Women's satisfaction with midwife-led continuity of care: an observational study in Palestine

Berit Mortensen, Lien M Diep, Mirjam Lukasse, Marit Lieng, Ibtesam Dwekat, Dalia Elias, Erik Fosse, Berit Mortensen, Lien M Diep, Mirjam Lukasse, Marit Lieng, Ibtesam Dwekat, Dalia Elias, Erik Fosse

Abstract

Objectives: A midwife-led continuity model of care had been implemented in the Palestinian governmental health system to improve maternal services in several rural areas. This study investigated if the model influenced women's satisfaction with care, during antenatal, intrapartum and postnatal period.

Design: An observational case-control design was used to compare the midwife-led continuity model of care with regular maternity care.

Participants and setting: Women with singleton pregnancies, who had registered for antenatal care at a rural governmental clinic in the West Bank, were between 1 to 6 months after birth invited to answer a questionnaire rating satisfaction with care in 7-point Likert scales.

Primary outcome: The mean sum-score of satisfaction with care through the continuum of antenatal, intrapartum and postnatal period, where mean sum-scores range from 1 (lowest) to 7 (highest).

Secondary outcome: Exclusive breastfeeding.

Results: Two hundred women answered the questionnaire, 100 who received the midwife-led model and 100 who received regular care. The median time point of interview were 16 weeks postpartum in both groups. The midwife-led model was associated with a statistically significant higher satisfaction with care during antenatal, intrapartum and postnatal period, with a mean sum-score of 5.2 versus 4.8 in the group receiving regular care. The adjusted mean difference between the groups' sum-score of satisfaction with care was 0.6 (95% CI 0.35 to 0.85), p<0.0001. A statistically significant higher proportion of women who received the midwife-led continuity model of care were still exclusively breastfeeding at the time point of interview, 67% versus 46% in the group receiving regular care, an adjusted OR of 2.56 (1.35 to 4.88) p=0.004.

Conclusions: There is an association between receiving midwife-led continuity of care and increased satisfaction with care through the continuum of pregnancy, intrapartum and postpartum period, and an increased duration of exclusive breastfeeding.

Trial registration number: NCT03863600.

Keywords: case-load Midwifery; continuity of care; developing country; experience; maternal care; satisfaction with care.

