title: An overview of the first 'no exit' midwifery group practice in a tertiary maternity hospital in Western Australia: Outcomes, satisfaction and perceptions of care.
abstract: BACKGROUND
  Midwifery group practice (MGP) is a care model offered by a primary midwife in a small team. Evidence confirms MGP is acceptable to women, safe and cost effective.
  
  
  METHODS
  We aimed to provide a systematic overview of the first 'no exit' MGP in a Western Australian (WA) tertiary maternity hospital, using a mixed methods approach, involving four phases. Between July 2013 and June 2014: phase one assessed MGP characteristics, obstetric and neonatal outcomes by parity; phase two examined women's satisfaction by mode of delivery; and phase three qualitatively explored perceptions of care. Phase four compared the proportion of MGP women and the 2012 WA birthing population.
  
  
  RESULTS
  Phase one included 232 MGP women; 87% achieved a vaginal birth. Phase two included 97% (226 of 232) women, finding 98% would recommend the service. Phase three analysis of 62 interviews revealed an overarching theme 'Continuity with Midwives' encompassing six sub-themes: only a phone call away; home away from home; knowing me; a shared view; there for me; and letting it happen. Phase four compared the MGP cohort to 33,393 WA women. Intrapartum MGP women were more likely than the WA population to have a vaginal birth (87% vs 65%, P≤0.001) and intact perineum (49% vs 36%, P≤0.001) and less likely to use epidural/spinal analgesia (34% vs 59%, P≤0.001), or have a caesarean (13% vs 35%, P≤0.001).
  
  
  CONCLUSIONS
  Mixed methods enabled systematic examination of this new 'no exit' MGP confirming safety and acceptability. Findings contribute to our knowledge of MGP models.
authors.affiliation: School of Nursing and Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia 6009, Australia. Electronic address: Lucy.lewis@curtin.edu.au.
authors.forename: Lucy
authors.initials: L
authors.lastname: Lewis
authors.affiliation: School of Nursing and Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia 6009, Australia. Electronic address: y.hauck@curtin.edu.au.
authors.forename: Yvonne L
authors.initials: YL
authors.lastname: Hauck
authors.affiliation: King Edward Memorial Hospital, Subiaco, Western Australia, Australia. Electronic address: caroline.crichton@health.wa.gov.au.
authors.forename: Caroline
authors.initials: C
authors.lastname: Crichton
authors.affiliation: King Edward Memorial Hospital, Subiaco, Western Australia, Australia. Electronic address: Alissa.Pemberton@health.wa.gov.au.
authors.forename: Alissa
authors.initials: A
authors.lastname: Pemberton
authors.affiliation: King Edward Memorial Hospital, Subiaco, Western Australia, Australia. Electronic address: Megan.Spence@health.wa.gov.au.
authors.forename: Megan
authors.initials: M
authors.lastname: Spence
authors.affiliation: King Edward Memorial Hospital, Subiaco, Western Australia, Australia. Electronic address: georgina.kelly@health.wa.gov.au.
authors.forename: Georgina
authors.initials: G
authors.lastname: Kelly
mesh_terms: D001315:Australia; D003266:Continuity of Patient Care / Q000458:organization & administration; D005260:Female; D006123:Group Practice / Q000458:organization & administration*; D006771:Hospitals, Maternity / Q000458:organization & administration*; D006801:Humans; D008880:Midwifery / Q000379:methods*; D010298:Parity; D036801:Parturition; D010549:Personal Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014904:Western Australia
keywords: Caseload midwifery; Childbirth; Continuity of care; Midwifery group practice; Women's experiences