Renovating midwifery care : the complexity of organisational change for midwives in Victoria, Australia
- Publication Type:
- Thesis
- Issue Date:
- 2009
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The importance of the role of the midwife in providing safe, quality care for women has
until recently, been underrated in Victoria, Australia. Acknowledgement of the need for
midwife-led models of care in state maternity service policies provided opportunities for
midwives to become recognised within the healthcare system and the wider community.
This professional doctorate aims to examine the ways in which the role of the midwife
and her practice has been impacted on by organisational renovations of midwifery care.
It identifies the complexity of the factors that affect the midwife’s ability or choice to
work in midwife-led models of care. Furthermore this doctorate highlights the need for
ongoing debate into midwifery in Australia.
Concepts related to midwifery practice are examined as they form the foundations for
the research and policy components of the portfolio. This includes an exploration of
midwifery philosophy, the antecedents to autonomous practice and the experience
midwives have of midwife-led care. An examination of the concepts of continuity of
care and woman-centred care provides a platform upon which to review models of
midwifery care. This review highlights the development of an ongoing relationship as a
source of satisfaction for midwives and women.
The second part of the doctorate reviews policies that guide the provision of maternity
services in Victoria. Analysis of these policies using Kingdon’s multiple streams
framework identifies the problems, the political actors and the policy developed,
establishing the context for organisational change in maternity care. The antecedents
for successful integration of organisational change are explored through a review of
change theory and leadership.
A case study approach utilised for the research component of the doctorate provides
insights into organisational change that occurred at two maternity sites in Victoria. The
findings of the study suggest there was a dichotomy between those midwives desiring
autonomous practice and wanting to work in midwife-led care and those wishing to
remain in one specialised area. Recommendations stemming from these findings
include the need for sufficient education and support during change, a review of
terminology used to describe midwifery models of care and research into the use of
integrated maternity units.
Complexity science is examined in order to bring the different strands of the doctorate
together, providing an explanation for the different outcomes that occur despite the
implementation of similar models. The connective leadership model was suggested as
the means to provide leadership that is inclusive of providing direction, mentoring new
leaders and providing support and opportunities for midwives to become empowered to
practice autonomously. Attention to the complexity of organisational change is vital to
ensure the future of midwifery.
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