Midwifery Group Practice
A woman centred primary health care model that offers well pregnant
women a care option of partnership with a known midwife.
Through the promotion of birth as a natural event for most women, the
MGP model of care aims to increase the onset of spontaneous labour
and decrease labour interventions. The ensuing outcomes will result in
an increased vaginal birth rate, a decreased caesarean section rate
and an increased level of satisfaction for women with regard to their
Submission for funding arose from the NSW government initiative
Towards Normal Birth
Principle outcome aimed at reducing Caesarean Section Rate for
women having their first baby.
All women will receive antenatal care and education through the
provision of consistent and balanced information, support during
labour, birth and post partum home care from a known midwife.
Women able to be booked to the MGP will be determined by a ‘low risk’
criteria based on the Australian College of Midwives National
Guidelines for Consultation and Referral (ACMI).
The provision of balanced and consistent information for women and
To provide care and facilities which are aligned with each woman’s
unique pregnancy and birthing journey and their subsequent transition
To provide the option of midwifery evidence based best practice in
promoting optimal maternal and neonatal outcomes
To promote women’s satisfaction during pregnancy and childbirth
through collaborative participation in decision making.
To offer pregnant/birthing women a choice of service
To provide continuity of care by a known midwife within a dedicated
To implement an affordable and sustainable model of maternity care
within the current budget.
Rostering and On Call
The MGP midwife will be on 24 hour call, during their rostered shifts.
When not on duty or on call, the MGP midwife will divert her mobile
phone to the on call MGP midwife.
The MGP midwife will attend booking-in, antenatal and intra-partum
care and postnatal visits as required for her caseload of women
according to on call and prior work loads.
Scheduled visits that cannot be rearranged for another time will be
provided by the next available MGP midwife on call.
Ongoing Pregnancy Care
Meeting other midwives – women's’ groups
Continuation of midwifery care in collaboration with obstetric team as
the need arises
MGP midwife will organise a consultation with senior obstetric medical
officer/Obstetric Staff Specialist for MGP women if medical
management is required.
On discharge from antenatal ward or DSU, the management plan will
indicate the lead carer and the schedule of planned visits. Ongoing
collaborative care will be between the woman, the MGP midwife and
the Obstetric Staff Specialist with a clear documented management
Midwives contactable by work mobile when on call.
MGP midwife will contact Birth Unit for admission after ongoing
consultation with the woman and arrangement to meet at Birthing Unit.
If a woman presents to Birth Unit without contacting the MGP
midwives Birth unit staff will contact MGP midwife on call.
Midwives work a maximum of 12 consecutive hours
Whenever possible, the MGP midwife will conduct pre-induction
assessment and consult with senior medical staff.
The MGP midwife will retain lead carer role unless induction is
complicated by a ‘C’ category risk.
The MGP midwife will conduct the prostin pre-induction assessment
Where possible, the MGP will be available for the woman’s care on the
day of the LSCS.
Postnatal discharge is anticipated 4-6 hours after birth.
The ACMI Consultation and Referral Guidelines for Postnatal Care will
be utilised for determining clinical risk.
MGP discharge planning will be undertaken by the MGP midwife and
MGP postnatal home and/or phone visiting is available for up to 7 days
with ongoing postnatal contact, parenting and breastfeeding support for
six weeks postpartum.
One day per week is scheduled for MGP midwives to attend meetings
and education sessions. This includes note review, case review and
reflection, peer review, clinical supervision and group meeting.
Adverse outcomes are subject to the usual reporting and review
Each MGP midwife will undertake yearly review and reflection on
There is recognition of the increased responsibility, accountability and
competency requirements when midwives become lead carers within
the MGP model.
All MGP midwives are encouraged and supported to continue their
professional development and develop a professional development
plan based on the ACM Self-assessment tool.
