Statewide Obstetric Support Unit (SOSU)

A team of midwives training

The State-wide Obstetric Support Unit is a state-wide integrated service, established on evidence based best practice, that provides safe and responsive, culturally sensitive, care in an environment that nurtures, develops and supports the maternal and newborn workforce and community of Western Australia.

The State-wide Obstetric Support Unit's (SOSU) primary role is to:

  • provide support to clinicians delivering obstetric and maternity services throughout the state to enable them to provide the highest quality service possible
  • liaise and work with metropolitan and country health services to promote the use of evidence-based guidelines and principles of clinical governance
  • promote educational programs and emergency drills aimed at improving safety and quality of care
  • provide a single reference point for advice
  • advise on workforce development and support (including recruitment and retention issues) if requested
  • assist with practice and service issues resolution as required.
Shared Maternity Care Guidelines

Antenatal shared care (shared care) is joint care of a pregnant woman by her General Practitioner (GP), midwife or private health care professional, and the hospital antenatal clinic. Antenatal shared care creates the opportunity to practice collaborative maternity care by combining the varied skills of each profession. It also aims to provide a community-based holistic model of care for women.
The aims of antenatal shared care are to:

  • provide pregnant women with flexibility, choice and continuity of care
  • provide health care professionals, including GPs and/or private medical or midwifery practitioners with evidence-based, best practice clinical guidelines for antenatal care
  • provide clear referral pathways and shared care protocols for GPs, midwives, private health care professionals and Health Service Providers
  • provide clear clinical pathways when low risk pregnancies deviate from normal
  • enhance the skills of GPs, midwives and private health care professionals caring for women during pregnancy
  • promote communication between GPs, midwives, private health care professionals and the participating Health Service Providers
  • reduce demands on hospital outpatient services
  • cater for the preferences and needs of all women including those from culturally diverse backgrounds.

Maternity shared care extends beyond the antenatal period to include the initial six weeks following birth and transition to parenthood. 

Statewide Obstetric Unit (SOSU) Shared Maternity Care Guidelines

Several WA Health maternity services offer shared care:

North Metropolitan Health Service

South Metropolitan Health Service

East Metropolitan Health Service

WA Country Health Service

Maternity services viewer

The Maternity Services Viewer (external site) was developed in collaboration with the WA Country Health Service (WACHS) and the Epidemiology department at Department of Health (DoH) following feedback from our maternity service providers across the State in relation to appropriate discharge decision making and coordination of discharge both into the metropolitan area and back to rural communities.

  • There appeared to be a knowledge deficit especially regarding resourcing of rural and remote health services mismatched with the immediate antenatal/postnatal requirements for that mother and baby
  • The web-based map of WA’s regions is supported by a database of all available maternity service providers within each region
  • If there isn’t an available maternity service in that town/community, the map will direct you to the nearest hospital with a maternity service and the distance to that town
  • Included in the data base is information on hospitals with maternity services,all other non-maternity hospitals, child health services, aboriginal medical services, GP’s,nursing posts, Patient Assisted Transport Services (PATS) contact details, etc
Models of care and definitions

Standardised classifications are used when describing maternity models of care as per the National Maternity Care Classification System (MaCCS).  Detailed descriptions of each of the models of care are listed below.

Models of Care 

Private Obstetrician Specialist Care: Antenatal care provided by a private specialist obstetrician. Intrapartum care is provided in either a private or public hospital by the private specialist obstetrician and hospital midwives in collaboration. Postnatal care is usually provided in the hospital by the private specialist obstetrician and hospital midwives and may continue in the home hotel or hostel.

Private Midwifery Care: Antenatal, intrapartum and postnatal care is provided by a private midwife or group of midwives in collaboration with doctors in the event of identified risk factors. Antenatal, intrapartum and postnatal care could be provided in a range of locations including the home.

General Practitioner Obstetrician Care: Antenatal care provided by a GP Obstetrician. Intrapartum care is provided in either a private or public hospital by the GP Obstetrician and hospital midwives in collaboration.  Postnatal care is usually provided in the hospital by the GP Obstetrician and hospital midwives and may continue in the home or community.

Shared Care Antenatal:  Care is provided by a community maternity service provider (doctor and/or midwife) in collaboration with hospital medical and/or midwifery staff under an established agreement and can occur both in the community and in hospital outpatient clinics. Intrapartum and early postnatal care usually takes place in the hospital by hospital midwives and doctors often in conjunction with the community doctor or midwife (particularly in rural settings).

Combined Care Antenatal: Care provided by a private maternity service provider (doctor and/or midwife) in the community. Intrapartum and early postnatal care provided in the public hospital by hospital midwives and doctors. Postnatal care may continue in the home or community by hospital midwives.

Public Hospital Maternity Care: Antenatal care provided in hospital outpatient clinics (either onsite or outreach) by midwives and/or doctors. Care could also be provided by a multidisciplinary team. Intrapartum and postnatal care is provided in the hospital by midwives and doctors in collaboration. Postnatal care may continue in the home or community by hospital midwives.

Complex Public Hospital Maternity Care: Antenatal care is provided to women with medical high risk/complex pregnancies by maternity care providers (specialist obstetricians and/or maternal fetal medicine subspecialist in collaboration with midwives) with an interest in high risk maternity care in a public hospital. Intrapartum and postnatal care is provided by hospital doctors and midwives. Postnatal care may continue in the home or community by hospital midwives.

Team Midwifery Care: Antenatal intrapartum and postnatal care is provided by a small team of rostered midwives (no more than 8) in collaboration with doctors in the event of identified risk factors. Intrapartum care is usually provided in a hospital or birth centre. Postnatal care may continue in the home or community by the team of midwives.

Midwifery Group Practice Caseload Care: Antenatal, intrapartum and postnatal care is provided within a publicly funded caseload model by a known primary midwife with secondary backup midwife/midwives providing cover and assistance with collaboration with doctors in the event of identified risk factors. Antenatal Care and postnatal care is usually provided in the hospital, community or home with intrapartum care in a hospital, birth centre or home.

Remote Area Maternity Care: Antenatal and postnatal care is provided in remote communities by a remote area midwife (or a remote area nurse) or group of midwives sometimes in collaboration with a remote area nurse and/or doctor. Antenatal care may also be provided via Telehealth or fly-in fly-out clinicians in an outreach setting. Intrapartum and early postnatal care is provided in a regional or metropolitan hospital (involving temporary relocation prior to labour) by hospital midwives and doctors.

No Formal Care: Not strictly a "model" of care, but this category includes women who have received no formal antenatal care and present to hospital late in pregnancy or in labour.

External Expert Reviewer Training

In partnership with the Patient Safety Surveillance Unit, WA Department of Health, SOSU is facilitating education session for senior midwives and obstetricians / GP obstetricians to establish a centralised pool of external, independent reviewers who Health Service Providers can invite to participate in a Root Cause Analysis panel and other forms of review commissioned by Health Service Providers. 

The Department of Health’s Clinical Incident Management (CIM) Policy (supported by the Clinical Incident Management Toolkit) is a conduit for compliance with the NSQHS Standard 1 Governance for Safety and Quality in Health Service Organisations that requires clinical incidents are recognised, reported and analysed, with the information used to improve safety systems.

The CIM Policy requires the identification of human error and system failure but does not mandate the use of root cause analysis (RCA) for investigation of clinical incidents, but rather provides for alternate investigation methodologies such as clinical review to be used, appropriate to the incident being investigated.