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

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).

Factors That Contribute to Excessive Sleepiness in Midwives Practicing in the United States

“…Becoming self‐aware of one's sleep status, rather than ignoring the presence of sleepiness and sleep deprivation, may require a significant cultural shift in the mindset of many midwives . There has been some debate within the midwifery community regarding the delivery of continuity or caseload care (a single midwife providing all prenatal, intrapartum, and postpartum care) versus team‐based midwifery care (continuity of midwifery care shared between practice partners) . Although some midwives consider continuity of midwifery care to only be care provided by a single provider, others believe that continuity of care may also be achieved by working closely with other care partners .…”

The impact of caseload midwifery, compared with standard care, on women's perceptions of antenatal care quality: Survey results from the M@NGO randomized controlled trial for women of any risk

“…7 The World Health Organization includes standards for improving quality care in health facilities such as effective and respectful communication that responds to women's needs and preferences, and the provision of sensitive emotional support. 13 As part of the M@NGO trial, we explored women's views across the entire spectrum of pregnancy and birth using specifically designed questionnaires offered at 36 weeks of pregnancy, 6 weeks and 6 months postpartum. 9 Although the Cochrane review on midwife-led continuity of care did not include a meta-analysis of women's experiences, most of the included studies reported a higher rate of maternal satisfaction in midwife-led continuity models of care.…”

Meeting the Needs of Mothers During the Postpartum Period: Using Co-Creation Workshops to Find Technological Solutions

“…Mothers also seem to need some continuity in their contact with health professionals; they would like to address the same person from the beginning of pregnancy to the end of the postpartum period. This need for continuity has already been shown in several studies [23-26]. In practice, parents and professionals think that the solutions should be accessible to everyone and be available at all times.…”