Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial.

Della A Forster,Mary Anne Biro,Mary-Ann Davey,Tanya Farrell,Helen L Mclachlan,Lisa Gold,Maggie Flood,Touran Shafiei,Ulla Waldenström

doi:10.1186/s12884-016-0798-y

Abstract

BackgroundContinuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women’s satisfaction with care across the maternity continuum.MethodsPregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating.ResultsTwo thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88 % in the caseload group and 74 % in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95 % CI 2.79, 4.03), intrapartum care (OR 2.14; 95 % CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95 % CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95 % CI 2.64, 3.85).ConclusionFor women at low risk of medical complications, caseload midwifery increases women’s satisfaction with antenatal, intrapartum and postpartum care.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007).

Highlights

Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care
We conducted a randomised controlled trial (RCT) comparing caseload midwifery care with standard care and found that women allocated to caseload midwifery were less likely to have a caesarean birth, analgesia during labour, and an episiotomy; that fewer infants were admitted to the special care nursery; and that mother and infant safety outcomes did not differ statistically between the study groups [2]
We investigated overall satisfaction with these episodes of care, as well as specific aspects of care, such as perception of emotional support, information and decision making, and whether care was provided in a competent way

Summary

Introduction

Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. Other studies have reported associations between positive ratings of satisfaction and different aspects of care, such as conveniently located care [8], safe care with skilled professionals [8, 9], positive staff attitudes and behaviours (e.g. respectful, kind, empathetic) [8,9,10,11], being remembered between visits [12], having an active say in decision making [13], having enough information [8, 10, 13], perceiving care providers as helpful [13], and a consistent philosophy of care [11] Both team midwifery models (that include four to 12 midwives) and caseload midwifery models (where women are allocated a primary ‘known’ midwife) have been shown to increase women’s satisfaction [4, 6, 14]

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