Exploring the key elements required for midwives to develop a new model of postnatal care within an acute care setting

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Aim This research aimed to explore the key elements to improve the quality of postnatal care provided to women in a public hospital postnatal ward in Sydney and to attempt to implement a new model of postnatal care. Background Reports, internationally and nationally, indicate that women are least satisfied with hospital-based postnatal care when compared with antenatal, labour and birth care. Many researchers have identified the components of postnatal care that women find most helpful however, there continues to be barriers to develop and test innovative approaches or models of postnatal care within hospital settings. The focus of this project was to try to move the postnatal ward to a culture that is woman and baby centred rather than illness or institution-centred. The development process drew on Practice Development approaches that would enable midwives to facilitate change in the environment and culture of the postnatal ward with a view to improving postnatal care for women and their families. Method A qualitative descriptive study, using a three phased approach, was adopted for this research. Phase one was to identify the issues and concerns by conducting focus groups with staff. Phase two challenged usual practices and explored new ways of providing care in the postnatal ward. This phase incorporated working with the staff utilising Practice Development approaches. The third phase explored with key stakeholders the outcomes and issues of phase two including the barriers and limitations to enable midwives to implement a new model of postnatal care. Findings There were a number of barriers for change to occur including the current system of maternity care provided to women. This has also been reported by others over the past few decades. Within an acute care hospital environment, the midwives struggled to provide quality midwifery care with a philosophy of care counter to that which had been imbedded over many years. Midwives were caught up managing the day to day issues and most were unable to reflect on the care women received or to have the time to contemplate changes. Challenging the usual rituals and routines with the midwives generated some attainable changes that included providing women with more information about what to expect following birth and updated policies for healthy women and babies. The policies reflect the latest evidence and a more woman and baby centred approach to a daily assessment. This research also explored ways for midwives to be able to spend more time with women, and included challenging the everyday non-midwifery tasks undertaken by midwives working within the hospital system. These non-midwifery tasks included managing administration, security, catering and domestic duties. Barriers towards providing a more woman and baby centred way of providing postnatal care included the need for further professional development of the midwives and more professional support. There was also a need for role modelling of womancentred approaches to care and the development of a different way of providing care that included midwifery continuity of care. Conclusion Maternity services in hospitals have been subsumed into the general wards often governed by sickness priorities and it is acknowledged changing to a more womancentred approach was challenging. Without support from leaders, the change towards a woman-centred approach may not happen within the constraints of the medicalised model. Implications for Practice My research found a number of implications for others planning improved postnatal care for women in an acute care setting. Key elements included the need for midwives to have a clear articulation of their vision for the ward. Change may not happen if midwives do not believe the benefits of providing individualised care that meets the needs of the women. For this to be realistic and achievable, strong visionary leadership is key to moving the ward vision forward and implementing a new model of care. The timing for change in this setting is critical. It is unreasonable to implement change with midwives during a period of restructure. This can have a negative impact on successful change by threatening the midwives personal sense of control. In summary, this research found that effective leadership, adopting a shared vision, providing high support and high challenge were all important elements to support moving towards a more woman-centred care approach. Threatening the midwives sense of control over their professional world was also found to be an important factor when attempting to bring about change and will be discussed in this thesis.
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