gms | German Medical Science

Background: Caseload midwifery is a model of care which offers a known caregiver to the woman. The midwife is the primary provider of care throughout pregnancy, childbirth and the postnatal period, providing care for an agreed number of women per year. In the model, midwifes work on-call in a team of two to three midwifes [1]. This model of care was introduced a few years ago in public maternity services in the state of Victoria, Australia. In accordance to the user’s demand for a model of care with a known primary provider of care, this model is being introduced in every part of Australia. The results of two randomized controlled trials which were performed in Australia - M@NGO [2] and COSMOS [3] – proof that Caseload Midwifery is a safe and cost-effective model of care. For the implementation and realization of Caseload Midwifery, Australia has clear guidelines for being on-call, shifts and an adequate workload [4].

Aims/research question: The aims of this thesis are to show the experiences, opinions and recommendations of Australian experts of midwifery for implementing and realizing the Caseload Midwifery model by the example of the state of Victoria. On the foundation of the Normalization Process Theory (NPT) the thesis is going to name the factors by which the process of implementation of this model of care is going to succeed.

Methods: Data collection was conducted with nine semi-structured interviews with experts and was evaluated using the qualitative content analysis by Mayring [5].

Results: The results highlight that caseload midwifery implies a "different kind" of working, which requires both good communication and regulations, and flexibility and evolvement. For the process of implementation of this model of care it is important to provide a good understanding of the model and to involve all employees. Sufficient funding, support from management and obstetric teams, as well as motivated and qualified midwives were named as basic requirements for the successful implementation of caseload midwifery. By the use of NPT a concept was developed which displays the recommendations, advices and experiences of the interviewed experts regarding a successful implementation process of Caseload Midwifery.

Relevance: Currently there are calls from the population in Germany for a one to one care model with a primary provider of care which are being expressed through demonstrations and petitions. Caseload Midwifery as a midwife-led model of care can offer a high degree of continuity of care(r) by a primary provider of care.

Recommendations/conclusion: The results highlight how new options of care can be implemented and developed further. The Caseload Model represents a possibility for offering women continuity of care. For midwifery in Germany, it is recommendable to check if and in which ways Caseload Midwifery can be implemented as a reaction to nationwide protests and demands.

Ethical considerations: The requirements of the Helsinki Declaration have been fulfilled. The interviewees were informed and gave their written consent to participate voluntarily. The resulting data were analysed in anonymous form.