Evaluating clinical outcomes on implementing and managing team midwifery in Malta.

Abstract

This study explored the need of enhancing clinical documentation through the Total midwifery care is provided to pregnant women by small teams of midwives within a Team Midwifery System of Care. The purpose of this study was to change the fragmented care given in Traditional Systems of Care, into a Team Midwifery System of Care. This system was hypothesised to provide clients with continuity of care by known carers throughout the three phases of childbirth: antenatal, intrapartum, and postnatal care. This change was to result in a reduction in the use of analgesia in labour and in obstetric interventions. These same parameters were hypothesised as being beneficial to Team Midwifery clients when compared with Traditional Systems' clients. Lewin's (1951) Force-Field Change Model was utilised to implement and manage the change. A convenience sample of 294 women was divided into three groups: a Team Midwifery Group, run by midwives, private care and hospital care control groups, run by obstetricians and general practitioners. The control groups served as a comparison in this quasi-experimental design. Assignment of "Low Risk" women to the Team Midwifery System Group was voluntary. Matching criteria - parity, expected and actual dates of delivery - were used to form the control groups. Information was collected from the women's case notes and pregnancy co-operation cards. Group differences were analysed using Chi Square Tests. Of the four hypotheses tested in this study, only the one regarding known carers at delivery, yielded statistical significance for the Team Midwifery Group. Results addressing all other levels of care were similar in all three groups. This suggests that the Team Midwifery System of Care is a viable supplement to present day care. Further studies are needed to plan the integration of Team Midwifery and the concept of continuity of care into the present day system.