‘Wonderful journey’ for Leonie and Steph

Leonie Hewitt, Registered Midwife from the Ryde Midwifery Group Practice, and new mum Stephenie White are clearly delighted to see each other. They laugh and catch up on family news during a postnatal visit with 10-day-old baby Juliet.

It’s an easy rapport that comes after a nine-month journey together, with Leonie providing maternity care throughout Steph’s pregnancy, birth of baby Juliet and the first three weeks of caring for her new baby.

The Ryde Midwifery Group Practice where Leonie works employs a continuity of maternity care model where a woman is cared for by one midwife throughout her pregnancy, birth and the postnatal period. ‘It’s a model that is woman-focused, where a midwife develops a strong relationship with the woman in her care,’ said Leonie.

‘Midwives really get to know each woman and understand her needs. Because we know her so well, and have followed the course of the pregnancy closely, we pick up very quickly if something is going wrong.

‘Where necessary, we refer women to other health workers – obstetricians, physiotherapists, for example.

‘Women have a sense of being in control of their own care. They feel calmer, more empowered, clearer about what they want.

‘Midwives give women the time and attention they need. The midwife knows their whole story. They can call up the midwife they know anytime they need.

‘It’s a process where women feel respected and develop trust and confidence in themselves and their midwife,’ said Leonie.

Leonie also cared for Steph during her first pregnancy and birth to baby Alexander, now two years old.

‘It was such a wonderful experience – I felt so supported,’ said Steph. ‘There was no question that I wanted to be cared for by Leonie when I found out I was pregnant the second time. You build a strong bond with your midwife.’

Steph chose this model of maternity care because she wanted to be in control of decisions around her pregnancy and birth. ‘Leonie gave me all the information I needed. Even in the throes of birth I knew I was being supported by someone who knew me well. I knew Leonie had my best interests, and the best interests of my baby, at heart,’ she said.

Leonie provides maternity care to around 40 women each year – from the first antenatal visit through to around three weeks after the birth. ‘We don’t leave until everything is going beautifully,’ she said. ‘Most women here don’t need to see anyone else.’

Only 12% of the women going through the practice need to be transferred to Royal North Shore Hospital (RNSH). ‘If things in a labour are deviating from normal, the midwife rings RNSH and an ambulance, and we go there together,’ said Leonie.

‘We’re clearly doing something right with this model of maternity care. We have happy, more relaxed mums and bubs, and the numbers needing medical intervention are much lower than in a traditional birthing unit. Of the dozens of women I have cared for this year, only one has needed a cesarean birth.’

Continuity of midwifery care benefits women, babies

Researchers who examined 11 trials of 12,276 women found continuity of midwifery care offers a number of advantages for childbearing women.

Women in midwife-led care were less likely to have:

  • antenatal hospital admission;
  • epidural or any need for pain relief;
  • episiotomy;
  • forceps and vacuum birth;
  • baby dying before 24 weeks of pregnancy.

Women in midwife-led care were more likely to:

  • have a normal vaginal birth;
  • feel in control during labour and birth;
  • breastfeed;
  • have a shorter hospital stay for the baby.

Conclusions:

  • All women should be offered midwife-led models of care and women should be encouraged to ask for this option.
  • Access to continuity of midwifery care has been confirmed to deliver significant health benefits to mothers and babies, while remaining as safe as standard maternity care systems.

Summary from Midwife-led versus other models of care for childbearing women by Hatem M, Sandall J, Devane D, Soltani H, Gates S. (2008). Cochrane Database of Systematic Reviews 2008, Issue 4. Art No.: CD004667. DOI:10.1002/14651858.CD004667.pub2. Supplied by Associate Professor Hannah Dahlen from the Australian College of Midwives.