Mapping midwifery continuity of care in Australia; Women’s access and pattern of employment – Results of a national survey

BACKGROUND: Midwifery continuity of care improves perinatal outcomes, yet implementing these models can be challenging, particularly in regional and rural settings. Midwives express a preference for working within these models of care however historically opportunities are often restricted to full‑time employment. Most women have limited knowledge of how to access midwifery continuity. Evaluating the prevalence and accessibility of midwifery continuity of care models, and how midwives provide this care remains a complex task. AIM: The aim of this study was to nationally map Australian midwifery continuity of care models, identifying which women could gain access and how midwives provide the care. METHODS: A cross-sectional study design with an online survey was undertaken. Quantitative analyses included descriptive statistics. FINDINGS: Midwifery group practice (MGP) was offered by 73.1% (n = 79/108) of respondents (responding services), 45.6% (n = 36/79) of respondents offering MGP made it available to women with risk factors. Pre-existing diabetes 48.1% (n = 38/79), vaginal birth after caesarean section 87.3% (n = 69/79) and psychosocial risk factors 89.9% (n = 71/77). Access was also reported for women under 18 years 88.5% (n = 69/78), migrant/refugee women 93.6% (n = 73/78) and Aboriginal and Torres Strait Islander women 94.9% (n = 75/79). Over a third 35.2% (n = 38/108) of respondents were from regional, rural or remote areas. Homebirth was available in 23.4% (n = 18/77) of respondents. Almost all respondents supported midwives to work part-time 90.9% (n = 70/77) and 64.1% (n = 50/78) did not require midwives to have a minimum number of years' experience. CONCLUSION: Australian midwifery continuity is provided through various models. Survey responses identified women with pregnancy risk factors can access midwifery continuity. Midwives were offered flexible work options with opportunities for early career midwives to provide continuity.