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.
"A philosophy of care behind the MLU has been proposed in the literature as to provide a safe, home-from-home environment, where women can retain choice and control in the management of their labor (Hundley et al., 1995). This concept has evolved into a concept of family-centered care, where the midwife seeks to facilitate a nonintrusive, no-intervention approach to birth. "
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: With an estimated 120 midwife-led units (MLUs) and 15 years' experience, the United Kingdom displays expertise in what ways women and professionals might benefit from MLUs. This study explored midwives' satisfaction and skills for working in an MLU and a consultant
unit (CU) and how these compared.
METHODS: In this exploratory study, both quantitative and qualitative data were collected by anonymous questionnaire from 45 midwives in 2 Scottish maternity units (July 2007).
RESULTS: Midwives working in the MLUs reported a higher level
of job satisfaction than midwives working in the CU. Demographic characteristics of the 2 groups differed: MLU midwives were older, had been in practice longer, and had higher grade posts. Qualitative findings revealed some reasons midwives preferred working in the MLU with the emotional support
they could give to women, and highlighted some negative predictors of midwives' satisfaction. The questionnaire also explored the midwives' practice: most agreed that the ability to avert and manage problems, work in a low-technology setting, and let labor be are necessary to work in these
CONCLUSION: Our findings revealed midwives' greater satisfaction from working in MLU compared to CU. We identified midwives' opinions of specific skills to work in MLU, highlighting areas of importance for midwifery.
"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
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