QUALITY OF MIDWIFERY LED CARE - ASSESSING THE EFFECTS OF DIFFERENT MODELS OF CONTINUITY FOR WOMENS SATISFACTION

Background-Changing Childbirth (1993), a report on the future of mater nity services in the United Kingdom, endorsed the development of a pri marily community based midwifery led service for normal pregnancy, wit h priority given to the provision of ''woman centred care''. This has led to the development of local schemes emphasising continuity of midw ifery care and increased choice and control for women. Aims-To compare two models of midwifery group practices (shared caseload and personal caseload) in terms of: (a) the extent to which women see the same mid wife antenatally and know the delivery midwife, and (b) women's prefer ences for continuity and satisfaction with their care. Methods-A revie w of maternity case notes and survey of a cohort of women at 36 weeks of gestation and 2 weeks postpartum who attended the two midwifery gro up practices. Questionnaires were completed by 247 women antenatally ( 72% response) and 222 (68%) postnatally. Outcome measures were the lev el of continuity experienced during antenatal, intrapartum, and postna tal care, women's preferences for continuity of carer, and ratings of satisfaction with care. Results-The higher level of antenatal continui ty of carer with personal caseload midwifery was associated with a low er percentage having previously met their main delivery midwife (60% v 74%). Women's preferences for antenatal continuity were significantly associated with their experiences. Postnatal rating of knowing the de livery midwife as ''very important indeed'' was associated with both p revious antenatal ratings of its importance, and women's actual experi ences. Personal continuity of carer was not a clear predictor of women 's satisfaction with care. Of greater importance were women's expectat ions, their relations with midwives, communication, and involvement in decision making. Conclusions-Midwifery led schemes based on both shar ed and personal caseloads are acceptable to women. More important dete rminants of quality and women's satisfaction are the ethos of care emp hasising friendliness and support, the consistency of care, good commu nication, and participation in decisions.