to examine whether there are differences in the midwife's role in, and satisfaction with, intrapartum care and delivery of women at low obstetric risk in a midwife-managed delivery unit compared to a consultant-led labour ward.
a pragmatic randomised controlled trial. Subjects were randomised in a 2:1 ratio between the midwives' unit and the labour ward.
Aberdeen Maternity Hospital, Grampian, UK.
midwives within the delivery suite who cared for the 2844 women at low obstetric risk receiving care in a pragmatic randomised controlled trial of the two delivery areas.
continuity of carer and midwife satisfaction.
midwives looking after women in the midwives' unit group were significantly more likely to be of a higher grade, more qualified and have a longer length of experience than those in the labour ward group. There was greater continuity of carer both during labour and after delivery in the midwives' unit group. Despite a small but statistically significant difference in overall satisfaction between the groups, area of 'booking' or area of delivery were not important in predicting midwife satisfaction. Autonomy and continuity of carer were the best predictors of midwife satisfaction.
midwife-managed intrapartum care increases continuity of carer and, therefore, midwife satisfaction. Extending this outside the delivery suite requires a system of care that is acceptable to midwives as well as women. Such systems will depend to a large extent on geography, consumer demand and availability of resources. However, midwife satisfaction should also be considered. In order to do this further research is required to fully evaluate the effect these systems have on the midwives working in them.
"Still, we would indicate as influencing factors increased continuity, including greater availability of one-to-one care and continuous support during labour that has been shown to be related to improved birth experience (Hodnett, Gates, Hofmeyr, Sakala, & Weston, 2011). Increased job satisfaction as a positive consequence of midwives working in a team model (Hundley et al., 1995; Turnbull, Reid, McGinley, & Shields, 1995) may also be important along with general organisational characteristic of FMUs, facilitating midwives' development of meaningful and caring relationships with women and their families, as suggested by Walsh (2006). FMU care was significantly associated with very positive birth experiences for women with low levels of education and in particular for the wider group of women with a low level of employment. "
[Show abstract][Hide abstract] ABSTRACT: Overall birth experience is an important outcome of birth, and studies of psycho-social birth outcomes and women's perspectives on care are increasingly used to evaluate and develop maternity care services. We examined the influence of birthplace on women's birth experiences and perceptions of care in two freestanding midwifery units (FMU) and two obstetric units (OU) in north Denmark, all pursuing an ideal of high-quality, humanistic and patient-centred care. As part of a matched cohort study, a postal questionnaire survey was undertaken. Two hundred and eighteen low-risk women in FMU care, admitted between January-October 2006, and an obstetrically/socio-demographically matched control group of 218 low-risk women admitted to an OU were invited to participate. Three hundred and seventy-five women (86%) responded. Birth experience and satisfaction with care were rated significantly more positively by FMU than by OU women. Significantly better results for FMU care were also found for specific patient-centred care elements (support, participation in decision-making, attentiveness to psychological needs and to wishes for birth, information, and for women's feeling of being listened to). Adjustment for medical birth factors slightly increased the positive effect of FMU care. Subgroup analysis showed that a significant, negative effect of low education and employment level on birth experience was found only for the OU group. Our results provide strong support of FMU care and underline the big challenges in providing individual and supportive care for all women, especially in OUs. Policy-makers and professionals need to consider how the advantages provided by FMU care can support the effort to improve women's birth experience and possibly also the combat of the negative effect of social disadvantage on health.
