John Heider

1
John Heider The Tao Of
Leadership Humanics 1986
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Oakwood Midwifery Group6 Midwives

• The Oakwood Midwifery Group Practice has been
  offering care to the women belonging to the
  Forest Hill General Practice Surgery since 1999,
  working alongside 9 GPs.
• The demographics of the women are not wholly
  representative of the hospital but, in general,
  reflect a more affluent area covering Forest Hill
  and East Dulwich in South-East London.
• The Midwifery Group developed from the strongly
  held beliefs of six midwives that caseload
  midwifery offered them the opportunity to work
  with a select group of likeminded colleagues to
  deliver an agreed philosophy of women-centred
  midwifery-led care.
• This innovative way of working drew inspiration
  from the BUMPS team in Leicester and the
  One-to-One Team in West London as well as the two
  established group practices already functioning,
  in their own ways at Kings College Hospital.

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Oakwood Midwifery Group6 Midwives

• The group was originally split into three primary
  sub-team midwife partnerships but to effectively
  deal with staff turnover and level of experience
  is now split into two primary sub-team
  partnerships.
• Each midwife has a caseload of 3 women per month
  equalling 36 women per year, for whom she is the
  primary midwife. In turn she acts as the second
  midwife for her partners women with whom she
  will share some of the care.
• The group work according to a four-week roster,
  which allows the midwife to have defined working
  hours and planned days off, helping in the
  life-work balance.
• The women can contact the midwife 24 hours a day
  by a pager system. When not on call, the pager is
  forwarded to one of the paired partners on duty.
• There are guidelines on when to contact for
  information, support and arranging appointments
  these being mainly during normal office hours.
  This is an important aspect of developing
  boundaries within the relationship and
  maintaining the work-life balance for the
  midwife.
• Similarly, mobile phones are set to withhold the
  midwifes number to ensure the boundary between
  professional and personal life as well as
  ensuring the women are always directed to an
  on-duty midwife through the pager system.

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Oakwood Midwifery Group6 Midwives

• Aside from GP referrals, the women can refer
  themselves directly to the midwife at an early
  pregnancy clinic where they will be allocated a
  named midwife.
• The aspects of care are discussed and then agreed
  between woman and midwife with the ongoing care
  primarily taking place in the womans home.
• The midwife offers information, encouraging the
  woman to make fully informed choices throughout
  her care and not to accept the routine without
  question. The advocate role is a fundamental part
  in relationship.
• The philosophy, that birth is a normal
  sociological and physiological event, is
  emphasised and indeed presumed until shown to be
  otherwise. The ethos is to trust the womans
  knowledge about her body and respect her
  autonomy.
• At 36 weeks a birthtalk will take place where the
  choices for birth will be discussed and a
  preferred birthplan agreed. This is an hour-long
  appointment with two of the partnered midwives
  and the woman with her birth partner(s) at her
  home.

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Oakwood Midwifery Group6 Midwives

• When the woman believes she is in labour she can
  page the midwife. She is then assessed at home
  and care can be delivered as appropriate from
  this assessment.
• Unless the woman appears to be in established
  labour, the group believes it is appropriate to
  leave the woman and avoid any early, unnecessary
  internal examination which may create a clinical
  path
• This practice is based on the midwifes
  confidence to empower and facilitate rather than
  control the process as outlined in the opening
  quote and it often takes time to install this
  level of confidence in a new group midwife.
• As each midwife comes prepared for a homebirth,
  the woman can opt to stay at home even at this
  point. A second midwife will also attend for a
  homebirth, normally at second stage or earlier if
  support is needed.
• The groups homebirth rate is 30 - 40.
• If the hospital is to be the place of birth the
  midwife will follow her woman in for the birth.

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Oakwood Midwifery Group6 Midwives

• The postnatal care can follow the standard
  protocol guidelines but is adapted to be
  appropriate to the woman and her families needs.
• The easy contact to her midwife through the pager
  system for support facilitates independence and
  options such as early discharge from the
  hospital.
• Two of the midwives have been trained to
  undertake full baby checks, eliminating the need
  for checks by hospital paediatrician or GP,
  extending the continuity of care.
• The postnatal care may continue up to 28 days
  before full discharge.

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Oakwood Midwifery Group6 Midwives

• The main advantages, to the midwife, of this way
  of working, are the increased level of autonomy
  and accountability in a supportive environment,
  which fosters individual development.
• This way of working also has an increased level
  of job satisfaction.
• The pairing of midwives who share a caseload and
  the predefined shift pattern reduce the element
  of burnout, which is often associated with
  caseload midwifery.
• Working within the Oakwood Midwifery Group has
  also given us the opportunity to share in the joy
  of this experience with women.
• See http//www.guardian.co.uk/society/2007/may/18/
  health.medicineandhealth1

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Three Team Roster3 x 2 Midwives
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Two Team Roster2 x 3 Midwives
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Oakwood Midwifery GroupFakta og tal

• Etableret 1999 baseret i en læge praksis med 9
  praktiserende læger
• Gruppen acceptere kvinder uden henvisning fra
  praktiserende læge og kan tilbyde fuldbyrdigt
  baby check, så hele forløbet kan holdes helt
  udenfor sygehus og medicinsk sammenhæng, så længe
  behov og forløb dikterer det muligt
• Konsultation, fødselssamtale og barsels besøg i
  hjemmet, med op til 28 dages barselspleje efter
  behov
• 3 kvinder per jordemoder per måned 36 kvinder
  per år per jordemoder svarende til WHOs optimale
  guidelines
• 2 jordemødre til hjemmefødsler, 1 jordemoder til
  hospitalsfødsler
• Mobil telefon, personsøger og hjemmefødselsudstyr
  for hver jordemoder, inklusiv ilt og lattergas
• 30 - 40 hjemmefødsler
• Fire ugers vagtskema med faste vagter og
  mini-teams til at skabe støtte og gode rammer for
  en god balance mellem arbejde og privat liv for
  at reducere burn-out
• Gennemsnit 12 - 14 tilkaldevagter per jordemoder
  per skema med to jordemødre på kald hver nat