College of Healthcare Sciences
3 December 2021
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What is woman-centred care?
Midwives play an incredibly important role in our societies, communities, and families. To our mothers and infants, the care and education that midwives bring is invaluable. JCU’s Head of Midwifery, Dr Marie McAuliffe, gives us insight into the difference that midwives make to the health of mothers and infants and how investing in the midwife can lead to healthier futures for our current and future generations.
May 5 is International Day of the Midwife, and the 2021 theme is “Follow the data: invest in the midwife”. Investing in the role of the midwife means: ensuring that pregnant mothers in rural and remote communities don’t have to leave their homes, families, and jobs for a certain period in order to visit a clinic or GP; ensuring that pregnant mothers can have choice over their antenatal care, labour and birth experience, and postnatal care because they have access to a midwife; and ensuring that pregnant mothers receive care that improves and supports their physical, mental, and emotional health and wellbeing.
These three outcomes of well-supported midwifery care align with the overall philosophy of midwifery, which is woman-centred care. “It’s care that focuses on what the woman wants and what the midwife can do for her,” Marie says. “Woman-centred care prioritises producing the best health outcomes for the woman, while working to ensure that the woman and her needs and wants are being heard.”
Providing the best care and outcomes for each individual pregnant mother is the main reason societies and health care systems need to invest in the midwife.
Following the data
To follow the data and understand its importance, we must first know what the data is and the outcomes it suggests.
“In the last twenty years, there has been a significant increase in the amount of data about the outcomes of midwifery care,” Marie says. “Data that has been gathered from both Australian and international studies has clear evidence that women who receive antenatal care have better outcomes, and that has been well-established for a long time. Data from over the last two years has shown that women who receive antenatal care from a midwife have better short-term and long-term outcomes than those who receive antenatal care from clinic or hospital visits.”
Marie says the short-term outcomes relate to attendance. “With a midwife, mothers are shown to actually attend visits and receive care more consistently,” she says. “During those visits, the mother receives education that is important and specific to that individual woman.”
As well as more consistent attendance for antenatal care, the data shows that another aspect of midwifery with excellent outcomes is continuity of care. Marie describes this continuity as a woman receiving care and education from a known midwife through the antenatal period, labour and birth, and into the postnatal period.
“The data says that women who have a known midwife in labour have higher satisfaction levels for their labour and birth experience,” Marie says. “There is also data that suggests continuity of care with a known midwife reduces the risk of interventions in labour, which impacts both the woman’s experience and her health outcomes.”
Marie says there is evidence that having the care of a known midwife in the postnatal period also improves breastfeeding, with additional evidence showing that the outcomes of breastfeeding include better maternal-infant bonding and even a higher IQ of the baby.
Investment relies on value
Although the evidence is clear that having the continual support and care of a known midwife produces the best outcomes for both pregnant mothers and infants, there is still limited access to this kind of care. Investing in midwives means ensuring that they are readily available and accessible to any woman who would choose midwifery care.
“Midwives are not just doing breathing exercises with pregnant mothers or only present at the birth to declare the gender,” Marie says. “They have expert knowledge of all aspects of the woman’s physiological experience from pregnancy through to postnatal care. That’s where the investment needs to happen — right across the continuum of care.”
This continuum of care starts as early during pregnancy as possible, and is consistent through to labour and birth and on to postnatal care. Marie says ensuring that women can receive the best possible continuum of care starts with valuing women’s health.
“When we value women’s health and we value the role of a mother in our society, it follows that we should value and invest in the health professional that is going to provide the best care and outcomes for our women and mothers.”
JCU Head of Midwifery, Dr Marie McAuliffe
Investing in and supporting the profession of midwifery is especially important to those in rural and remote communities. “It’s important for women to receive care and give birth where they live,” Marie says. “If women have to leave their families, jobs, and communities to receive prenatal care, they are less likely to attend. They are then more likely to have a less satisfying labour and birth experience because they didn’t receive the physiological care and education that contributes to a positive birth experience.
“For our Indigenous mothers, being able to give birth in the place where they live or where they are from is extremely important because of their connection to country. So, having access to a known midwife throughout the continuum of care is important for spiritual and cultural reasons as well as physiological or practical reasons.”
Where does this investment start?
“Investment needs to start at the top, and that will then set the standard for the rest of the health care system,” Marie says. “For example, there is no designated chief of midwifery in Australia. In Queensland, the Chief Nursing Midwifery Officer for Queensland Health is not a midwife. There are midwifery advisors, but at the government level, there is no one to ensure that midwifery and midwives are being invested in and supported by our federal and state health systems.”
Marie suggests that if the value for the health and wellbeing of mothers and babies was instituted at the government level, the appropriate investment in midwifery care would follow. Although influencing such change would need to happen at the political and federal level, Marie encourages us that individual people, especially those who choose to pursue midwifery as a profession, can make a difference.
By valuing women’s and infants’ health, we can better recognise and support our midwives and be a voice that not only celebrates their importance and value to our communities, but that calls for value and investment to be the standard, rather than a dream.
Dr Marie McAuliffe
Marie McAuliffe brings clinical experience from her midwifery and neonatal practice into her position as a Senior Lecturer in Nursing and Midwifery at JCU. Her experience as a clinician, educator, and administrator in regional and rural health services informs curriculum development and learning and teaching methodologies across JCU’s Nursing and Midwifery programs. These programs are focused on the development of a skilled and resilient nursing and midwifery workforce, fit for the rural, remote and tropical health care contexts.
Marie's research interests include women’s health, models of maternity care and midwifery education using mixed method research methodologies. Marie’s PhD examined the experience of women admitted to intensive care (ICU) during pregnancy or birth.