PURPOSE:
To describe the relationship between sustainable continuity of midwifery care (CoMC) practice models and working conditions, drawing on experiences of New Zealand midwives.

DISCUSSION:
Since 1990, New Zealand midwives have practised autonomously across their full scope. Funding settings enabling full fee-for-service payment from the government for CoMC has seen self-employed CoMC practices flourish to become the predominant service model, accessed by over 90% of pregnant women. Globally, few countries have scaled up CoMC models to the same degree. Self-employment has been a success factor, supporting midwives to exercise autonomy and flexibility in practice partnerships, caseload size and composition, and in managing 24/7 on-call demands. Despite these enabling factors, inconsistent political support has challenged the sustainability of CoMC work. Maintaining fair pay and the conditions necessary to sustain long-term practice has been challenging. The New Zealand College of Midwives has consistently advocated for fair pay and sustainability, culminating in legal action against the government. A decade later, a final High Court ruling is imminent. Because of this advocacy, progress has been achieved with critical sustainability elements identified, now added into contracting conditions including; a second midwife fee, additional care supplements, rural missed birth fees and universal travel payments. This presentation outlines the critical factors which have enabled New Zealand midwives' to successfully scale up CoMC models, and the critical contract components which have supported the sustainability of their services. Key lessons that can inform international midwifery practice will also be presented.

EVIDENCE WHERE RELEVANT:
Relevant data from New Zealand and international frameworks will be drawn on

KEY MESSAGE:
CoMC models can be scaled if supported by health and political systems for long-term success. Politicians, policymakers, and funders must consult midwives working in these models to develop context-appropriate solutions. Funding must meet the needs of midwives and communities, ensuring fair pay and equal access and outcomes for women. Workforce - sustainability 2 (including three-minute presentation competition)