Caseload Midwifery
Pregnant women face several challenges of having to choose from a wide variety of services for pregnancy, birth, and postnatal care. Women need information on the various midwifery options that are available, their pros, cons, and the consequences of each choice. The factors that make the options different include whether the care is private or public, and whether the service is handling is by an obstetrician, a midwife, or a general practitioner (GP) as the main caregiver.
Caseload midwifery is a model of care led by a midwife, whereby there is a professional agreement between the midwife and the pregnant woman, such that there is sharing of responsibilities, personal negotiation, self-actualization, empowerment, and making informed choices, between the midwife and the pregnant woman (Wilde, 2006). A midwife takes care of a woman with one or two more midwifes acting as reserves. The main caregiver meets the woman six to eight times antenatlally, while the reserve caregivers can meet the woman once or twice antenatally. The main caregiver refers the woman to a doctor for medical attention during the twelve to sixteen week pregnancy periods, the thirty sixth week, as well as after forty weeks (Johnson et al., 2005). Forrest recommends that any of the three midwifes should be present for the intrapartum phase and postnatal phase, and they should accompany the woman for twenty-four hours (2006). The primary caregiver should visit the woman in the first ten days and until the period of six postpartum as required (Forrest, 2006). Caseload midwives work hand in hand with obstetricians, general practitioners, child-health nurses, social workers and other relevant health personnel, to ensure that the woman is well and comfortable during the antenatal, intrapartum, and postnatal periods (Wilde, 2006).
The caseload model of midwifery has a positive response and satisfaction from women’s perspective, because of the high standards of antenatal care and the preparedness presented for birth and motherhood (Wilde, 2006). Women who opt for the caseload model tend to require reduced medical attention, reduced induction, reduced episiotomies, and an increase in the request for pethidine (Wilde, 2006). Wilde claims that he increase in the request for pethidine is an indication of the women’s comfort in relating with the midwife or the midwife’s intuition of the pain relief needs of the woman (2006). Flint & Poulengeris comment that women have the feeling of increased control in labor and the labor experience is positive when a familiar midwife is present (1988). Harmonious advice from the caregivers reduces the necessity for hospital admissions, reduces hospital visiting hours, and reduces anxiety and pain levels, as is the case in the caseload mode of midwifery (Swan, 1993). The Caseload midwifery model offer several advantages compared the standard hospital care given to pregnant women. Midwives also have a positive response towards midwifery since they operate like independent practitioners who are responsible for their caseload of clients. The caregivers experience increased job satisfaction and an exposure to practice and enhance their midwifery skills (Wilde 2006). There is also an expansion of the scope of practice for the caregiver through the provision of health education and counseling.
Some of the disadvantages of the caseload midwifery model include the increased demand for the flexibility of the midwife, since they are fully responsible for taking care of the client in the antenatal, intrapartum, and postnatal stages. The fact the caregiver has to be on-call and to attend long shifts tires the caregiver (Wilde 2006). Being on-call interferes with the caregiver’s personal life since she has to abandon all other duties to attend to the client in case of a call (Wilde 2006).
References
Flint, C., & Poulengeris, P .(1988). In Wilde, K. (2006). Midwifery-Led Models of Care. School of Nursing and Midwifery. text
Forrest, R. (2006). In Wilde, K. (2006). Midwifery-Led Models of Care. School of Nursing and Midwifery. text
Johnson,M., Stewart,h., Langdon, R., Kelly,P., & Yougn, L.(2005). In Wilde, K. (2006). Midwifery-Led Models of Care. School of Nursing and Midwifery. Text
Swam, M.(1993). In Wilde, K. (2006). Midwifery-Led Models of Care. School of Nursing and Midwifery. text
Wilde, K. (2006). Midwifery-Led Models of Care. School of Nursing and Midwifery. text
