Working towards a common goal

In maternity care a collaborative approach is best for mother and child, but is it happening in practice? Annie May reports.

Doctors and midwives are unwilling to compromise in the way they approach maternity care, according to a new survey.

Both groups also disagree greatly on who should be the primary carer, claims the survey conducted by the Queensland Centre for Mothers and Babies (QCMB).

“Despite continuous references to collaboration in maternity care, there are general inconsistencies into how the term is used or perceived, particularly between doctors – GPs and obstetricians – and midwives,” says the centre’s Associate Professor Sue Kruske.

The survey asked 461 GP obstetricians, obstetricians and midwives in Queensland about their views on collaboration between doctors and midwives.

The results showed while there was widespread agreeance with the definition of collaboration, there were significant differences in the way this definition translated into practice, says Kruske.

More than half of the doctors surveyed said they should be the primary carer of pregnant women. Only 4 per cent of midwives agreed.

In contrast, more than 90 per cent of midwives believed they should be the primary carer compared with almost one-third of doctors.

There is also a lack of faith in the current system to promote collaboration. More than 70 per cent of midwives and 60 per cent of doctors believe the system doesn’t support collaboration.

The issue of respect between the two groups was also looked at. While media reports suggest there is a lack of esteem shared between both sides, project leader of QCMB’s Maternity Care Collaboration project, Michelle Heatley says the survey shows this isn’t the case.

Doctors were more likely than midwives to feel respected, trusted and valued members of the team, however this was based on perception, not always reality, says Heatley.

Almost 95 per cent of doctors said they respected midwives, whereas only 75 per cent of midwives who agreed they respected doctors.

“If simply compared alongside each other, these figures could be taken as midwives not respecting doctors, but 75 per cent is still a very high number. This shows there is a high level of trust and respect among health professionals, which is essential in collaboration,” Healtey says.

The findings come after the NHMRC announced it would act as the go-between for obstetricians and midwives following repeated failed attempts to get both groups into the same room to agree on referral guidelines.

The NHMRC made the move after the Royal Australian and New Zealand College of Obstetricians and Gynaecologists refused to attend a meeting to determine referral guidelines with the Australian College of Midwives.

From November, midwives will be able to access the MBS provided they work collaboratively with doctors.

Attempting to develop a model to achieve this requirement is the Maternity Care Collaboration project, which is exploring ways in which maternity care professionals provide care in Queensland.

“We are currently compiling results from the survey to give us a greater picture of the perceptions and practices of groups involved in maternity care,” says Heatley.

“Once we have that it will give is focus areas to work on.”
Looking around Queensland to identify “good collaboration” is at the heart of the project, she says.

“There are doctors and midwives in the state who are successfully working together and we will look at what we can take from them to develop a model for those who aren’t collaborating.”

Developing a model that understands and works with the differences between rural and metropolitan areas is essential, Heatley says.

The work of the team also includes developing communication strategies to improve the sharing of information, both among care providers and between providers and their clients.

“Working with stakeholders and communication experts, the team will be developing models of communication and strategies to implement the models to enhance “true and effective” collaboration in Queensland maternity care.

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