Sensitive Midwifery - Issue 44 - October 2019

Last word The Birthing Team maternity care model S ince The Birthing Team (TBT) was established in 2017, 800 babies have been born through its a ff ordable maternity product. Now available in four cities across South Africa, TBT is an independent commercial company at each site, owned by the clinicians who work in it. Each TBT company partners with a particular private sector hospital to o ff er an end-to-end maternity service, based on a global fee. This maternity product model is evidence-based and promotes natural childbirth, recommending operative deliveries only when they are medically necessary. Another major di ff erence to the TBT model (except for a small number of private midwife units in large metropoles), is that midwives are the primary caregivers, only involving medical o ffi cers or obstetricians when necessary. These midwives work to the top of their professional scope of practice in a collaborative manner with anaesthetists, paediatricians and allied health professionals, to provide TBT’s maternity product. Where there is a TBT, the labour ward is transformed into an a ff ordable yet highly productive system, supported to improve patient experience and clinical outcomes. How it all works PPO Serve and hospital leadership manage the change, together with the local champion, to embed team structures and processes. These include weekly meetings. New processes are also introduced for administrative and support sta ff , to ensure adherence to the requirements of the product. To achieve this, PPO Serve works collaboratively with the management and training departments to ensure accountability and alignment with the larger hospital system’s requirements and programmes. The team also develops relationships with other providers in its own environment to ensure transitions of care are managed seamlessly, to reduce costs and patient safety risks. The team uses the PPO Serve Intelligent Care System (ICS), a web-based workflow system that is preloaded with customisable assessments and care plans which enables some real-time decision support. PPO Serve provides management and system support, including analytics and reporting, in order for the frontline team to identify and work on top priorities to continually improve their own performance. Benefits for midwives and patients All TBT midwives receive supportive supervision as they regain their confidence to work independently, in a team. This enables each midwife to care well for, and maintain continuity of care through all phases of a woman’s maternity journey. Consequently, midwives rotate through the antenatal clinic, labour ward, postnatal ward and postnatal clinic, and also become proficient in provision of breastfeeding support, baby immunisation and contraception services. Obstetrician and MBA qualified Dr Howard Manyonga has extensive local and overseas experience in the public-, NGO- and private-health sectors. He has private practice and health systems management experience; has headed Women’s Health at the WITS Reproductive Health and HIV Institute; and was the COO of Marie Stopes South Africa. As executive team member with health services management company PPO Serve, Dr Manyonga led the development and rollout of The Birthing Team maternity care model. His grandmother was a traditional midwife. Posterior 60 eSensitive Midwifery Magazine Issue 44