Allen, J, Kildea, S, Tracy, MB, Hartz, DL, Welsh, AW & Tracy, SK 2019, 'The impact of caseload midwifery, compared with standard care, on women's perceptions of antenatal care quality: Survey results from the M@NGO randomized controlled trial for women of any risk.', Birth (Berkeley, Calif.), vol. 46, no. 3, pp. 439-449.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:The measurement and interpretation of patient experience is a distinct dimension of health care quality. The Midwives @ New Group practice Options (M@NGO) randomized control trial of caseload midwifery compared with standard care among women regardless of risk reported both clinical and cost benefits. This study reports participants' perceptions of the quality of antenatal care within caseload midwifery, compared with standard care for women of any risk within that trial. METHODS:A trial conducted at two Australian tertiary hospitals randomly assigned participants (1:1) to caseload midwifery or standard care regardless of risk. Women were sent an 89-question survey at 6 weeks postpartum that included 12 questions relating to pregnancy care. Ten survey questions (including 7-point Likert scales) were analyzed by intention to treat and illustrated by participant quotes from two free-text open-response items. RESULTS:From the 1748 women recruited to the trial, 58% (n = 1017) completed the 6-week survey. Of those allocated to caseload midwifery, 66% (n = 573) responded, compared with 51% (n = 444) of those allocated to standard care. The survey found women allocated to caseload midwifery perceived a higher level of quality care across every antenatal measure. Notably, those women with identified risk factors reported higher levels of emotional support (aOR 2.52 [95% CI 1.87-3.39]), quality care (2.94 [2.28-3.79]), and feeling actively involved in decision-making (3.21 [2.35-4.37]). CONCLUSIONS:Results from the study show that in addition to the benefits to clinical care and cost demonstrated in the M@NGO trial, caseload midwifery outperforms standard care in perceived quality of pregnancy care regardless of risk.
Parter, C, Wilson, S & Hartz, DL 2019, 'The Closing the Gap (CTG) Refresh: Should Aboriginal and Torres Strait Islander culture be incorporated in the CTG framework? How?', Australian and New Zealand Journal of Public Health, vol. 43, no. 1, pp. 5-7.View/Download from: UTS OPUS or Publisher's site
Hartz, DL, Blain, J, Caplice, S, Allende, T, Anderson, S, Hall, B, McGrath, L, Williams, K, Jarman, H & Tracy, SK 2019, 'Evaluation of an Australian Aboriginal model of maternity care: The Malabar Community Midwifery Link Service.', Women and birth : journal of the Australian College of Midwives, vol. 32, no. 5, pp. 427-436.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM:To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS:A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS:The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS:Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.
Woodhart, L, Goldstone, J & Hartz, D 2018, 'The stories of women who are transferred due to threat of preterm birth', Women and Birth, vol. 31, no. 4, pp. 307-312.View/Download from: UTS OPUS or Publisher's site
© 2017 Australian College of Midwives. Background: Women at risk of preterm birth before 32 weeks gestation are routinely transferred to facilitate birth at a hospital that has Neonatal Intensive Care. The clinical outcomes of being 'in-born" improves newborn and neonatal outcomes is well documented. However little is known about the women's experiences when such a complication occurs. Method: Using the NSW Agency for Clinical Innovation Patient and Carer stories method, 10 women were purposively invited and consented to tell their stories. Semi-structured interviews were undertaken during their inpatient stay and then again, by telephone in the months following their baby's due date. Themes were identified, illustrated by exemplars. Results: All women were multiparous. Without exception, the women said that having the support of their family was the most important factor in coping with their unexpected hospitalisation and the anxiety of having to deal with the uncertainty of their pregnancy outcome. The most difficult aspect of their experience was the distress of being separated from their children and families and undue stress and distress from their partners. Other issues they identified were: physical difficulties during transfer; information overload as they sought to understand their changing circumstances; accommodation issues; and financial stress resulting from their relocation. Conclusions: All women perceived their midwifery, obstetric and neonatal care to be exceptional and their neonatal outcomes were positive. Improvements may be made by facilitating family contact allowing flexible visiting, assisting with partner/family accommodation, providing women with their basic needs during transport and providing assistance to relieve financial strain.
