Continuity of care in maternity services: women's views of one team midwifery scheme

Objective: to describe the views of women using one team midwifery scheme a nd compare them with women using more traditional models of midwifery care. Design: postal and interview survey of 1482 consecutive women delivering ov er a six-month period. Setting: Hospital and community in the South-Ease of England Samples: three groups of women were surveyed: (I) the Study Group consisted of women who delivered either at Hospital A or at home, and who received t heir antenatal, intrapartum and postnatal care from one of seven midwifery teams; (2) Comparison Group A consisted of women who received their antenat al and postnatal care from traditionally organised community midwives who w ere delivered by hospital midwives at Hospital A; and (3) Comparison Group B consisted of women who received their antenatal and postnatal care from t raditionally organised community midwives who were delivered by hospital mi dwives at Hospital B. Methods: postal questionnaires and interviews, and an audit of midwife cont acts. Main outcome measures: process of care and satisfaction with care. Findings: 88% of women responded. Women cared for under the team scheme exh ibited no overall advantages in terms of satisfaction with various aspects of their care. Women cared for under the traditional model of care were the most satisfied with antenatal care. They had reported the highest percenta ge of named midwives, the highest continuity of carer antenatally and were the most likely to say that they had formed a relationship with their midwi ves. The majority of women who had met their delivering midwives previously did report that it made them feel more at ease, however, the majority of t hose who had not met their delivering midwives previously reported that it did not affect them one way or the other. Conclusion: in the team scheme, attempts to increase continuity of carer th roughout pregnancy, labour and the postnatal period appear to have occurred at the expense of continuity in the ante- and postnatal periods. From the women's perspective the findings of this study support the view that the sm aller the size of midwifery teams the better. The current focus on continui ty throughout pregnancy and childbirth and the postnatal period may be misg uided, if it is provided at the expense of continuity of carer in pregnancy and the postnatal period. (C) 2000 Harcourt Publishers Ltd.