hi Belinda,
I have personal experience with this recently, and I think I'll mail you off
line about it.
I didn't write this just under an impression and maybe it was just something
that went haywire as a one off.
The hours are extremely flexible, the reason mostly for the 12 hour in
hospital will be due to the complicated women they now get as it is an all
risk model normal laboring women are seen at home or keep in contact with
her midwife until they are established and come into hospital then, so 12
hours later if they are still going and all is well (or not) t he midwife
may well stay on (I recently did 15hours) it depends on how she is feeling
what is happening what her day has been like etc.
The complexity is in being an all risk model. It is not perfect but keep
in mind the literature does show that it is continuity of care rather that
carer that results in increased satisfaction etcetera. It is also a model
that is working through many teething problems, staff turnovers,
personality, experience and practice differences (the groups don't choose
who they work or partner with, which has been shown to be a key factor in
successful group practice models) and I am not saying that is specifically
a problem here but does add to the complexity of working in this type of
service.
I absolutely agree that continuity of care has increased satisfaction, but
you have to be able to promise this absolutely and not be let down at the
end. And as we both know experience and phylosophy can seriously change the
group dynamic.
There is still a lot of work to be done in getting the support and
collaborative working relationships, respect etc across the board that
would increase the effectiveness and decrease fragmentation and make the
workload more manageable for the midwives...
I also agree with this but part of it has to be midwives dedication to the
work they take on and if they want to provide that continuity then they
should be willing to put themselves wholeheartedly into it. working 1 or 2
days a week must make this pretty difficult. I certainly couldn't manage my
case load only working 2 days a week and don't cry off my women when I get
tired.
Thanks Belinda this is the most stimulating conversation for ages,
especially since the other mails I've made recently on other subjects don't
seem to have made it onto the list....
Lisa
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