The role of part-time arrangements in the sustainability of midwifery continuity of care models in Australia: An integrative review

INTRODUCTION International maternity care experts have called for expanding midwifery-led continuity of care (MCoC) models. However, the number of models need augmentation as the number of women receiving this care is small. The majority of the midwifery workforce in Australian public health systems comprises women who work part-time. This aspect of the midwifery workforce demands careful consideration when attempting to change a maternity care system and sustain new models of care. Sparse research has been undertaken to explore whether part-time factors could play a role in the growth and sustainability of MCoC in Australia. This integrative review aims to analyze the role of part-time practice arrangements in the sustainability of MCoC models in Australia. METHODS Following a systematic search of research databases (CINAHL, ScienceDirect, Cochrane Database of Systematic Reviews, and Proquest) and screening the literature with eligibility criteria including keywords related to midwifery continuity of care, workforce arrangements and full-time equivalent (FTE), eight Australian research articles were identified for evaluation. The articles were appraised for bias using the Mixed Methods Appraisal Tool (MMAT) and data were analyzed using an integrated convergent narrative synthesis method. RESULTS The resulting themes from the synthesis suggest that part-time MCoC roles may support the sustainability of the MCoC workforce without reducing quality of care to women. In various studies, midwives reported that FTE (full-time equivalent) of 0.5 may not meet the job's demands. However, this is likely influenced by local context and caseload size rather than the quantum of each midwife's FTE. The quality of the studies is limited due to the small scale of the studies; however, the qualitative results give a depth of understanding to the strengths and challenges that part-time arrangements in MCoC add to the midwifery workforce. CONCLUSIONS This review recommends that part-time arrangements in MCoC models in Australia be evaluated in conjunction with other routinely analyzed workforce data. Further considerations should be made by midwifery managers, leaders, stakeholders, and decision makers responsible for developing and supporting part-time job arrangements in caseload models of care in Australia.