Conflict of interest statement

Competing interests: EF is director of NORWAC. BM was partly employed by NORWAC until February 2017 as project manager for implementing the model.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Miller S, Abalos E, Chamillard M, et al. . Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet 2016;388:2176–92. 10.1016/S0140-6736(16)31472-6
    1. Geller SE, Koch AR, Garland CE, et al. . A global view of severe maternal morbidity: moving beyond maternal mortality. Reprod Health 2018;15:98 10.1186/s12978-018-0527-2
    1. Bohren MA, Vogel JP, Hunter EC, et al. . The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med 2015;12:e1001847 10.1371/journal.pmed.1001847
    1. Lukasse M, Schroll A-M, Karro H, et al. . Prevalence of experienced abuse in healthcare and associated obstetric characteristics in six European countries. Acta Obstet Gynecol Scand 2015;94:508–17. 10.1111/aogs.12593
    1. Srivastava A, Avan BI, Rajbangshi P, et al. . Determinants of women's satisfaction with maternal health care: a review of literature from developing countries. BMC Pregnancy Childbirth 2015;15:97 10.1186/s12884-015-0525-0
    1. Sando D, Abuya T, Asefa A, et al. . Methods used in prevalence studies of disrespect and abuse during facility based childbirth: lessons learned. Reprod Health 2017;14:127 10.1186/s12978-017-0389-z
    1. World Health Organisation Who recommendations on antenatal care for a positive pregnancy experience. World Health Organization, 2016: 152
    1. Sandall J, Soltani H, Gates S, et al. . Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016;4:CD004667 10.1002/14651858.CD004667.pub5
    1. Van Lerberghe W, Matthews Z, Achadi E, et al. . Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality. Lancet 2014;384:1215–25. 10.1016/S0140-6736(14)60919-3
    1. Nair M, Yoshida S, Lambrechts T, et al. . Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview. BMJ Open 2014;4:e004749 10.1136/bmjopen-2013-004749
    1. Homer CSE, Friberg IK, Dias MAB, et al. . The projected effect of scaling up midwifery. Lancet 2014;384:1146–57. 10.1016/S0140-6736(14)60790-X
    1. Homer C, Brodie P, Leap N. Midwifery continuity of care : a practical guide. Sydney; New York: Churchill Livingstone/Elsevier, 2008.
    1. Perriman N, Davis D. Measuring maternal satisfaction with maternity care: a systematic integrative review: what is the most appropriate, reliable and valid tool that can be used to measure maternal satisfaction with continuity of maternity care? Women Birth 2016;29:293–9. 10.1016/j.wombi.2015.12.004
    1. Wick L, Mikki N, Giacaman R, et al. . Childbirth in Palestine. Int J Gynaecol Obstet 2005;89:174–8. 10.1016/j.ijgo.2005.01.029
    1. Rahim HFA, Wick L, Halileh S, et al. . Maternal and child health in the occupied Palestinian Territory. Lancet 2009;373:967–77. 10.1016/S0140-6736(09)60108-2
    1. Giacaman R, Abu-Rmeileh NME, Wick L. The limitations on choice: Palestinian women's childbirth location, dissatisfaction with the place of birth and determinants. Eur J Public Health 2007;17:86–91. 10.1093/eurpub/ckl089
    1. Mortensen B, Lukasse M, Diep LM, et al. . Can a midwife-led continuity model improve maternal services in a low-resource setting? A non-randomised cluster intervention study in Palestine. BMJ Open 2018;8:e019568 10.1136/bmjopen-2017-019568
    1. Mortensen B, Lieng M, Diep LM, et al. . Improving maternal and neonatal health by a midwife-led continuity model of care - an observational study in one governmental hospital in Palestine. EClinicalMedicine 2019;10:84–91. 10.1016/j.eclinm.2019.04.003
    1. Mortensen B. To be veiled or not to be - what unites is the question, Experiences from a continuity of Midwifery Care Model in Palestine and Norway. Master’s thesis. Bodø, Norway: University of Nordland, 2011: 121.
    1. Forster DA, McLachlan HL, Davey M-A, et al. . Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth 2016;16:28 10.1186/s12884-016-0798-y
    1. Waldenstrom U, Rudman A. Satisfaction with maternity care: how to measure and what to do. Women's Health 2008;4:211–4. 10.2217/17455057.4.3.211
    1. Bohren MA, Hofmeyr GJ, Sakala C, et al. . Continuous support for women during childbirth. Cochrane Database Syst Rev 2017;7:CD003766 10.1002/14651858.CD003766.pub6
    1. World Health Organisation Standards for improving quality of maternal and newborn care in health facilities. WHO, 2016.
    1. Waldenstrom U, Brown S, McLachlan H, et al. . Does team midwife care increase satisfaction with antenatal, intrapartum, and postpartum care? A randomized controlled trial. Birth 2000;27:156–67. 10.1046/j.1523-536x.2000.00156.x
    1. Fereday J, Collins C, Turnbull D, et al. . An evaluation of midwifery group practice. Part II: women's satisfaction. Women Birth 2009;22:11–16. 10.1016/j.wombi.2008.08.001
    1. Harvey S, Rach D, Stainton MC, et al. . Evaluation of satisfaction with midwifery care. Midwifery 2002;18:260–7. 10.1054/midw.2002.0317
    1. McFadden A, Gavine A, Renfrew MJ, et al. . Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2017;2:CD001141 10.1002/14651858.CD001141.pub5
    1. Zhang Z, Zhu Y, Zhang L, et al. . What factors influence exclusive breastfeeding based on the theory of planned behaviour. Midwifery 2018;62:177–82. 10.1016/j.midw.2018.04.006
    1. Victora CG, Bahl R, Barros AJD, et al. . Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387:475–90. 10.1016/S0140-6736(15)01024-7
    1. ten Hoope-Bender P, Lopes STC, Nove A, et al. . Midwifery 2030: a woman’s pathway to health. What does this mean? Midwifery 2016;32:1–6. 10.1016/j.midw.2015.10.014
    1. Mortensen B. Palestinian midwives on the front line. Journal of Middle East Women's Studies 2018;14:379–83. 10.1215/15525864-7025595
    1. ten Hoope-Bender P, de Bernis L, Campbell J, et al. . Improvement of maternal and newborn health through midwifery. Lancet 2014;384:1226–35. 10.1016/S0140-6736(14)60930-2

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner