Community maternity hubs and midwifery caseload practice: a future-focused primary health model with integrated access to secondary and tertiary services

Abstract

Background: The first 1000 days of life, commencing in pregnancy, are critical to long-term health and wellbeing. Poor health outcomes at the start to life have been shown to manifest in chronic disease, including major public health problems, e.g. obesity, heart disease and mental health problems. Long term costs for individuals, families and health systems are increased. Evidence also show that outcomes for mothers and babies can improve where there is early uptake of antenatal care. In specific areas of Australia, access to early antenatal care has been identified as suboptimal. This can relate to local population need and circumstances, even where established health services are available. New approaches are needed.

Innovation and originality: This paper provides an overview of a new maternity service innovation implemented in Logan, South-East Queensland to address identified population specific need, specifically women from migrant and refugee communities, Aboriginal and Torres Strait Islander women, and women from low SES backgrounds/circumstances. It describes an emerging model of maternity care that fully implements the Lancet series Framework for Quality Maternal and Newborn Care and is underpinned by principles of primary health, community development, co-design and cultural safety. The new model includes continuity of midwifery care with a named midwife, partnership with existing non-government community services oriented to local population need, and integrated support from established secondary and tertiary maternity services, including hospital and specialist consultation and referral.

Implications for policy makers: Principles and process for developing successful partnerships between women, communities, local government, funders and established health services to enable replicability will be highlighted. Current evidence and policy debate in Australia and the UK oriented to expansion of these new service models will be discussed in relation to service co-design and governance.