The effect of primary midwife‐led care on women's experience of childbirth: results from the <scp>COSMOS</scp> randomised controlled trial

McLachlan, Helen; Forster, Della; Davey, Mary‐Ann; Farrell, Tanya; Flood, Margaret; Shafiei, Touran; Waldenström, Ulla

doi:10.1111/1471-0528.13713

Cited by 98 publications

(67 citation statements)

References 23 publications

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“…Whilst non-interpersonal factors contributed to trauma, the majority of descriptions involved care provider actions and interactions. These findings are consistent with other studies that identify the relationship between the care provider and the woman as critical to the birth experience [20, 21, 37]. Whilst care providers may consider their actions and interactions to be routine, some woman experience them as traumatic [19].…”

Section: Discussionsupporting

confidence: 89%

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

Reed

Sharman

Inglis

2017

BMC Pregnancy Childbirth

203

154

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BackgroundMany women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women’s experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes.MethodsAs part of a large mixed methods study, 748 women completed an online survey and answered the question ‘describe the birth trauma experience, and what you found traumatising’. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process.ResultsFour themes were identified in the data: ‘prioritising the care provider’s agenda’; ‘disregarding embodied knowledge’; ‘lies and threats’; and ‘violation’. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women’s own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider’s clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault.ConclusionCare provider actions and interactions can influence women’s experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

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Section: Discussionsupporting

confidence: 89%

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

Reed

Sharman

Inglis

2017

BMC Pregnancy Childbirth

203

154

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“…21,22 Questions were also included from previous studies of models of care in Victoria. 21,22 Questions were also included from previous studies of models of care in Victoria.…”

Section: Survey Toolmentioning

confidence: 99%

“…The 6-week questionnaire used in the M@NGO study was largely based on previously validated questionnaires from English and Australian studies: the English Evaluation of a Community Based Caseload Midwifery program at Guy's and St Thomas' Trust between 2005 and 2007 2,20 (J. Sandall personal communication), and the Australian RCT of caseload midwifery for low-risk women (COSMOS). 21,22 Questions were also included from previous studies of models of care in Victoria. [23][24][25] All were designed to explore the self-reported health outcomes for women and babies and their perceptions and experiences of midwifery care.…”

Section: Survey Toolmentioning

confidence: 99%

The impact of caseload midwifery, compared with standard care, on women's perceptions of antenatal care quality: Survey results from the M@NGO randomized controlled trial for women of any risk

Allen

Kildea

Tracy

et al. 2019

Birth

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Background:The measurement and interpretation of patient experience is a distinct dimension of health care quality. The Midwives @ New Group practice Options (M@NGO) randomized control trial of caseload midwifery compared with standard care among women regardless of risk reported both clinical and cost benefits. This study reports participants' perceptions of the quality of antenatal care within caseload midwifery, compared with standard care for women of any risk within that trial. Methods: A trial conducted at two Australian tertiary hospitals randomly assigned participants (1:1) to caseload midwifery or standard care regardless of risk. Women were sent an 89-question survey at 6 weeks postpartum that included 12 questions relating to pregnancy care. Ten survey questions (including 7-point Likert scales) were analyzed by intention to treat and illustrated by participant quotes from twofree-text open-response items. Results: From the 1748 women recruited to the trial, 58% (n = 1017) completed the 6-week survey. Of those allocated to caseload midwifery, 66% (n = 573) responded, compared with 51% (n = 444) of those allocated to standard care. The survey found women allocated to caseload midwifery perceived a higher level of quality care across every antenatal measure. Notably, those women with identified risk factors reported higher levels of emotional support (aOR 2.52 [95% CI 1.87-3.39]), quality care (2.94 [2.28-3.79]), and feeling actively involved in decision-making (3.21 [2.35-4.37]). Conclusions: Results from the study show that in addition to the benefits to clinical care and cost demonstrated in the M@NGO trial, caseload midwifery outperforms standard care in perceived quality of pregnancy care regardless of risk. K E Y W O R D S antenatal care, midwifery, randomized controlled trial, survey 440 | ALLEN Et AL.

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“…Good quality midwifery care saves the lives of women and babies, with continuity of midwife carer (CMC) a key component of this [1]. A growing body of evidence, including a Cochrane review of 17 randomised controlled trials of over 17,000 women [2] shows that, compared to fragmented models of care, CMC results in better, or at least as good, outcomes and greater maternal satisfaction [2][3][4][5][6]. Despite this evidence, fragmented maternity care remains dominant in many countries and efforts to implement CMC have tended to be small scale, slow to grow or not sustained [4].…”

Section: Introductionmentioning

confidence: 99%

Implementing continuity of midwife carer – just a friendly face? A realist evaluation

McInnes

Aitken-Arbuckle

Lake

et al. 2020

BMC Health Serv Res

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Background: Good quality midwifery care saves the lives of women and babies. Continuity of midwife carer (CMC), a key component of good quality midwifery care, results in better clinical outcomes, higher care satisfaction and enhanced caregiver experience. However, CMC uptake has tended to be small scale or transient. We used realist evaluation in one Scottish health board to explore implementation of CMC as part of the Scottish Government 2017 maternity plan.Methods: Participatory research, quality improvement and iterative data collection methods were used to collect data from a range of sources including facilitated team meetings, local and national meetings, quality improvement and service evaluation surveys, audits, interviews and published literature. Data analysis developed contextmechanism-outcome configurations to explore and inform three initial programme theories, which were refined into an overarching theory of what works for whom and in what context. Results: Trusting relationships across all organisational levels are the context in which CMC works. However, building these relationships during implementation requires good leadership and effective change management to drive whole system change and foster trust across all practice and organisational boundaries. Trusting relationships between midwives and women were valued and triggered a commitment to provide high quality care; CMC team relationships supported improvements in ways of working and sustained practice, and relationships between midwives and providers in different care models either sustained or constrained implementation. Continuity enabled midwives to work to full skillset and across women's care journey, which in turn changed their perspective of how they provided care and of women's care needs. In addition to building positive relationships, visible and supportive leadership encourages engagement by ensuring midwives feel safe, valued and informed.Conclusion: Leadership that builds trusting relationships across all practice and organisational boundaries develops the context for successful implementation of CMC. These relationships then become the context that enables CMC to grow and flourish. Trusting relationships, working to full skill set and across women's care journey trigger changes in midwifery practice. Implementing and sustaining CMC within NHS organisational settings requires significant reconfiguration of services at all levels, which requires effective leadership and cannot rely solely on ground-up change.

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The effect of primary midwife‐led care on women's experience of childbirth: results from the COSMOS randomised controlled trial

Cited by 98 publications

References 23 publications

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

The impact of caseload midwifery, compared with standard care, on women's perceptions of antenatal care quality: Survey results from the M@NGO randomized controlled trial for women of any risk

Implementing continuity of midwife carer – just a friendly face? A realist evaluation

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