Abstract
BackgroundSatisfaction with birth care is part of quality assessment of care. The aim of this study was to investigate possible differences in satisfaction with intrapartum care among low-risk women, randomized to a midwifery unit or to an obstetric unit within the same hospital.MethodsRandomized controlled trial conducted at the Department of Obstetrics and Gynecology, Østfold Hospital Trust, Norway. A total of 485 women with no expressed preference for level of birth care, assessed to be at low-risk at onset of spontaneous labor were included. To assess the overall satisfaction with intrapartum care, the Labour and Delivery Satisfaction Index (LADSI) questionnaire, was sent to the participants 6 months after birth. To assess women’s experience with intrapartum transfer, four additional items were added. In addition, we tested the effects of the following aspects on satisfaction; obstetrician involved, intrapartum transfer from the midwifery unit to the obstetric unit during labor, mode of delivery and epidural analgesia.ResultsWomen randomized to the midwifery unit were significantly more satisfied with intrapartum care than those randomized to the obstetric unit (183 versus 176 of maximum 204 scoring points, mean difference 7.2, p = 0.002). No difference was found between the units for women who had an obstetrician involved during labor or delivery and who answered four additional questions on this aspect (mean item score 4.0 at the midwifery unit vs 4.3 at the obstetric unit, p = 0.3). Intrapartum transfer from the midwifery unit to an obstetric unit, operative delivery and epidurals influenced the level of overall satisfaction in a negative direction regardless of allocated unit (p < 0.001).ConclusionLow-risk women with no expressed preference for level of birth care were more satisfied if allocated to the midwifery unit compared to the obstetric unit.Trial registrationThe trial is registered at www.clinicaltrials.govNCT00857129. Initially released 03/05/2009.
Highlights
Satisfaction with birth care is part of quality assessment of care
Antenatal care is provided by midwives in primary care; no continuity of care is offered at the midwifery unit nor at the obstetric unit
The results showed a nonsignificant difference in operative delivery rate, but revealed that low-risk women allocated to the midwifery unit (MU) had a significant higher chance of giving birth without interventions like epidural analgesia and augmentation with oxytocin without affecting the outcome for mother and baby compared to the obstetric unit (OU) [25]
Summary
The aim of this study was to investigate possible differences in satisfaction with intrapartum care among low-risk women, randomized to a midwifery unit or to an obstetric unit within the same hospital. Low-risk birth care units intend to present an alternative setting for women with low risk of complications during labor. These birth units are established to counterbalance the trend of centralizing birth care in obstetric units that has been occurring over recent decades in industrialized countries. The Department of Obstetrics and Gynecology at Østfold Hospital Trust is one of five large obstetric clinics in Norway which have established alongside midwifery units These units aim to provide an alternative setting for birth for women with low risk of complications who regard labor and delivery as a physiological process. The economic perspective of laboring in low-risk birth care units compared to obstetric units for low-risk women has been investigated, revealing both cost savings and improved outcomes [6, 7]
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