Adequate professional development and up skilling will be built into the
model. MGP midwives will demonstrate competency in the following
– Skilled in current antenatal assessment and care
– Skilled in promoting and supporting the use of water in birth
– Skilled in promoting and supporting breast feeding
– Skilled in promoting and supporting development of parenting capacity
– Skilled in completing well mother and baby discharge assessments
Clinical Effectiveness of Midwifery Group Practice model of care
Fewer assisted births
Fewer labour inductions
Less epidural analgesia
Altered Patterns of perineal trauma
Fewer Caesarean sections
Turnbull, D., Baghurst, P., Collins, C., Cornwell, C., Nixon, A., Donnelan-
Fernandez, R. and Antoniou, G. (2009). An evaluation of Midwifery Group
Practice. Part 1: Clinical effectiveness. Women and Birth, 22; 3-9.
Maternal Satisfaction Levels
MGP is associated with higher level of maternal satisfaction
Noted by women - better access to quality information
- participation in decision making
- sense of control during labour
- better relationship with caregiver
Williams, K., Lago, L., Lainchbury, A. and Eagar, K. (2010). Mother’s views of
caseload midwifery and the value of continuity of care at an Australian regional
hospital. Midwifery, 26; 615-621.
Midwifery Led Antenatal
For well, healthy women having
their first baby
Schedule of Care
Based on NICE guidelines
10 appointments for 1st time
Options of care
Obstetrix –medical history,
family history, psychosocial
assessment, lifestyle issues
Generally attended urine pregnancy test at home & BHcG through GP
BGA, Hb, MCV, hepatitis B, syphilis, rubella, MSU for C&S, ?Hepatitis
C, ?HIV, ? Varicella
Dating Scan if LMP unknown or irregular
Nuchal Translucency offered
Genetic counseling if appropriate
Review test results
Organize morphology us for 18-
Measure & plot fundal height
Hb, MCV, 50gm AGT or 75gm GTT
Anti D 625 IU if rhesus negative mother
Review results of tests
Anti D 625 IU
Check presentation of baby- discuss options of breech
LV/PA swab for GBS
38 weeks & 40 weeks
Discuss options of post dates management
What happens when a pregnancy
Other Health Care Providers
20 years old, single
Carer for her mother
Past Medical History
Hospitalised with pyelonephritis at age 13
Asthma, ventolin prn
Miscarriage at 5 weeks gestation 2010
Miranda’s pregnancy journey
16/02/11 – 9/40 - referred to MGP from ANC Booking in Visit
06/03/11 – 12/40 – presented to ED with a post coital bleed, given Anti
D and an EPAS appointment was made
07/03/11 – EPAS - Miranda was sent for an NT scan. Result – low risk
10/03/11 – 12/40 - presented to ED with PV bleeding, abdominal pain and
lower pelvic pain radiating to right loin.
Treated 2 weeks prior for a UTI but had not finished the course of antibiotics
Attended an ultrasound. Findings included a sub chorionic haemorrhage plus a
complex mass 78x32x43mm superior to the right kidney
Discharged with follow up by GP
15/03/11 – 13/40 - first visit with MGP, saw GP same day for referral to
gastrointestinal specialist, discussion with O&G consultant and
appointment made for High Risk Clinic
08/04/11 – 16/40 - MGP visit, seen by GIT specialist prior and awaiting
High Risk Clinic
20/04/11 – 18/40 - High Risk Clinic visit with Consultant and Midwife –
Provisional diagnosis by GIT specialist following discussion at medical
oncology case meeting – angiomyolipoma plus abnormal right kidney
with cystic component. Uncertain of pathology but feel the mass is
benign and long standing. Surgical management deferred until after
birth. GIT specialist requiring monthly scans of mass and follow up.
Miranda’s Care Plan
MGP care in consultation with High Risk Consultant
Regular ultrasounds – morphology scan and then growth scans at
28/32/36 weeks gestation
04/05/2011 – scan reviewed by O&G Consultant – morphology scan
NAD, mass unchanged, mild dilatation of right renal pelvis. For review
at high risk clinic at 28/40 following growth scan
15/05/2011 – presented with UTI, treatment commenced
The Journey Continues……..