Choice and chance in low risk maternity care

Sociodemographic variables affecting the health seeking behaviour of mothers in a saudi community

OBJECTIVES

Studies have shown that good antenatal care is associated with favorable outcome for both mothers and children. However, there are several factors that influence the utilization of such care even when available. The objective of this paper is to examine maternal demographic variables that influence antenatal care and the desire of mothers to consult a physician when their children aged below two are ill.

METHODS

This is a cross-sectional study of women living in Riyadh, Saudi Arabia. From a map of residential areas, a multi-stage sampling approach was employed to select a random sample of houses. All women with children aged less than two years were included in a house- to- house survey. A structured questionnaire was used for data collection. Epi-Info was used for statistical analysis.

RESULTS

Results show that 96.6% of the mothers had at least one antenatal care visit, while 80.9% had had more than six visits. Delivery under medical supervision was reported by 97.8% of the sample. The use of antenatal care and the number of visits were statistically significantly associated with age, education and marital status. The last two variables were also statistically significantly associated with the place of delivery. Nearly 83% of the mothers reported one or two illnesses in their children within the last two weeks. About 90.5% of these mothers consulted a physician on the illness and there was a 12.4% severe morbidity rate as evidenced by hospital admission. Physician consultation was statistically significantly associated with nationality, education and the occupation of the mother p<0.05. Hospital admission was also statistically significantly associated with age, nationality and occupation of the mother p<0.05. The commonest illness in the children in the last two weeks was diarrhea (34.3%) followed by fever (33.4%) and breathing difficulties (16%), although the highest frequency of episodes of illness was diarrhea and fever. Nevertheless, breathing difficulties followed closely by ear infection constituted the two highest prevalences among children who were brought for medical consultation (94.4% and 93.3% respectively).

CONCLUSION

The study shows a higher proportion of mothers attending antenatal care than has been previously reported for the country. The pattern of reported children's illnesses reflects what has been previously seen from hospital studies. It also shows a high rate of physician consultation. This is probably due to the extensive coverage of free government health services in Riyadh. It will be worthwhile to document other socio-demographic variables affecting health seeking behavior of mothers in other parts of the country. There is a need to educate young illiterate mothers in sound child rearing practices. This will help minimize the distress of childhood diseases.

Changing Childbirth: a pilot project

OBJECTIVE

To compare the outcomes of an adapted pilot Changing Childbirth initiative providing continuity of care by a group of known midwives with traditional maternity care.

DESIGN

Between-groups trial to compare levels of satisfaction and clinical outcomes for two groups of women, cared for either under this Changing Childbirth scheme or the traditional model of care.

METHOD

Of the 200 women who agreed to participate in the project, 100 were randomly allocated to the pilot scheme and 100 to the traditional care package. During the postpartum period, information was collected via a questionnaire about participants' levels of satisfaction with a variety of aspects of care provided during the antenatal, delivery and postpartum periods. Data about clinical outcomes for the two groups were also obtained.

RESULTS

Women in the pilot group had significantly more continuity of care throughout each of the three periods, were generally more satisfied with their care, felt that they had more choice over a variety of aspects of care and experienced no compromise in clinical outcomes (P = 0.05 or less in each case).

IMPLICATIONS FOR PRACTICE

Many previous attempts to introduce the Changing Childbirth initiative have revealed significant problems, particularly with regard to the continuity of carer requirement. Taking account of local health care needs and existing provision, the present study adapted this concept to continuity of care. This did not apparently affect any of the guiding principles contained in the original document, and yet enhanced satisfaction. It would appear that the Changing Childbirth agenda can be adapted and integrated with local health care situations without sacrificing any of the overarching principles.

Professional attitudes to Changing Childbirth in Nottingham, UK

Changing Childbirth has been a central focus of maternity care policy in England. The objective of this study was to determine whether different professional groups involved in maternity care-hospital and community midwives, general practitioners and obstetricians-had different professional attitudes to a local implementation scheme. Data were obtained using a postal questionnaire, based on an agenda developed from focus groups. Whilst general practitioners appeared to be somewhat less optimistic than were midwives, there existed clear differences of opinion within the midwifery profession itself, depending upon whether the midwife worked in the community or in hospital. All professionals appeared conscious of the gap between the service ideals and the limited resources available to achieve them, and expressed uncertainty over future directions and ways of working.

Antenatal, delivery and postnatal comparisons of maternal satisfaction with two pilot Changing Childbirth schemes compared with a traditional model of care

OBJECTIVE

to investigate maternal satisfaction with two pilot schemes based on the Changing Childbirth initiative (DoH 1993) and to compare this with a traditional model of care. In addition, a limited number of clinical outcome measures were also assessed.

DESIGN

a retrospective between-group design was used. Questionnaire data were collected from three groups (two pilot and one control) about the antenatal, labour and postnatal periods to establish both satisfaction with key objectives of the Changing Childbirth initiative (DoH 1993), and basic clinical outcomes.

SETTING

a large Trust (see definition in main article) in Central England, that covered a wide range of socio-economic strata.

PARTICIPANTS

the two pilot groups comprised 112 and 103 women respectively and were randomly drawn from GP practices within the Trust's catchment area. The third group of 118 women (Control) was selected from the Trust's obstetric unit. Women at high obstetric risk were excluded from this study.

MEASUREMENT

a five-part questionnaire was devised that covered: (1) preferences for type of care, health-care professional, venue etc; (2) details of antenatal care provision and the participants' satisfaction with this; (3) labour, including clinical outcomes, labour and birth details and satisfaction with care; (4) postnatal care information, including satisfaction scores; and (5) information and advice given throughout the ante, delivery and postnatal periods and satisfaction with this. The questionnaires were administered six weeks postnatally.

FINDINGS

although the two pilot groups had been set up to follow a one-to-one midwifery care model, the second group naturally evolved into providing care from within a small group of midwives. This variation did not lead to any differences in any of the outcome measures. The women in the obstetrician-led group were not dissatisfied with the care, information and treatment they received, but they were significantly less satisfied than either of the two pilot groups. The pilot groups also rated more highly the information and choice that they had, and felt that the midwives acted as partners in the process. These findings applied to the antenatal, delivery and postnatal periods. No differences in clinical outcomes were observed between the groups.

CONCLUSIONS

midwifery-led care was much preferred to obstetrician-led care and did not lead to any deficits in clinical outcomes. The pilot scheme that adapted the initiative into small-group provision showed no reduction in satisfaction levels or other outcome measures. Since burn-out and stress have been identified as features of one-to-one midwifery provision, this model might have potential for offsetting this problem, while still maintaining the spirit of the Changing Childbirth policy. From the perspective of maternal well-being, both physical and psychological, the initiative reported here appears to have been highly successful.

Organising midwifery led care in The Netherlands

The growing pressure for changes in the care available for pregnant women at low risk found a voice in the report on maternity services from the House of Commons Health Committee published in February 1992. The demand for greater autonomy and responsibility by midwives and the need to rationalise medical working practices in the light of changes in junior doctors' hours adds urgency to the need to find ways of instituting change while maintaining safety. A visit to the Netherlands allowed first hand evaluation of aspects of the Dutch model of maternity care of relevance to establishing midwifery led care for women with uncomplicated pregnancies in the United Kingdom.