Social Science [?] Medicine 04/2012; 74(7):973-81. DOI:10.1016/j.socscimed.2011.12.023 · 2.89 Impact Factor
"Team midwifery care is associated with reduced instrumental vaginal births , decreased interventions during labour including induction [4,34], augmentation , analgesic use  and episiotomy [35,36], decreased caesarean sections [37,38] and satisfaction for women [36,39,41], with no statistically significant differences in perinatal morbidity or mortality [4,14]. Working in team midwifery models has been shown to increase midwives’ satisfaction although the model often takes time to be accepted, and the views of other care providers may impact on the team midwives, who in turn feel better as they perceive more support from their colleagues [19,42-44]. "
[Show abstract][Hide abstract] ABSTRACT: Research on new models of care in health service provision is complex, as is the introduction and embedding of such models, and positive research findings are only one factor in whether a new model of care will be implemented. In order to understand why this is the case, research design must not only take account of proposed changes in the clinical encounter, but the organisational context that must sustain and normalise any changed practices. We use two case studies where new models of maternity care were implemented and evaluated via randomised controlled trials (RCTs) to discuss how (or whether) the use of theory might inform implementation and sustainability strategies. The Normalisation Process Model is proposed as a suitable theoretical framework, and a comparison made using the two case studies - one where a theoretical framework was used, the other where it was not. CONTEXT AND APPROACH: In the maternity sector there is considerable debate about which model of care provides the best outcomes for women, while being sustainable in the organisational setting. We explore why a model of maternity care--team midwifery (where women have a small group of midwives providing their care)-- that was implemented and tested in an RCT was not continued after the RCT's conclusion, despite showing the same or better outcomes for women in the intervention group compared with women allocated to usual care. We then discuss the conceptualisation and rationale leading to the use of the 'Normalisation Process Model' as an aid to exploring aspects of implementation of a caseload midwifery model (where women are allocated a primary midwife for their care) that has recently been evaluated by RCT.
We demonstrate how the Normalisation Process Model was applied in planning of the evaluation phases of the RCT as a means of exploring the implementation of the caseload model of care. We argue that a theoretical understanding of issues related to implementation and sustainability can make a valuable contribution when researching complex interventions in complex settings such as hospitals.
Application of a theoretical model in the research of a complex intervention enables a greater understanding of the organisational context into which new models of care are introduced and identification of factors that promote or challenge implementation of these models of care.
BMC Public Health 10/2011; 11 Suppl 5(Suppl 5):S8. DOI:10.1186/1471-2458-11-S5-S8 · 2.26 Impact Factor
"The impact of the caseload midwifery model on staff retention and attrition is unknown, but is another important issue for consideration in light of the fact that a 2002 review of the midwifery workforce in Australia concluded that there is a national shortage of midwives that is expected to increase over the next few years . It is possible that the continuity inherent in caseload midwifery and potential for lower intervention childbirth would improve midwife satisfaction [18-21]; however studies in the UK and Australia have reported problems with the widespread implementation and organisation of models that promote continuity of carer. Issues for midwives include high and unsustainable workloads, personal costs (impinging on family life) [22,23]; and burnout and stress . "
[Show abstract][Hide abstract] ABSTRACT: Background
In Australia and internationally, there is concern about the growing proportion of women giving birth by caesarean section. There is evidence of increased risk of placenta accreta and percreta in subsequent pregnancies as well as decreased fertility; and significant resource implications. Randomised controlled trials (RCTs) of continuity of midwifery care have reported reduced caesareans and other interventions in labour, as well as increased maternal satisfaction, with no statistically significant differences in perinatal morbidity or mortality. RCTs conducted in the UK and in Australia have largely measured the effect of teams of care providers (commonly 6–12 midwives) with very few testing caseload (one-to-one) midwifery care. This study aims to determine whether caseload (one-to-one) midwifery care for women at low risk of medical complications decreases the proportion of women delivering by caesarean section compared with women receiving 'standard' care. This paper presents the trial protocol in detail.
A two-arm RCT design will be used. Women who are identified at low medical risk will be recruited from the antenatal booking clinics of a tertiary women's hospital in Melbourne, Australia. Baseline data will be collected, then women randomised to caseload midwifery or standard low risk care. Women allocated to the caseload intervention will receive antenatal, intrapartum and postpartum care from a designated primary midwife with one or two antenatal visits conducted by a 'back-up' midwife. The midwives will collaborate with obstetricians and other health professionals as necessary. If the woman has an extended labour, or if the primary midwife is unavailable, care will be provided by the back-up midwife. For women allocated to standard care, options include midwifery-led care with varying levels of continuity, junior obstetric care and community based general medical practitioner care. Data will be collected at recruitment (self administered survey) and at 2 and 6 months postpartum by postal survey. Medical/obstetric outcomes will be abstracted from the medical record. The sample size of 2008 was calculated to identify a decrease in caesarean birth from 19 to 14% and detect a range of other significant clinical differences. Comprehensive process and economic evaluations will be conducted.
Australian New Zealand Clinical Trials Registry ACTRN012607000073404.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.