Allen, J, Kildea, S, Hartz, DL, Tracy, M & Tracy, S 2017, 'The motivation and capacity to go 'above and beyond': Qualitative analysis of free-text survey responses in the M@NGO randomised controlled trial of caseload midwifery', MIDWIFERY, vol. 50, pp. 148-156.View/Download from: UTS OPUS or Publisher's site
Roome, S, Hartz, D, Tracy, S & Welsh, AW 2016, 'Erratum: Why such differing stances? A review of position statements on home birth from professional colleges (BJOG: An International Journal of Obstetrics and Gynaecology (2016) 123 (376-382))', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 123, no. 6, p. 1037.View/Download from: Publisher's site
Roome, S, Hartz, D, Tracy, S & Welsh, AW 2016, 'Why such differing stances? A review of position statements on home birth from professional colleges', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 123, no. 3, pp. 376-382.View/Download from: UTS OPUS or Publisher's site
Tracy, SK, Welsh, A, Hall, B, Hartz, D, Lainchbury, A, Bisits, A, White, J & Tracy, MB 2014, 'Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes.', BMC Pregnancy and Childbirth, vol. 14, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: In many countries midwives act as the main providers of care for women throughout pregnancy, labour and birth. In our large public teaching hospital in Australia we restructured the way midwifery care is offered and introduced caseload midwifery for one third of women booked at the hospital. We then compared the costs and birth outcomes associated with caseload midwifery compared to the two existing models of care, standard hospital care and private obstetric care. METHODS: We undertook a cross sectional study examining the risk profile, birth outcomes and cost of care for women booked into one of the three available models of care in a tertiary teaching hospital in Australia between July 1st 2009 December 31st 2010. To control for differences in population or case mix we described the outcomes for a cohort of low risk first time mothers known as the 'standard primipara'. RESULTS: Amongst the 1,379 women defined as 'standard primipara' there were significant differences in birth outcome. These first time 'low risk' mothers who received caseload care were more likely to have a spontaneous onset of labour and an unassisted vaginal birth 58.5% in MGP compared to 48.2% for Standard hospital care and 30.8% with Private obstetric care (p < 0.001). They were also significantly less likely to have an elective caesarean section 1.6% with MGP versus 5.3% with Standard care and 17.2% with private obstetric care (p < 0.001). From the public hospital perspective, over one financial year the average cost of care for the standard primipara in MGP was $3903.78 per woman. This was $1375.45 less per woman than those receiving Private obstetric care and $1590.91 less than Standard hospital care per woman (p < 0.001). Similar differences in cost were found in favour of MGP for all women in the study who received caseload care. CONCLUSIONS: Cost reduction appears to be achieved through reorganising the way care is delivered in the public hospital system with the introduct...
Tracy, SK, Hartz, D, Tracy, M, Allen, J, Forti, A, Hall, B, White, J, Lainchbury, A, Stapleton, H, Beckmann, M, Bisits, A, Homer, CS, Foureur, M, Welsh, A & Kildea, SV 2013, 'Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial', The Lancet, vol. 382, no. 9906, pp. 1723-1732.View/Download from: UTS OPUS or Publisher's site
Background Women at low risk of pregnancy complications benefit from continuity of midwifery care, but no trial evidence exists for women with identified risk factors. We aimed to assess the clinical and cost outcomes of caseload midwifery care for women irrespective of risk factors.
Hartz, DL, White, J, Lainchbury, KA, Gunn, H, Jarman, H, Welsh, AW, Challis, D & Tracy, SK 2012, 'Australian maternity reform through clinical redesign', AUSTRALIAN HEALTH REVIEW, vol. 36, no. 2, pp. 169-175.View/Download from: UTS OPUS or Publisher's site
Summary The aim of this paper is to review the clinical outcomes of descriptive and comparative cohort studies of the Australian caseload midwifery models of care that emerged during the late 1990s and early 2000s. These models report uniformly a decrease in caesarean section operation rates when compared to local, state and national rates, irrespective of the obstetric risk of the women cared for. These outcomes are in contrast to the findings of the randomised controlled trials and comparative cohort studies of caseload midwifery conducted, predominantly in the United Kingdom, in the mid to late 1990s. The Australian studies show that caseload midwifery is a model of care that is associated with lowered rates of caesarean section operations, and other obstetric intervention rates. The absence of definitive evidence of the effect of caseload midwifery, derived from published descriptive and comparative cohort studies, underlines the need for a sufficiently powered randomised controlled trial of caseload midwifery. The randomised controlled trial of caseload midwifery being undertaken in two major teaching hospitals in Australia will provide definitive answers relating to the effect of the caseload midwifery model of care for women of all risk in the Australian context.
