28 May 2009- Melbourne

1. Provision of a Caseload Model of Care and ‘Group Antenatal Care’ Presenter: Jo CostelloHospital: (Hera 2)Key contact person for this project:Jo Costello, jo.costello@mater.org.au, 0434564913 28 May 2009- Melbourne

2. Meeting the recommendations of Re-Birthing (2005) ‘Addressing the problems’ • Care belongs to consumers • Care is safe & feels safe • Care is open & honest • Care is local or feels local • Carers work together & communicate

3. Key changes implemented A Caseload Model of Care was implemented in 2006 to address recommendations of the Re-Birthing Report of Maternity services in QLD (Hirst C, March 2005) • Women either self refer / ref via GP or identified as being suitable for this model • Screening tool > Midwife allocated > Booking history at home > Obstetric appt • Women are allocated to groups determined by geographical area & EDC • Creates groups of women of a similar gestational age who follow the pregnancy journey together • Groups contain a mix of nulliparous and parous women • AN check done by midwife on yoga mat with main discussion taking place with all women and midwives in team present • Known carer in labour - early labour by phone contact at home and midwife met in birth suite once labour established • PN care continues on an individualised basis for up to 6 weeks • Women and babies invited to a reunion 6 – 8 weeks post birth

4. Key issues Pregnant women in original models of care: • Felt care was fragmented and lacked continuity • Women did not always feel they had enough information to make informed decisions about their care • Did not always develop social networks with other pregnant women, particularly isolated, vulnerable women / teenagers • Felt their concerns were not always acknowledged • Were less likely to ask questions of both Health Care Professionals • Felt the postnatal period was not acknowledged as a priority and that support was lacking during this time, especially related to breast feeding support

5. Aim of this project For pregnant women to experience continuity of care / carer • Work within safe guidelines and evidence based care • Collaborative care continues throughout process with named lead obstetrician / team registrar • Meet other mothers / families and develop social networks within their own community • Share knowledge, questions and concerns related to pregnancy in a relaxed and secure environment • Take the lead in identifying own problems and sourcing solutions within the group • Become active participants in choices and care decisions regarding their care • What areas? – Low risk women in a tertiary unit • By When? – Immediate following reorganisation of services (Est 2006) • With what resources? - Within current resources with anticipated cost savings

6. Outcomes so far

7. Project evaluation • Excellent feedback from women • Women know all of midwives in the team and similarly the Midwives feel they get to know women and families • Women feel empowered and confident • Increases their knowledge in order to make informed choices • Reduces unnecessary intervention • Improves postnatal support and breast feeding (BF) rates with 66% of women still BF at 3 months of age