Continuity of care is an important and distinct aspect of childbirth experience: findings of a survey evaluating experienced continuity of care, experienced quality of care and women\u2019s perception of labor

Hilde Perdok,François G Schellevis,Jolanda Colli,Tjerk Jan Schuitmaker,Karla Hoogendoorn,Corine J Verhoeven,Ank De Jonge,Jeroen Van Dillen

doi:10.1186/s12884-017-1615-y

Abstract

BackgroundTo compare experienced continuity of care among women who received midwife-led versus obstetrician-led care. Secondly, to compare experienced continuity of care with a. experienced quality of care during labor and b. perception of labor.MethodsWe conducted a questionnaire survey in a region in the Netherlands in 2014 among 790 women after they gave birth. To measure experienced continuity of care, the Nijmegen Continuity Questionnaire was used. Quality of care during labor was measured with the Pregnancy and Childbirth Questionnaire, and to measure perception of labor we used the Childbirth Perception Scale.ResultsThree hundred twenty five women consented to participate (41%). Of these, 187 women completed the relevant questions in the online questionnaire. 136 (73%) women were in midwife-led care at the onset of labor, 15 (8%) were in obstetrician-led care throughout pregnancy and 36 (19%) were referred to obstetrician-led care during pregnancy. Experienced personal and team continuity of care during pregnancy were higher for women in midwife-led care compared to those in obstetrician-led care at the onset of labor. Experienced continuity of care was moderately correlated with experienced quality of care although not significantly so in all subgroups. A weak negative correlation was found between experienced personal continuity of care by the midwife and perception of labor.ConclusionThis study suggests that experienced continuity of care depends on the care context and is significantly higher for women who are in midwife-led compared to obstetrician-led care during labor. It will be a challenge to maintain the high level of experienced continuity of care in an integrated maternity care system.Experienced continuity of care seems to be a distinctive concept that should not be confused with experienced quality of care or perception of labor and should be considered as a complementary aspect of quality of care.

Highlights

To compare experienced continuity of care among women who received midwife-led versus obstetrician-led care
Of all participants 41.7% were primiparous and 87.2% had a spontaneous vaginal birth. (19.3%) women were referred during pregnancy and (19.8%) women were referred during labor to obstetrician-led care
Experienced continuity of care during pregnancy was moderately correlated with experienced quality of care not significantly so in all subgroups A weak negative correlation was found between experienced personal continuity of care by the midwife and perception of labor

Summary

Introduction

To compare experienced continuity of care among women who received midwife-led versus obstetrician-led care. Experienced quality of care during labor and b. Continuous support during labor from the same maternity caregiver has been associated with a positive childbirth experience [1, 2]. This is referred to as “relational continuity” or personal continuity which supports trust and familiarity between care provider and the patient. Continuity of care is only one of the aspects, which can be measured when evaluating childbirth experience. Quality of care [7], satisfaction with care [8, 9] and perception of labor [10] are measured in studies evaluating childbirth experiences

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Discussion

Conclusion