Exploring maternity managers’ views and experiences of implementing a MAPS continuity of care model in NSW: a qualitative study

Background: Midwifery continuity of care improves outcomes for mothers and babies. High levels of satisfaction with these models of care have been reported by both women and midwives; however, implementation and scale-up have been slow. In New South Wales, Australia, health services have responded by introducing a modified model of continuity of care called midwifery-led antenatal and postnatal service (MAPS). This study explored the experiences of midwives who work in the model of care, the women who receive the care and the managers who implemented the models. Aim: To explore the implementation of a MAPS model from the perspective of maternity managers in seven sites across New South Wales, Australia. Methods: Data were collected via two online focus groups with managers for this statewide study. The Quality Maternal Newborn Care (QMNC) framework was used to guide the focus groups. Data were analysed by coding and mapping to the framework. This analysis identified strengths of the findings and areas for improvement resulting in the final themes and subthemes. Findings: The findings from the focus groups with managers (n = 8) across five local health districts (seven sites) resulted in the following three themes: implementing and evolving the model, increasing access to continuity and managing a skilled and flexible workforce while sustaining the model. Conclusions/Implications: The MAPS model is a way of attracting midwives and sustaining a workforce; however, resources need to be allocated to support managers with implementation. Managers in their quest for scale-up of continuity of care view MAPS as value-add rather than a replacement for midwifery continuity. MAPS can be viewed as a way to transition midwives to providing continuity of care.