THE MIDWIFERY MODELS OF

CARE
WHO IS A MIDWIFE?
The International Definition of a Midwife goes on to state:
The midwife is recognized as a responsible and accountable
professional who works in partnership with women to give the
necessary support, care and advice to during pregnancy, labour
and the postpartum period, to conduct births on the midwife’s
own responsibility and to provide care for the newborn and the
infant.
This care includes preventative measures, the promotion of
normal birth, the detection of complications in the mother
and child, the accessing of medical care or other appropriate
assistance when necessary and the carrying out of emergency
measures when necessary.
The midwife has an important task in health counselling and
education, not only for the woman but also within the family
and the community.
The work should involve antenatal education and
preparation for parenthood and may extend to women’s
health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home,
community, hospitals, clinics, or health units.

The ICM definition of a midwife (ICM, 2005)

 WHAT IS A MIDWIFERY?
Midwifery is both an art and a science.
 The art of midwifery consists of sensitivity to the needs of
women and families, and being able to meet these needs in
the most appropriate way.
 The science of midwifery overlaps with that of other disciplines
such as medicine and nursing. The crux of the art and science
of midwifery lies in the knowledge of and devotion to keeping
birth, and other related processes normal.
 Midwives see their clients as whole, capable people for
whom the processes of pregnancy, labor, delivery and
parenting offer the opportunity for significant personal growth
 THE MIDWIFERY CARE PHILOSOPY
The Philosophy and Model of Midwifery Care (ICM, 2011)

The ICM believes that a midwife offers care based

on a philosophy, which influences the model of
care. As midwives we believe that :
1. Childbearing is a profound experience, which carries significant
meaning to the woman, her family and the community.
2. Birth is a normal physiological process.
3. Midwives are the most appropriate care providers to attend
women during pregnancy, labour, birth and the postnatal
period.
4. Midwifery care empowers women to assume responsibility for
their health and for the health of their families.
 THE MIDWIFERY CARE PHILOSOPY
The Philosophy and Model of Midwifery Care (ICM, 2011)

The ICM believes that a midwife offers care based on a

philosophy, which influences the model of care. As
midwives we believe that:
5. Midwifery care takes place in partnership with women and is
personalised, continuous and non-authoritarian.
6. Midwifery care combines art and science. Midwifery care is holistic in
nature, grounded in an understanding of the social, emotional, cultural,
spiritual, psychological and physical experiences of women and based
upon the best available evidence.
7. Midwives have confidence and trust in, and respect for women and their
capabilities in childbirth.
8. The woman is the primary decision-maker in her care and she has the
right to information that enhances her decision-making abilities.
BERDASARKAN FILOSOFI TERSEBUT...
The Philosophy and Model of Midwifery Care (ICM, 2011)

As a result:
1.Midwifery care promotes, protects and supports
women's reproductive rights and respects ethnic and
cultural diversity
2.Midwifery practice promotes and advocates for non-
intervention in normal childbirth
3.Midwifery practice builds women's self confidence in
handling childbirth
4.Midwives use technology appropriately and effect
referral in a timely manner when problems arise
5.Midwives offer anticipatory and flexible care
BERDASARKAN FILOSOFI TERSEBUT...
The Philosophy and Model of Midwifery Care (ICM, 2011)

As a result:
6.Midwives provide women with appropriate
information and advice in a way that promotes
participation and facilitates informed decision making
7.Midwifery care maintains trust and mutual respect
between the midwife and the woman
8.Midwifery care actively promotes and protects
women’s wellness and enhances the health status of
the baby.
HOLISTIC MIDWIVES
› Act as guardians of natural childbirth and well
women, care-providing birthing women with
support and guidance to ensure a healthy
pregnancy, labor and delivery with minimal
intervention.
› Understand that pregnancy and birth are normal
processes, and work to optimize the well-being of
mothers and their babies as the foundation of
care giving.
› Approach the experience of childbirth as far
more than a physical event, perceiving it as a
profound emotional, mental and spiritual Rite of
Passage for both mother and child.
HOLISTIC MIDWIVES
› Respect the dignity, integrity and response-
ability of the women they serve, recognizing that
the primary caretaker and most important
determinant of a healthy pregnancy and positive
birth experience is the woman herself.
› Work in partnership with mothers, their families
and their communities, helping them to explore
their options and make informed decisions based
on their unique circumstance.
 SPECIFIC MODELS OF MATERNITY CARE

