Summary
Background
The report of the Maternity Services Review stated that while there were a variety of models of maternity care in Australia, the dominant models involved medical care in either a private or public hospital, and consumers were dissatisfied with the lack of access to other models of care (Commonwealth of Australia 2009). The report also highlighted the lack of standardised terminology and definitions to identify and differentiate models of maternity care in Australia. To address these and other issues identified in the Review and subsequent National Maternity Services Plan (Australian Health Ministers' Conference 2011), the then Australian Government Department of Health and Ageing engaged the AIHW, working with the National Perinatal Epidemiology and Statistics Unit (NPESU), to undertake the National Maternity Data Development Project (NMDDP).
Literature review
This report provides an overview of the literature that relates to models of maternity care and to developing an appropriate nomenclature. In examining the literature, the uses and usefulness of such a nomenclature were considered, including its ability to meet the needs of data collection in Australia. The review was not meant to identify which aspects of models of care are more important or which overall models produce better outcomes. Rather, the literature was examined for the characteristics of different models of care which would enable existing and future models of maternity care to be clearly defined and identified.
Results
The literature review found no attempts in Australia or internationally to develop a standard nomenclature or taxonomy for models of maternity care. The results showed that while there are broad categories of models of care in Australia (Major Model Categories), there are substantial variations within them. Models of care are also constantly evolving; and so, a nomenclature that does not allow for this dynamic will not be meaningful or useful. Models of care are a complex concept and have many components, all of which may impact on the quality and outcomes of maternity care experienced by women and their babies.
The literature review identified the characteristics that differentiate models of care and grouped them into three broad domains, the characteristics of: the women cared for in the model; the care providers working in the model; and the care provided in the model.
Models of Care Framework as the basis of a classification system
The concept for a framework to define models of care was initially proposed by members of the NMDDP Advisory Group. Based on the literature review, this draft framework was enhanced and further developed. The framework has three main dimensions (Women, Carers, Care), each with a number of data elements and sample data values that describe models of care. This framework will inform the development, initially, of a data set specification which could be used in conjunction with the broader Major Model Categories as a system to classify maternity models of care. A structured classification system will enable data on models of maternity care and outcomes for women and babies to be collected, analysed and reported on a national basis.