Midwifery practice arrangements which sustain caseloading Lead Maternity Carer midwives in New Zealand

A Corresponding Author: andrea. gilkison@aut.nz B School of Midwifery, AUT University, New Zealand INTRODUCTION AND BACKGROUND Implementing caseload, continuity of care, midwifery models improves outcomes and has significant benefits for the woman and baby (National Health Service, 2014; Sandall, Devane, Soltani, Hatem, & Gates, 2010; Sandall, Soltani, Gates, Shennan, & Devane, 2013), and enhances women’s and midwives’ satisfaction (Collins, Fereday, Pincombe, Oster, & Turnbull, 2010; Ministry of Health, 2011). The New Zealand Nurses Amendment Act (1990) provided New Zealand midwives with the legal ability to practise as autonomous health professionals. Midwives in New Zealand are funded by the government to provide midwifery care throughout pregnancy, labour, birth and the postpartum period up to six weeks, for women who have chosen to book with them (Ministry of Health, 2007). To support this continuity of care for women, New Zealand midwives are able to work as a Lead Maternity Carer (LMC) and provide care to a caseload of women. The predominant choice as LMC is a midwife (Ministry of Health, 2012), however, a general practitioner or an obstetrician can fulfil this role; it is the woman who determines who her LMC will be. Providing LMC care to a caseload of women often means that the midwife needs to be available to her caseload at any time of the day or night – to provide care during labour or for any urgent or emergency issues (Ministry of Health, 2007). For some midwives this requirement is unsustainable and it has been argued may potentially increase burnout (Young, 2011), whilst for others it is enjoyable and satisfying (McAra-Couper et al., 2014). Our wider study aimed to explore what it is about working as a LMC midwife, providing continuity of care, which sustains midwives and supports them to continue to work in this role. A previous paper has described this study and the main themes summing up what sustained them in practice were identified as: the joy of working in partnership with women; having good collegial relationships with practice partners who are philosophically aligned; managing the unpredictability of being on-call; having clear boundaries; having good relationships with colleagues in maternity units; having supportive families and friends; and the way the practice was organised (McAra-Couper et al., 2014). This paper reviews the specifics of practice arrangements which contributed to sustainable midwifery practice for our participants. In 2013, 38.1% (1,118 midwives) of the New Zealand midwifery workforce reported caseloading as their main work situation, 86% of the caseloading midwives worked as self-employed LMCs (Midwifery Council of New Zealand, 2013). Midwives who work Background: The New Zealand Lead Maternity Carer (LMC) midwifery model has benefits for women and babies and is a satisfying way to work for midwives. Due to the need to be on-call for long periods of time, there have been questions raised about the sustainability of the model for midwives and the potential for burnout. Objective: This qualitative descriptive study explored what sustains on-call, caseloading Lead Maternity Carer (LMC) midwives in New Zealand. Methods: Eleven midwives with 12 to 20 years in practice were interviewed and thematic analysis used to identify themes which sustained these LMC midwives in practice. Findings: Overall, the study found that it was the joy of midwifery practice, managing the unpredictability of being on-call, having clear boundaries, having good relationships with colleagues, having supportive families and friends, and workable practice arrangements which sustain them in practice. This paper presents the findings from the theme: workable practice arrangements. The midwives interviewed explained that having regular time off, a manageable caseload size, working together as a practice, the financial arrangements, and the sharing of arrangements with women created a sustainable way to practice. Conclusion: This paper has identified aspects of sustainable practice which are congruent with the international research but also very specific to the New Zealand model of midwifery.