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Title: An evaluation of women's satisfaction with midwife managed care : a randomised controlled trial of 1299 women
Author: Shields, Noreen Rush
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 2000
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Government policy documents in the United Kingdom in the last five years indicate that major changes are necessary to ensure a more client-centered maternity service. Programmes of care with an enhanced role for the midwife are advocated. In 1992, Glasgow Royal Maternity Hospital was successful in attracting funding from the Scottish Office Home and Health Department for the setting up and evaluation of a Midwifery Development Unit. A randomised controlled trial of 1299 women evaluated the efficacy of this unit. The trial hypothesis was that compared with traditional shared care, midwife managed care offers women the similar clinical outcomes, the same complication rates, similar (or reduced) rates of intervention, enhanced satisfaction with care and enhanced continuity of care. This study reports women's satisfaction with midwife managed care when compared with shared care. The study compares women's satisfaction over different periods: antenatal, intrapartum, hospital-based and home-based postnatal care. The dimensions of satisfaction examined are: choices and decisions, interpersonal relationships with staff, information transfer, social support and general satisfaction. In addition, dimensions pertinent to specific time periods were examined (e.g. accessibility of antenatal care). Further analyses examined factors that may affect satisfaction with care (e.g. level of continuity of care and carer). The main method of data collection was three self-report questionnaires sent to women's homes although a case-record review was employed to examine continuity of care. The first questionnaire administered at 34-35 weeks of pregnancy asked about satisfaction with antenatal care. The second questionnaire administered at 7 weeks postnatal reviewed satisfaction with intrapartum care and hospital-based, and home-based postnatal care. A third questionnaire administered at 7 months postnatal reviewed satisfaction with intrapartum care. This questionnaire was sent to a reduced sample of women (n=362 midwife managed care, n=345 shared care) due to trial time constraints. Women receiving midwife managed care were significantly more satisfied with their maternity care throughout all time periods than women receiving shared care. The largest differences between the two groups appeared between antenatal and hospital-based postnatal care. The analysis of additional factors illustrated the importance of continuity in enhancing satisfaction. These results have implications for policy makers and providers indicating that schemes with the potential to improve continuity in antenatal and postnatal periods should be advocated.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available