models of care for having a baby

Have you ever heard of Midwifery Group Practice? MGP? Sometimes it’s even called ‘caseload’ or ‘team midwifery’. It all generally means the same thing and it represents an amazing model of care that mamas can have during their pregnancy, birth and postpartum. This blog post is super relevant to all my Aussie mamas out there, however, I know this type of midwifery happens in other places around the world like the United Kingdom. This specific type of care is considered the ‘gold standard’ of maternity care and I believe all women should have some type of involvement in it. 

Midwives embody a holistic style of care where they not only think about clinical aspects of your pregnancy, but also consider the psychological, spiritual, and emotional sides of things.

I think this is super important as pregnancy is a major life event for you and your family. A woman should be surrounded and supported by her loved ones during this time. The familiarity of these people normalise the situation and make it more a ‘life-event’ rather than a ‘medical journey’. The word ‘midwife’ means ‘with-woman’ and I think that really sets up a good tone for this blog as I begin to tell you about my favourite and most rewarding type of midwifery. 

So what actually is it?

Midwifery group practice can be defined as care by the same midwife or same small group of midwives during your entire pregnancy, labour, birth, and extended postpartum period.

This team is a group of registered midwives who have adequate qualifications and have worked in the hospital model before. MGP is mainly focused on the woman, and meeting her individual wants and needs- this is what we call ‘woman-centred care’. Having a known care provider throughout this whole journey allows you to build trust and be informed about everything going on. 

Evidence shows that having continuity of midwifery care means you are more likely to have a normal vaginal birth, and less likely to experience medical intervention such as episiotomy, forceps or caesarean section. But why? Well mama, if you have built a relationship with the same midwife your whole pregnancy, you are more likely to TRUST them when it comes to labour and birth and also they have the ability to empower and support you knowing what you truly want. There is a lot of discussion that goes on in pregnancy about this stuff, and MGP midwives are experts at optimising normal birth processes. 

Mamas who have had MGP during their pregnancy report to have a more positive birth experience and are much more satisfied with their care; it is a more well-rounded type of care. It works as a process of not having to explain yourself over and over to different people. Your midwife will only need to hear it once and from there you can work in partnership to build up a care-plan that is driven by YOU mama. MGP allows you to receive an abundance of information and education visit by visit where you build up knowledge and are able to ask questions. Having the same midwife is a big benefit of this process. 

MGP happens in public hospitals as well as stand-alone birth centres. The experience usually begins early in pregnancy around 14-16 weeks. Sometimes this is a tad earlier than most public services. You will meet your main midwife or ‘primary’ midwife at this point and they will go through the usual ‘booking-in’ process. This visit is essential as all clinical information is gathered so we can prepare for your birth. This appointment can be a lengthy one and we usually ask you to come by yourself so we can get a thorough history. From then on, depending on how far along your pregnancy you are you will usually see this same midwife every 2-3 weeks. The facility where you are having your baby plays a part to where these visits happen. Some MGP midwives do antenatal visits at your home, some do them in the antenatal clinic at the hospital, and others can even run visits from your local GP. Speak to your care provider about where these antenatal visits will take place. Like I mentioned, education is a big one throughout this time. Your midwife can answer all your questions and empower you to think about what you really want for your labour and birth. MGP midwives will also conduct all relevant clinical tests and check up on bub every visit. 

Mamas I speak to say that it is so nice and comforting to see the same midwife every time and that they really ‘get to know’ your journey and story. They get to see you grow and flourish, and await the exciting arrival of your little babe. 

Your primary midwife will be the main person running the appointments, however you may also meet some other midwives in their midwifery team. Some teams are made up of 3 or 4 midwives and each midwife will usually have a ‘buddy’ midwife to relieve them if they cannot make it. It is great to get to know them whilst you are still pregnant so if they need to be at your birth they are a familiar face that you have seen before. 

Communication between you and your midwife is key and usually there will be regulations on how and when you can contact them. Although, you do build a trusting rapport with these amazing people, it needs to be remembered that they are providing a professional service. Speak to them openly about what boundaries are set. MGP midwives can communicate via text or phone within their working hours. In the case of an emergency or if they are unavailable, it is crucial to seek medical care from the facility you are booked in at. Often this can be as easy as giving the delivery ward/ birth unit a ring. The lovely midwives there are available 24 hours a day, 7 days a week. This is a great option if your midwife is out of reach. 

But what about the birth?

When your birth is near, your midwife will be on call and will be ready for your babe to come into the world. Like I said, communication is vital, and midwives can make an assessment over the phone whether it is time to come into hospital or not. Did you know labouring at home is amazing in early labour! Having a comfortable and familiar environment around you can help you relax and progress seamlessly. Try having a warm shower or using a heat pack at this time. 

I seem to be mentioning ‘comfortable’ and ‘familiar’ a whole lot, but that is the entire point of MGP. We hope to create a woman-centred experience that is familiar and where mamas feel safe.

