AbstractObjective: To compare the efficacy, maternal satisfaction and midwife acceptability of caseload managed midwifery care and team midwifery.
Design: Two midwives providing caseload care for 35 - 40 women were studied as were six whole time equivalent midwives providing team midwifery care. Women from each group completed questionnaires at set intervals. Individual interviews were carried out with the midwives and other maternity service providers. The key principles of safety (i.e. obstetric outcome) satisfaction, continuity of carer, communication, choice and control were the focus for comparison. Other outcomes were also measured.
Participants: Seventy - nine women who were receiving care from caseload holding midwives were matched with the same number of women from the control group. The same caseload women (the intervention group) were sent questionnaires at 20 and 36 weeks of pregnancy and at 10 days and 6 weeks postnatally.
Setting: Urban South Wales.
Findings: Results suggested that women have positive views about midwifery care regardless of caseload or team care. Their level of satisfaction was enhanced by caseload care which also facilitated continuity of carer. Obstetric outcomes in terms of complication rates and patterns of care delivery were similar for both groups. However, women in this study who received caseload care, had more interventions such as induction or augmentation of labour, continuous fetal monitoring and systemic analgesia.
Key conclusions: Improvements in care from the maternal perspective could be attributed to the attitudes and personal philosophy of the midwife in her willingness to share information, perhaps more so than to the model of care. Caseload midwifery however makes it easier to establish a supportive relationship. The personality of a midwife who chooses to work within a continuity scheme also appears to be an influencing factor. Finally, within this study, it is possible that the efforts to achieve better psychological outcomes were to the detriment of physical outcomes.
Implications for practice: Any organisation of maternity care must prioritise the need for competent and supportive midwives above schemes that simply maximise continuity of carer. Any organisation of care should promote opportunities for information sharing, unity of care and a philosophy of individualised care.
|Date of Award||Oct 1999|
|Supervisor||David Cohen (Supervisor), Sandy Kirkman (Supervisor) & Donna Mead (Supervisor)|