Towards a sustainable model of midwifery practice in a continuity of carer setting: the experience of New Zealand midwives

Abstract

New Zealand midwives may have gained autonomy in the 1990 Amendment to the Nurses Act but that alone did not enable the midwife to offer full professional midwifery services in an equitable way to women around the country. Being able to access the government funded Maternity Benefits Schedule on an independent basis was the single most significant factor for the midwife in becoming an independent practitioner within the publicly funded health service. This was both enabling and potentially disabling since it is apparent that the funding of maternity care directs the way that midwives practice and influences the size of their personal caseloads. Caseloads can have a direct bearing on the financial viability of the midwives practice and a large personal caseload may result in burnout or can have the potential to lead to less than satisfactory continuity of carer for clients. This study used a feminist narrative methodology to explore midwives experience of working in a continuity of carer model of midwifery practice. Midwives from five different midwifery group practices participated in the research. The midwives had all worked for more than three years in a continuity of carer model of practice and there was a variation in the funding model of each of the midwifery group practices. The findings of the study show that as well as personal and professional issues requiring a constant balancing act the funding model within each practice influenced the size of individual caseloads and the way in which midwives organise their practice. This thesis concludes with recommendations to the Health Funding Authority to consider more flexible funding models such as direct capitation that would enable midwives to have more financial stability in managing their midwifery practices.