A standardised approach to outcome measurement for all women and improved continuity of care is integral to detecting, preventing and improving the symptoms and treatment of incontinence in pregnant and postnatal women, a Queensland-based midwifery researcher has argued at a peak national conference held this week.
Speaking at the National Conference on Incontinence, Dr Valerie Slavin, a midwifery researcher based at Griffith University, suggested the two shifts were key to opening up dialogue and getting more women to disclose issues they may be having with incontinence.
“When asked the right questions in a meaningful way, midwives will identify those problems so that we can address it,” Dr Slavin told the ANMJ.
“We provide maternity care to about 300,000 women in Australia every year… but we don’t fully evaluate what the impact of our care [is].”
Dr Slavin, who continues to practice in clinical settings alongside her research work, added that while National Maternity Indicators help measure mostly process-based outcomes, “they fall short” when it comes to informing “performance, quality and the value of maternity care”.
She also argued that “fragmented models” of care, where a woman receives care from a variety of healthcare workers in often busy clinics, doesn’t always build the rapport necessary for a woman to comfortably divulge her symptoms to an attending midwife.
“Unfortunately, only around 10% of women in Australia receive continuity of midwifery care… because of that, and a lack of standardised measurement, they’re less likely to divulge that sort of information,” Dr Slavin noted.
She instead argues for an approach that uses continuity of care and the measurement of incontinence for all women, over time, that is “patient-focused” as opposed to “organisationally focused”.
“Standardised outcome measurement using patient-reported outcome measures informs the performance, quality and the value of our care. It doesn’t just tell us what’s happening, that she’s leaking urine, it gives us a nuanced understanding of how symptoms might change, its impact on her life and how our care might impact a woman’s experience of incontinence,” she said.
Dr Slavin’s proposed measurements are drawn from the International Consortium for Health Outcomes Measurement (ICHOM), whose outcomes — which also cover mental health and quality of life among other measures — for maternity care were used by Dr Slavin as part of her broader PhD research.
Dr Slavin, who has practiced as a midwife for 20 years, said her studies helped to evaluate and improve the outcomes further, and she now intends to test their feasibility within routine clinical settings, something that she hopes will clarify and cement best practice within maternity care moving forward.
“[At the moment] we’re providing too much care that women don’t always need, which may be causing harm and we need to address that. Measuring outcomes that are patient-focused can inform better quality and higher value care,” she said.
The National Conference on Incontinence was held across the past two weeks, from the 20-22 and 27-29 October, and was presented online by the Continence Foundation of Australia.