Women's experiences of continuity of midwifery care in a randomised controlled trial in Australia

Abstract

Objective: To compare the experiences of women who received a new model of continuity of midwifery care with those who received standard hospital care during pregnancy, labour, birth and the postnatal period.Design: A randomised controlled trial was conducted. One thousand and eighty-nine women were randomly allocated to either the new model of care, the St George Outreach Maternity Project (STOMP), or standard care. Women completed a postal questionnaire 8-10 weeks after the birth.Participants: Women in the trial were of mixed obstetric risk status and more than half the sample were born in a non-English speaking country.Results: Questionnaires were returned from 69 per cent of consenting women. STOMP women were significantly more likely to have talked with their midwives and doctors about their personal preferences for childbirth and more likely to report that they knew enough about aspects of labour and birth, particularly induction of labour, pain relief and caesarean section. Almost 80 per cent of women in the STOMP group experienced continuity of care, that is, one of their team midwives was present, during labour and birth. STOMP women reported a significantly higher 'sense of control during labour and birth'. Sixty three per cent of STOMP women reported that they 'knew' the midwife who cared for them during labour compared with 21 per cent of control women. In a secondary analysis, women who had a midwife during labour who they felt that they knew, had a significantly higher sense of 'control' and a more positive birth experience compared with women who reported an unknown midwife.Postnatal care elicited the greatest number of negative comments from women in both the STOMP and the control group. Conclusion:The reorganisation of maternity services to enable women to receive continuity of care has benefits for women. The benefits of a known labour midwife needs further research.

Women׳s views about maternity care: How do women conceptualise the process of continuity?

“…In terms of relational continuity, continuity of staff, continuity of relationship and continuity across pregnancies can be conceptualised as different expressions of a 13 desire to know and be known by caregivers (Homer et al, 2002). Personal, caring and co-operative relationships with maternity care professionals are basic to mothers feeling good about their birth experience (Howarth et al, 2011).…”

“…Continuity of care is considered a critical dimension in maternity care (Boulton et al, 2006;Commonwealth of Australia, 2010;Homer et al, 2002;Hundley et al, 1995).…”

Caseload midwifery in a multi-ethnic community: The women's experiences

“…Research to date indicates that caseload midwifery increases women's satisfaction when compared with traditional midwifery practice (Homer et al 2002, McCourt et al 1998, McCourt & Stevens 2006) but there has been limited research on the implementation of this form of practice serving deprived multi-ethnic communities.…”

“…One of the key areas of concern in the Healthcare Commission's review of maternity services (2008) was that there was not adequate continuity of care for women. Caseload midwifery has been introduced in a number of units in the UK and in other countries with integrated midwifery services with favourable results, including increased continuity, a reduction in intervention in labour and increased satisfaction for women , Benjamin et al 2001, Homer et al 2001, Homer et al 2002, McCourt et al 1998, North Staffordshire 2000, Sandall et al 2001. These findings echo those of wider studies of continuity in health care (Haggerty et al 2003, Nutting et al 2003 Despite positive findings, the introduction of caseload practice has not been widespread, although there is little research to suggest why this may be.…”

En modell for jordmorstudenters praktiske studier sett i lys av ulike læringsteorier – et vitenskapelig essay

“…Forskning støtter opp under at kvinner som opplever en slik kontinuitet få r et bedre utfall av fødselshjelpen og en bedre fødselsopplevelse (Homer, Davis, Cooke & Barclay, 2002;Johnson, Stewart, Langdon, Kelly & Yong, 2005;Rolls & McGuinness, 2007;Hodnett, 2008;Sandall, Hatem, Devane, Soltani & Gates, 2009;Williams, Lago, Lainchbury & Eagar, 2010;Fontein, 2010;Hodnett, Gates, Hofmeyr, Sakala & Weston, 2011). Ifølge Nasjonal helseplan (Helse-og omsorgsdepartementet, 2007Á2010) og Nasjonale faglige retningslinjer for svangerskapsomsorgen (Sosial-og helsedirektoratet, 2005) er kontinuitet og trygghet for kvinnene karakteristisk for en svangerskaps-og fødselsomsorg av høy kvalitet.…”