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

Forster, Della; McLachlan, Helen; Davey, Mary-Ann; Biro, MA; Farrell, Tanya; Gold, L; Flood, Margaret; Shafiei, Touran; Waldenstrom, U

doi:10.26181/21875406.v1

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

journal contribution

posted on 2023-01-12, 03:38 authored by Della ForsterDella Forster, Helen McLachlanHelen McLachlan, Mary-Ann DaveyMary-Ann Davey, MA Biro, Tanya Farrell, L Gold, Margaret FloodMargaret Flood, Touran ShafieiTouran Shafiei, U Waldenstrom

Background: Continuity 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. Methods: Pregnant 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. Results: Two 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). Conclusion: For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care.

Funding

We gratefully acknowledge the National Health and Medical Research Council for trial funding, the women and midwives who participated in the study; and members of the study Reference Group, the Safety Committee and the Data Monitoring Committee. We acknowledge the dedicated research midwives and research assistants and the support of the study by hospital management, midwifery and obstetric teams, as well as the Information Technology Department and Health Information Services.

History

Publication Date

2016-02-03

Journal

BMC Pregnancy and Childbirth

Volume

16

Issue

1

Article Number

28

Pagination

13p.

Publisher

BioMed Central

ISSN

1471-2393

Rights Statement

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.