The scope of practice review brings an opportunity to give patients what they want – continuity of care and better outcomes.
In the same week that we saw the publication of the considered Scope of Practice Issues Paper 2 – and commentary by the RACGP about the possible fracturing of the health system and the advent of “McMedicine” – we also saw the release of primary care midwifery research that shows us what the future could look like.
Evidence from this study debunks the rhetoric and confirms the fundamental importance of the intent of the scope of practice review – to enable non-medical professions to work to full scope for better health outcomes for all Australians.
The study, published in Women and Birth, the journal of the Australian College of Midwives, used 2747 maternal health records from 2014-2022 from Australia’s largest midwifery-led primary midwifery care practice, My Midwives.
Among the findings is this:
“Compared to national data, primiparous women [cared for by private midwives] had fewer inductions (22.9% vs 45.8%), caesarean sections (22.6% vs 32.1%), instrumental vaginal births (17.0% vs 25.7%), episiotomies (9.5% vs 23.9%) and more birthed vaginally after caesarean section (75.9% vs 11.9%). Significantly less babies were born with a birthweight <2750 g (0.5% vs 1.2%) and 83.7% babies were exclusively breastfed at six weeks. Collaborating hospitals would receive less DRG funding compared to public patients, require less intrapartum midwifery staff and receive a net benefit, even when bed fees were waived.”
Midwifery-led continuity of care with a known midwife is best practice. It is safe. It works in concert with GPs, obstetricians and other health professionals when required. It has better outcomes than standard care and it is better value. It is community-based care. It takes pressure off the hospital system and off GPs.
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And it’s what women want. In a scoping review published last month, Faktor et al. found that “women in Australia consistently want access to midwifery continuity of care as an enabler for addressing their maternity care needs”.
“Transforming Australian maternity care policy and service provision towards continuity would better meet women’s needs.”
These timely articles tell the story of the opportunity that the scope of practice review brings: to remove barriers to enable non-medical professions such as midwifery work to full scope, thereby improving health outcomes in a safe, constructive, collaborative, multi-disciplinary context.
It is an opportunity not to be missed, not just for midwifery, but for the health system at large, and, most importantly for patient choice of, and access to, high-value care.
Isn’t that the goal?
Helen White is the CEO of the Australian College of Midwives.
