Mansfield District Hospital

Rural Maternity Initiative Program

Project Statement

Following receipt of grant funding in 2007 and 2009 from the Dept. Health Rural Maternity Initiative, Mansfield District Hospital now stands on the brink of implementing a midwifery model of care that surpasses its already excellent service provision.

The model proposed will continue to draw upon the extremely good partnership already in existence between local General Practitioner Obstetricians and the staff of MDH. It also however has the potential to create a sustainable service model, build internal capacity, improve job satisfaction, and enhance recruitment and retention of midwives in a time of national staffing shortages and an ageing nursing workforce. Moreover, it will deliver what is considered best practice care to the women of our community without jeopardizing the health and wellbeing of the MDH staff.

Impedes for change

Mansfield District Hospital has provided Maternity Services to its local community and surrounding areas for over 150 years and currently does so in accordance with a traditional staffing system of three eight hour rostered shifts covering the 24 hour period.  However, due workforce shortages it increasingly faces a genuine risk to the sustainability of this service.

To date maintaining an operational service has often meant that the facilities existing midwives have been required to share an in-charge and midwife role, work shifts in addition to their contracted hours, and undertake on-call duty. Recognizing that a third of its midwives are over 55yrs old and therefore the potential of further workforce shrinkage is great, the Hospital embarked early on preemptive change.

In 2006 MDH began to examine the multitude of midwifery care models already implemented in like facilities across the state. Then, in 2007, with the support of rural maternity initiative (RMI) funding it put into operation what is now known as a shared care model. Although this model enabled midwives to assist the GP Obstetricians more in prenatal care of women it did not ease the issues of workforce shortages.

Further phase 2 RMI funding obtained this financial year has therefore been used to create a model which will enable the Hospital to continue to manage service provision with its current midwife population (which is approximately half what is required for 24hr shift based cover) by developing a service around the hybrid midwifery model of care such as the one outlined below.

Solution Statement

The model consists of a team of three to four midwives. Each staff member is be allocated a group of women for whom they are the primary carer and their contracted hours are set in accordance to their allocation of women (making the assumption that a full time staff member is allotted up to 40 women per annum).

The model ensures that each staff member is allocated four clear days off work inclusive of on-call requirements each fortnight. A degree of flexibility around the needs of allocated women will dictate the necessity for the staff involved to develop their own roster. Opportunity does however exist for each staff member to be rostered off for four days in a row once per month if that is the workers desire. Additionally there is no set requirement that the primary carer be available to birth their allocated women, a back-up system will guarantee undisturbed time off.

The midwives will continue to provide up to 50% of the antenatal care of their women and will ensure that the patient is introduced to their midwives team partner as the time of birth draws close.  All postnatal care is provided either by the primary midwife or their team partner in collaboration with ward staff and the patients General Practitioner. Domiciliary care will be delivered for the most part in the woman’s home by her primary midwife and all labors will continue to be attended by the woman’s General Practitioner Obstetrician.

Key benefits

1.       Nursing staff and Midwives recognize the need for implementation of a sustainable model and have chosen the model presented as their preferred option for midwifery care at MDH.

2.       The impact of a loss of maternity services in Mansfield would be significant. Service demand on North East Health and Benalla Hospitals would increase beyond these facilities current level of capacity.

3.       The model represents a service that requires 2.1 effective full time midwives (compared to the current requirement of 6.2 (which to date has not been achieved). It is therefore sustainable.

4.       The model remains inclusive of all staff (both midwives and non midwives) recognizing the necessity of engagement of all within the small rural context.

5.       The model continues to capitalize on the excellent relationships in existence with local general practitioners whilst still enhancing midwifery continuity of care and quality outcomes.

6.       The model will remove the current burden that a birth currently places on the ward roster and emergency department.

7.       The model typifies best practice in work life balance with the nurses being able to manage their own time around personal needs and commitments.

8.       The model has the potential to attract staff that only want to work in midwifery or that are direct entry graduates. Currently these staff are lost to larger centers where their professional ambitions can be fulfilled.