A continuity of care project with two on-call schedules: Findings from a rural area in Sweden

Ingegerd Hildingsson,Annika Karlström,Birgitta Larsson

doi:10.1016/j.srhc.2020.100551

Ingegerd Hildingsson, Annika Karlström + Show 1 more

Open Access

https://doi.org/10.1016/j.srhc.2020.100551

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Abstract

BackgroundIn many countries, various continuity models of midwifery care arrangements have been developed to benefit women and babies. In Sweden, such models are rare. AimTo evaluate two on-call schedules for enabling continuity of midwifery care during labour and birth, in a rural area of Sweden. MethodA participatory action research project where the project was discussed, planned and implemented in collaboration between researchers, midwives and the project leader, and refined during the project period. Questionnaires were collected from participating women, in mid pregnancy and two months after birth. ResultOne of the models resulted in a higher degree of continuity, especially for women with fear of birth. Having a known midwife was associated with higher satisfaction in the medical (aOR 2.02 (95% CI 1.14–4.22) and the emotional (aOR 2.05; 1.09–3.86) aspects of intrapartum care, regardless of the model. ConclusionThis study presented and evaluated two models of continuity with different on-call schedules and different possibilities for women to have access to a known midwife during labour and birth. Women were satisfied with the intrapartum care, and those who had had a known midwife were the most satisfied. Introducing a new model of care in a rural area where the labour ward recently closed challenged both the midwives’ working conditions and women’s access to evidence-based care.

Highlights

In many countries, various continuity models of midwifery care arrangements have been developed to benefit women and babies
Two studies [3,4] compared either standard public care with standard obstetric private care and Public Midwifery Group Practice (MGP) / caseload care. This latter model uses terms MGP, caseload, or continuity of care interchangeably, and equates to continuity of mid wifery care of no more than 3 or 4 midwives working in partnership across 7 days and 24 h a day but carrying an individual caseload of no more than 40 women each per annum
We present one of the initiatives taken to provide continuity of midwifery care

Summary

Introduction

Various continuity models of midwifery care arrangements have been developed to benefit women and babies. Aim: To evaluate two on-call schedules for enabling continuity of midwifery care during labour and birth, in a rural area of Sweden. Conclusion: This study presented and evaluated two models of continuity with different on-call schedules and different possibilities for women to have access to a known midwife during labour and birth. Two studies [3,4] compared either standard public care with standard obstetric private care and Public Midwifery Group Practice (MGP) / caseload care This latter model uses terms MGP, caseload, or continuity of care interchangeably, and equates to continuity of mid wifery care of no more than 3 or 4 midwives working in partnership across 7 days and 24 h a day but carrying an individual caseload of no more than 40 women each per annum. The majority of the women belonged to Model 2 (141 vs 85) and had a normal vaginal birth, with the total caesarean section rate being 15%

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