Antenatal, delivery and postnatal comparisons of maternal satisfaction with two pilot Changing Childbirth schemes compared with a traditional model of care

OBJECTIVE: to investigate maternal satisfaction with two pilot schemes based on the Changing Childbirth initiative (DoH 1993) and to compare this with a traditional model of care. In addition, a limited number of clinical outcome measures were also assessed. DESIGN: a retrospective between-group design was used. Questionnaire data were collected from three groups (two pilot and one control) about the antenatal, labour and postnatal periods to establish both satisfaction with key objectives of the Changing Childbirth initiative (DoH 1993), and basic clinical outcomes. SETTING: a large Trust (see definition in main article) in Central England, that covered a wide range of socio-economic strata. PARTICIPANTS: the two pilot groups comprised 112 and 103 women respectively and were randomly drawn from GP practices within the Trust's catchment area. The third group of 118 women (Control) was selected from the Trust's obstetric unit. Women at high obstetric risk were excluded from this study. MEASUREMENT: a five-part questionnaire was devised that covered: (1) preferences for type of care, health-care professional, venue etc; (2) details of antenatal care provision and the participants' satisfaction with this; (3) labour, including clinical outcomes, labour and birth details and satisfaction with care; (4) postnatal care information, including satisfaction scores; and (5) information and advice given throughout the ante, delivery and postnatal periods and satisfaction with this. The questionnaires were administered six weeks postnatally. FINDINGS: although the two pilot groups had been set up to follow a one-to-one midwifery care model, the second group naturally evolved into providing care from within a small group of midwives. This variation did not lead to any differences in any of the outcome measures. The women in the obstetrician-led group were not dissatisfied with the care, information and treatment they received, but they were significantly less satisfied than either of the two pilot groups. The pilot groups also rated more highly the information and choice that they had, and felt that the midwives acted as partners in the process. These findings applied to the antenatal, delivery and postnatal periods. No differences in clinical outcomes were observed between the groups. CONCLUSIONS: midwifery-led care was much preferred to obstetrician-led care and did not lead to any deficits in clinical outcomes. The pilot scheme that adapted the initiative into small-group provision showed no reduction in satisfaction levels or other outcome measures. Since burn-out and stress have been identified as features of one-to-one midwifery provision, this model might have potential for offsetting this problem, while still maintaining the spirit of the Changing Childbirth policy. From the perspective of maternal well-being, both physical and psychological, the initiative reported here appears to have been highly successful.