Continuity Of Care Model

Continuity of care model v standard
Through Australia, the models of care are highly varied. The research suggests that when comparing continuity of care to standard care, continuity of care allows for women and midwives to gain rapport and thus an increase in the overall satisfaction of care (Aune; (Yelland; Schmied, 2007; Brown, 2005; Jenkins, 2013; McLacklan, 2006). Women are more likely to develop confidence in skills with a known midwife and, therefore, an increase in self esteem and maternal satisfaction. Despite this research, it is almost impossible for all women to receive continuity of care due to part time rostering, length of stay and number of staff. Although the amount of women being cared for by continuity of care models are
increasing, it still remains a minority. For women in the standard model, receiving inconsistent advice was a problem resulting in a lower level of satisfaction (Fenwick, 2009 B). Many models focus predominately on antenatal and intrapartum rather than postnatal. (McLacklan, 2006.) McLachlan et al 2006 suggest that due to this lack of provision of information, often women have different expectations of postnatal ward compared to the reality of an extremely busy and short-staffed environment with little time to rest.

Environment
The environment of the postnatal ward is commonly described as being “chaotic” and “busy” and subsequently affects the care provided and the psychosocial support offered to women.
(p1.yelland 2006; Fenwick, 2009; Brown, 2005; McLacklan, 2006). The lack of flexibility and hospital routines and procedures often interrupt women trying to sleep. The hospital routine does not take into account that most mothers are up during the night and regularly sleep during the day. Antenatally there is a contrast as women are able to go home from an appointment and sleep in their own bed with their partner’s
support.

Ratios
In Victoria, during antenatal and the intrapartum period, there is a 1:1 ratio of midwife-to-woman with an allocated time. The woman can ask questions and can be at the focus of the care without the midwife being interrupted over a 9 month period (Schmied, 2007). However, during the postnatal period the current ratio of midwife to women/babies in an AM and PM shift is 1:8 and night shift 1:10 with most women staying on average 2-3 days, having dropped from 5 days (Mckellar, 2005; Brown, 2005; McLacklan, 2006). Poor staff to patient ratio has subsequently led to sup-optimal care and education.
Length of stay and education
A shorter length of stay is associated with a decreased level of satisfaction. McLachlan v brown
This presents a number of challenges in how education is provided to women due to this change in length of stay (Mckellar, 2005).
Studies show that the current provision of education is not meeting the standards for parents (McKellar, 2005) and it is difficult to educate women during the short time they are on the postnatal ward as they are also mainly tired (McLacklan, 2006). Research shows that the length of stay should be flexible and based on individual needs of each woman and that fixed length of stay may inhibit rather than support individualised care (McLacklan, 2006). Due to lack of time, midwives miss the opportunity to make an assessment of the woman’s needs and therefore not able to make individualised care plans leading women to not feeling that they received the required information causing a greater level of dissatisfaction (McLacklan, 2006; Fenwick,2009.) The findings from one survey suggested that on average, women were receiving a total of 3 hours of education and support over a 72 hour period (MCKellar, 2005). A survey showed that multiparous women were less likely to see the midwife and receive an education based on the assumption that they remembered the knowledge from their last child (Fenwick, 2009). This does not take into consideration the length of time-based between children, forgetting knowledge and skills and that each baby is different ( Fenwick, 2009). However, primiparous women were overall less satisfied with postnatal care than multiparous
women ( Fenwick, 2009; Brown, 2005). Sadly, on discharge women reported feeling “they lacked confidence, particularly for breastfeeding… and [had] little follow-up or community support”. (Schmied, 2007 p100.)