Mothers' views of caseload midwifery and the value of continuity of care at an Australian regional hospital

Objective: to evaluate mothers' satisfaction with a caseload-midwifery scheme, and whether this varied according to the extent of continuity of care provided. Design: mothers' satisfaction with care was assessed using a postal survey, which was linked with their clinical outcomes data. Setting: the Wollongong Hospital, the major public hospital in the Illawarra region, New South Wales, Australia. Participants: 174 women gave birth during the evaluation period of a pilot midwifery group practice (MGP) programme at the Wollongong Hospital between 5 July 2004 and 30 April 2005. This group included 87 primiparous and 87 multiparous women, all of whom met the Australian College of Midwives' criteria for low-risk pregnancies. Intervention: the MGP was staffed by six midwives working in two groups of three. Each midwife took on a primary caseload of 40 women per year, and provided support as a secondary midwife to women cared for by colleagues. Measurements: mothers' satisfaction with care and adjustment to motherhood were assessed with self-completed questionnaires. Survey responses were linked with clinical data, allowing examination of the relationship between maternal satisfaction and continuity of care. Findings: the MGP achieved high levels of continuity of care, both objectively (based on birth records) and from mothers' perspectives. Overall, mothers' evaluations of their care were very positive. Women indicated that their relationships with their midwives were genuinely caring and a valued source of reassurance and comfort during pregnancy, labour and early motherhood. Although continuity of care did not predict summary scores for maternal satisfaction, it was related to some individual items on the satisfaction scales. Satisfaction with control and communication was predicted by parity and the level of intervention during labour and birth. Key conclusions: continuous care appears to facilitate the development of supportive relationships between women and their midwives. Women's perceptions about continuous and respectful treatment were related to objectively measured continuity of care. The qualitative data confirm the importance of less tangible benefits, such as the quality of relationships between women and their caregivers. Implications for practice: the viability of caseload-midwifery-led care for low-risk pregnancies depends, in part, on the model's acceptability to consumers. This study demonstrated that the caseload model is associated with high levels of maternal satisfaction. Supportiv erelationships with midwives in a caseload scheme are highly valued by women. (C) 2009 Elsevier Ltd. All rights reserved.