1. Community Midwifery/Home Birth

– Community midwifery care is provided for the
majority of women during the antenatal and the
postnatal periods. The importance of early contact
in the antenatal period is that ‘it gives more time for
informed choices in planning their care and ensures
women can take advantage of all support and tests’
(Shribman, 2007).
 SPECIFIC MODELS OF MATERNITY CARE
2. Midwifery-led Care
– Options for midwifery-led models of care include those situated
as stand-alone models in the local community or along side the
acute hospital setting.
– These units have the potential to deliver safe, quality care for
women and babies promoting a philosophy of normal and natural
childbirth if strategically organised ((DoH, 2007; Gould, 2009).
– These models of care require strong midwifery stakeholders’
voices to be heard at policy and planning groups nationally.
Midwifery led units on a hospital site are currently operational in
the four countries; however, the patterns of care provided may
vary to reflect local need. A Cochrane review (2009) involving
12,276 women where midwife-led were compared with other
models of care and examined aspects of continuity, normality
and safety.
 SPECIFIC MODELS OF MATERNITY CARE
3. Team Midwifery and Caseload Midwifery
– These models of midwifery care are currently practiced
throughout the United Kingdom. In some cases, small teams of
six or more community-based midwives aim to provide
antenatal, intrapartum and postnatal care for women, supported
by core staff on the maternity ward, delivery suite and antenatal
clinics.
– This model is based on evidence from trials showing clear
advantages for women who receive care from a team of
midwives. Alternatively, Williams et al (2009) demonstrated that
in Australia the caseload model where a maximum of two
midwives may provide full care throughout pregnancy, labour
and the postnatal period to a small group of women.
– This was reported to be associated with high levels of maternal
satisfaction and that supportive relationships with midwives in a
caseload scheme are highly valued by women.
 SPECIFIC MODELS OF MATERNITY CARE
4. Obstetric-led care
– For those women who are classified as being in high risk
groups, consultant-led model is the safest option and therefore
must be provided in a modern maternity system to promote
safety for both mother and child in high risk groups.
– Although the lead professional is the obstetrician, throughout
the woman’s pregnancy, coordination and continuity of care
is provided by midwives and a range of other professionals
which may include anaesthetists and paediatricians.
 SPECIFIC MODELS OF MATERNITY CARE
5. General Practitioner (GP)-led care
– Internationally, the involvement of General Practitioners (GPs)
in maternity care is significantly reduced, similar rationale
being cited as: interference with lifestyle and interruption of
office routine; fear of litigation and costs of malpractice
insurance; insufficient training and numbers of cases to retain
competency.
– The future promotion of this model of maternity care would
require greater partnership and collaboration with midwives,
preferably in shared care programs, however, the advice from
NICE (2008) emphasises that GPs should refer all pregnant
women to maternity services as soon as possible.
 SPECIFIC MODELS OF MATERNITY CARE
6. Non-NHS midwifery care
– For women choosing to have maternity care outside what is
provided by the NHS, a range of care should be made available.
– Independent midwives are registered midwives who have chosen
to work alongside the NHS in a self-employed capacity.
– Independent midwives fully support the principles of the NHS and
are currently working to ensure that all women have access to the
full range of services available.
– The role of the independent midwife encompasses the care of
women and babies during pregnancy, birth and the early weeks of
motherhood.
– Women who access independent midwives are also entitled to NHS
care when they need it. Non-NHS care should also be available
from obstetricians for those women who wish to access it. Some
midwives are now exploring the development of a social enterprise
model of care.
 SPECIFIC MODELS OF MATERNITY CARE
7. Midwifery Group Practice
– Midwifery Group Practice (MGP) also known as 'Case-load
Midwifery', enables women to be cared for by the same
midwife (primary midwife) supported by a small group of
midwives throughout their pregnancy, during childbirth and in
the early weeks at home with a new baby. MGP is also defined
further as in the case-load midwifery section above
(Queensland Nurses Industrial Award, 2006; Davis-Floyd,
Barclay, Daviss & Tritten, 2009).
 SPECIFIC MODELS OF MATERNITY CARE
8. Case-load Midwifery Model
– Case-load midwifery is an example of a midwifery-led model of
care which requires an on call component. The philosophy in
case-load midwifery is that a midwife enters into a professional
partnership with the pregnant woman.
– This allows for equality, shared responsibility, informed
choices, empowerment, individual negotiation and self-
fulfilment for both the woman and the midwife.
– The care is woman centred, pregnancy and birth are viewed as
normal and healthy life events and continuity of care is
ensured by having one primary midwife as the main caregiver
(Queensland Nurses Industrial Award, 2006; Davis-Floyd,
Barclay, Daviss & Tritten, 2009).
 SPECIFIC MODELS OF MATERNITY CARE
9. Multidisciplinary care
– A number of multi-professional team approaches to the
management of complex pregnancy are emerging in the
maternity care literature.
– There has also been an midwives play a key listening role
with women and encourage women to look forward to ordinary
aspects of pregnancy and parenthood in the midst of a complex
increase in the number of maternity units.
– Reports of multi-professional approaches to management of
other subgroups of women with complex pregnancy highlight
the importance of communication, with midwives acting as a
link between disciplines, and how pregnancy and birth.
 SPECIFIC MODELS OF MATERNITY CARE
10.Partnership Model
– Model of care where the midwife and woman are in partnership
throughout the pregnancy, birth and post birth period.
– The philosophy is the same as a midwifery model of care with
the woman central to the care and an equal decision maker
throughout her care with the midwife (Guilliland & Pairman,
1995).
THE MIDWIVES MODEL OF CARE
The Midwives Model of Care is based on the fact that
pregnancy and birth are normal life processes. It
includes:
›Monitoring the physical, psychological, and social
well-being of the mother throughout the childbearing
cycle
›Providing the mother with individualized education,
counseling, and prenatal care, continuous hands-on
assistance during labor and delivery, and postpartum
support
›Minimizing technological interventions
›Identifying and referring women who require
obstetrical attention
 PERBEDAAN DASAR MODEL KEBIDANAN & MEDIS

