CHANGING CHILDBIRTH - LESSONS FROM AN AUSTRALIAN SURVEY OF 1336 WOMEN

Objective To investigate the views and experiences of care in labour a nd birth of a representative sample of women who gave birth in Victori a, Australia in 1993. Design Cross-sectional survey mailed to women 6- 7 months after giving birth. Population All women who gave birth in a two week period in Victoria, Australia in September 1993, except those who had a stillbirth or neonatal death. Results After adjusting for p arity, the risk status of the pregnancy, and social and obstetric fact ors, specific aspects of care with the greatest negative impact on the overall rating of intrapartum care were: caregivers perceived as unhe lpful (midwives: adjusted OR 12.03 [95% CI 7.8-18.6], doctors: adjuste d OR 6.76 [95% CI 4.4-10.3]); and having an active say in decisions on ly sometimes, rarely or not at all (adjusted OR 8.90 [95% CI 4.9-16.1] ). In a separate regression analysis including parity, risk status, ob stetric and social factors, but not specific aspects of care, factors associated with dissatisfaction with intrapartum care included: partic ipation in a shared antenatal care programme (adjusted OR 1.89 [95% CI 1.2-3.0]) and being of nonEnglish speaking background (adjusted OR 1. 70 [95% CI 1.1-2.6]). The following factors lowered the odds of dissat isfaction: attending a birth centre (adjusted OR 0.34 [95% CI 0.1-1.0] ) and knowing the midwives before going into labour (adjusted OR 0.68 [95% CI 0.5-0.9]). Conclusion The survey demonstrates the potential fo r 'new' models of care to have either positive or negative effects on women's experiences of care. Evaluation of innovations in perinatal ca re taking into account women's views is a prerequisite for improvement s in maternity care.