title: Continuity of midwifery care for rural women through caseload group practice: Delivering for almost 20 years.
abstract: OBJECTIVE
  To describe the clinical outcomes and sustainability factors of a long-standing midwifery led caseload model of rural maternity care.
  
  
  METHODS
  Retrospective clinical audit from 1998 to 2011 and autoethnographic narrative of the midwifery program told by the longest serving midwives under three key themes relating to sustainable practice.
  
  
  METHODS
  Regional Health Service with annual birth rate of 500. Maternity care is provided by either public antenatal clinic/GP shared care or midwife-led care.
  
  
  METHODS
  Women attending a rural caseload midwifery group practice between the period 1998-2011 and midwives working in the same group practice during that period.
  
  
  METHODS
  Antenatal attendance, maternal mortality, infant morbidity and mortality, mode of birth, known midwife at birth, initiation of breastfeeding.
  
  
  RESULTS
  There were 1674 births between 1998 and 2011. Clinical outcomes for women and infants closely reflected national maternity indicator data. The group practice midwives attribute sustainability of the program to the enjoyment of flexibility in their working environment, to establishing trust amongst themselves, the women they care for, and with the obstetricians, GPs and health service executives. The rigorous application of midwifery principles including robust clinical governance have been hallmarks of success.
  
  
  CONCLUSIONS
  This caseload midwifery group practice is a safe, satisfying and sustainable model of maternity care in a rural setting. Clinical outcomes are similar to standard care. Success can be attributed to strong leadership across all levels of policy, health service management and, most importantly, the rural midwives providing the service.
authors.affiliation: Midwifery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.|Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Haines
authors.affiliation: Midwifery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Baker
authors.affiliation: Midwifery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
authors.forename: Diana
authors.initials: D
authors.lastname: Marshall
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000639:trends*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006297:Health Services Accessibility / Q000639:trends; D006301:Health Services Needs and Demand; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration / Q000639:trends*; D008507:Medically Underserved Area; D008880:Midwifery / Q000458:organization & administration / Q000639:trends*; D011247:Pregnancy; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration / Q000639:trends*; D013021:South Australia; D055815:Young Adult
keywords: caseload; continuity of midwifery care; rural maternity care