(Sources: Bryar 1995; Davis-Floyd 1987; Gillespie and Gerhardt 1995: 83; Helman 1985; Oakley 1999: 321; Porter 1999: 135; Rooks
1999; Van Teijlingen and Bryar 1996; Wagner 1994).
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 Continuity of Care Model
› Continuity of care is fundamental to the
midwifery model of practice.
› It is both a philosophy and a process that
enables the midwife to provide holistic care
and to establish an ongoing partnership with
the client in order to build understanding,
support and trust.
› Continuity of care is facilitated through a one to
one relationship between midwife and client.
 Continuity of Care Model
› There must be 24-hour on-call availability of
the primary care midwives known to the
woman.
› Every midwife must make the time commitment
necessary to develop a relationship of trust
with the woman during pregnancy, to provide
safe individualized care and support the
woman during the childbearing year.
 Continuity of Care Model
› Continuity of midwifery care means a woman is able to
develop a relationship with a midwife to work in
partnership for the provision of her care during
pregnancy, labour birth and the postnatal period.

› Whilst there are many ways in which midwifery care

may be organised, midwives can function autonomously
as primary care providers, and do so with the view to
personalising (individualising) care for each woman ,
providing referral to other health professionals if
required.
 Continuity of Care Model
› Rationale: Continuity of care is known to decrease
the need for pharmacological pain relief in labour
and surgical birth rates (both operative vaginal birth
and caesarean section) while increasing breastfeeding
rates and maternal satisfaction.
THANK YOU