Federation with a Change Impact Statement containing all of this information? A: Mercy Hospital for Women and the Australian Nurses Federation are actively engaged in discussions around the staffing model. Once those discussions are complete, we will be able to provide more information. There will be options for staff seeking part time work. There will be options for staff who do not want to work in Maternity Group Practice to use and maintain their skills in other parts of the hospital. The Maternity Group Practice roster will supersede the current Family Birth Centre roster. We are not in a position to estimate a date as yet as discussions with the Australian Nurses Federation are ongoing.
Posted on: Thu, 11 Jul 2013 05:31:04 +0000
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