Midwives' perceptions of organisational structures and processes influencing their ability to provide caseload care to socially disadvantaged and vulnerable women.
OBJECTIVE
This study examined midwives' perceptions of organisational structures and processes of care when working in a caseload model (Midwifery Group Practice MGP) for socially disadvantaged and vulnerable childbearing women.


METHODS
This study used Donabedian's theoretical framework for evaluating the quality of health care provision. Of the 17 eligible midwives, 15 participated in focus group discussions and two others provided written comments. Thematic analysis was guided by three headings; clinical outcomes, processes of care and organisational structure.


RESULTS
Midwives believed they provided an excellent service to socially disadvantaged and vulnerable childbearing women. Midwives gained satisfaction from working in partnership with women, working across their full scope of practice, and making a difference to the women. However the midwives perceived the MGP was situated within an organisation that was hostile to the caseload model of care. Midwives felt frustrated and distressed by a lack of organisational support for the model and a culture of blame dominated by medicine. A lack of material resources and no identified office space created feelings akin to 'homelessness'. Together these challenges threatened the cohesiveness of the MGP and undermined midwives' ability to advocate for women and keep birth normal.


CONCLUSIONS
If access to caseload midwifery care for women with diverse backgrounds and circumstances is to be enhanced, then mechanisms need to be implemented to ensure organisational structures and processes are developed to sustain midwives in the provision of 'best practice' maternity care.


CONCLUSIONS
Women accessing midwifery caseload care have excellent maternal and newborn outcomes. However there remains limited understanding of the impact of organisational structures and processes of care on clinical outcomes.
School of Nursing and Midwifery, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia. Electronic address: j.menke@griffith.edu.au.
Jane
J
Menke
School of Nursing and Midwifery, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia; Gold Coast University Hospital, Parklands, Queensland, Australia. Electronic address: J.fenwick@griffith.edu.au.
Jennifer
J
Fenwick
School of Nursing and Midwifery, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia. Electronic address: J.gamble@griffith.edu.au.
Jenny
J
Gamble
School of Nursing and Midwifery, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia. Electronic address: Hazel.Brittain@health.qld.gov.au.
Hazel
H
Brittain
Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia. Electronic address: d.creedy@griffith.edu.au.
Debra K
DK
Creedy
D005260:Female; D017144:Focus Groups; D006123:Group Practice; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration* / Q000592:standards; D008880:Midwifery; D010465:Perception; D011247:Pregnancy; D036301:Qualitative Research; D035862:Vulnerable Populations; D016526:Workload / Q000523:psychology*
Continuity; Organisational structure; Sustainability; Vulnerable women