Tracy, SK, Hartz, D, Hall, B, Allen, J, Forti, A, Lainchbury, A, White, J, Welsh, A, Tracy, M & Kildea, S 2011, 'A randomised controlled trial of caseload midwifery care: M@NGO (Midwives @ New Group practice Options).', BMC Pregnancy and Childbirth, vol. 11, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Australia has an enviable record of safety for women in childbirth. There is nevertheless growing concern at the increasing level of intervention and consequent morbidity amongst childbearing women. Not only do interventions impact on the cost of services, they carry with them the potential for serious morbidities for mother and infant.Models of midwifery have proliferated in an attempt to offer women less fragmented hospital care. One of these models that is gaining widespread consumer, disciplinary and political support is caseload midwifery care. Caseload midwives manage the care of approximately 35-40 a year within a small Midwifery Group Practice (usually 4-6 midwives who plan their on call and leave within the Group Practice.) We propose to compare the outcomes and costs of caseload midwifery care compared to standard or routine hospital care through a randomised controlled trial. METHODS/DESIGN: A two-arm RCT design will be used. Women will be recruited from tertiary women's hospitals in Sydney and Brisbane, Australia. Women allocated to the caseload intervention will receive care from a named caseload midwife within a Midwifery Group Practice. Control women will be allocated to standard or routine hospital care. Women allocated to standard care will receive their care from hospital rostered midwives, public hospital obstetric care and community based general medical practitioner care. All midwives will collaborate with obstetricians and other health professionals as necessary according to the woman's needs. DISCUSSION: Data will be collected at recruitment, 36 weeks antenatally, six weeks and six months postpartum by web based or postal survey. With 750 women or more in each of the intervention and control arms the study is powered (based on 80% power; alpha 0.05) to detect a difference in caesarean section rates of 29.4 to 22.9%; instrumental birth rates from 11.0% to 6.8%; and rates of admission to neonatal intensive care of all neonates fro...
Tracy, SK, Hartz, DL, McCann, Y, Latta, D & Nicholl, M 2005, 'An integrated service network in maternity - the implementation of a midwifery-led unit', Australian Health Review, vol. 29, no. 3, pp. 332-339.View/Download from: UTS OPUS
Maternity services in Australia are in urgent need of change. During the last 10 years several reviews have highlighted the need to provide more continuity of care for women in conjunction with the rationalisation of services. One solution may lie in the development of new integrated systems of care where primary-level maternity units offer midwiferyled care and women are transferred into perinatal centres to access tertiary-level obstetric technology and staff when required. This case study outlines the introduction of caseload midwifery into an Area Health Service in metropolitan Sydney. Our objective is to explore the concept of caseload midwifery and the process of implementing the first midwifery-led unit in NSW within an integrated service network. The midwifeled unit is a small but growing phenomenon in many countries.1 However, the provision of ?continuity? and ?woman-centred? midwifery care involves radical changes to conventional hospital practice.
Raymond, JE, Hartz, DL & Nicholl, M 2008, 'Ensuring safety and quality' in Homer, Brodie & Leap (eds), Midwifery Continuity of Care A practical guide, Churchill Livingstone Elsevier, Sydney, pp. 127-148.
Hartz, D, Tracy, S, Kildea, S, Allen, J, Hall, B & Lainchbury, A 2015, 'Towards defining caseload midwifery in the Australian context', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. S17-S17.View/Download from: Publisher's site
Hartz, D, Hall, B, Allen, J, Lainchbury, A, Forti, A, Kildea, S, Tracy, M, Foureur, M, Homer, C & Tracy, S 2013, 'The M@NGO Trial: Does caseload midwifery reduce caesarean section operation rates?', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. S8-S9.View/Download from: Publisher's site