When you are in labour, and that familiar face walks through the doors, mamas believe that they can do it. They feel strong, they feel empowered, and they know they can trust the person who they have gotten to know very well in the past 5 months. 

When you arrive at the hospital during your labour, your midwife will be there too (or not far behind). They will assess your labour and make clinical decisions about the situation. Usually everything runs smoothly and we want to have a normal labour and birth. You may have discussed various options and positions for labour. It may be your preference to have a ‘drug-free’ labour. Your midwife can facilitate this and encourage you to use the shower, bath, massage, and breathing techniques.

MGP midwives have a regulated amount of hours that they are allowed to stay and you might get extra support from their ‘buddy’ midwife during your labour and birth. This may also happen if they are unavailable to make your birth altogether- not to worry mama, you have already met their great team during your pregnancy. 

Another great benefit of MGP is that there is a higher rate of breastfeeding in the initial period after birth. If breastfeeding is something that you choose to do mama your midwife can work closely to help this process.

Skin-to-skin is a fantastic tool at establishing an early and nutritive latch. Once your babe is born, your midwife will check them head-to-toe, and allow you, and your partner, to bond with your new little bundle of joy. 

MGP hopes to get you and your family home ASAP! Sometimes this can be as soon as 4 hours following birth. Of course if there are complications, or if you or bub need additional observations- you will stay in hospital. When you are on the postnatal ward, your midwife will come and check up on you there. If you are discharged straight from the delivery ward, your midwife will come and visit you at home. This can be every day for the initial postpartum! They assess things like your baby’s feeding patterns, baby’s weight and also check up on you mama! They discuss things like how you are going, talk about, and debrief the birth, and assess clinical features like your stitches and bleeding. 

In the Postpartum… 

One of my favourite parts of MGP is the postnatal follow up! Standardised models may only see you for the week following your birth, but with MGP, your midwife can visit you up to 6 weeks! That’s amazing! Again, they check on feeding, growth, and weight gain of your little bubba. Your midwife will assist you with mother crafting if you need it, and play a part in your transition to motherhood. At this time, perinatal mental health is a huge thing that can often get left behind in the conventional hospital model.

Your MGP can talk about your emotions and how a new baby can impact your mental health. Postnatal anxiety and depression are real issues that need to be more openly talked about.

It’s not easy being a mama- it’s one of the toughest jobs that exists! If you are feeling symptoms of either postnatal anxiety or depression make sure you seek help from your midwife or medical professional. A great resource that I recommend all mamas is PANDA. They specialise in perinatal mental health and can help you if you need. Find their resource here: 

The long awaited arrival of your baby is exciting for your MGP midwife too! It is actually the most rewarding model of care for midwives to work in and where they gain the greatest job satisfaction. All that time listening to babe’s heartbeat on the inside, then to meet them during birth is a huge journey that you have walked together. Further on into the postpartum, your midwife will watch you grow into an amazing mother who nourishes their growing baby! 

I often see mamas going back and having more babies with the same MGP team! The experience goes full circle and is truly rewarding and satisfying for everyone involved. 

How can I access MGP? 

It comes down to if your hospital offers MGP or not! These days the model is becoming more and more widely available for mamas to experience. I believe that every hospital should offer it … or at least some form of it. When you are referred to your local health service, you may specifically request to have MGP, and from there, your situation will be assessed and you will be contacted. 

Most times, a requirement to participate in MGP is to have a pregnancy that is considered ‘low-risk’. Complex pregnancies require the skills of obstetricians and medical teams, and sometimes midwives cannot conduct these types of appointments. However, good news, tertiary centres are working hard at establishing specialised MGP teams to work in collaboration with doctors to provide not only an essential medical service, but a holistic aspect from continual midwifery care. I really hope to see more of these teams popping up soon because all mamas deserve the care of a midwife. 

Sometimes you may be contacted in early pregnancy to see if you would like to participate in MGP. Mama, if this is you, say YES! I could not recommend the model of care more highly and there are just so many great benefits that you can’t pass up. If you are booked in at a birth centre, you will more than likely already have a fantastic MGP team waiting for you!

In Australia, the MGP model is fairly new, however each year more hospitals and more teams are becoming available. In university, midwifery students are taught all the benefits of continuity of care and are often eager to get involved. So mama, stay tuned, MGP is the future of maternity care!

MGP program

In recap, the main benefits of MGP include: 

  • A higher chance of having a normal vaginal birth

  • Less chance of having medical intervention like episiotomy, forceps, vacuum, or C-section

  • More likely to breastfeed

  • Greater mother satisfaction and more positive birthing outcomes

  • Shorter hospital stays- can get discharged from the delivery ward

  • Better and longer postnatal follow up

  • Well-rounded support and greater prevention of perinatal mental health issues

If you have never heard of MGP, I hope this blog has explained it a bit better for you. Speak to your healthcare provider and work closely with your midwife or medical professional to decide if this is the right path for you. Midwifery group practice encapsulates all sides of maternity care and creates a holistic balance between clinical aspects of care and emotional and psychological needs.