Satisfaction with caregivers during labour among low risk women in the Netherlands: the association with planned place of birth and transfer of care during labour

The DELIVER study; the impact of research capacity building on research, education, and practice in Dutch midwifery

BACKGROUND

Few examples exist of research capacity building (RCB) in midwifery. As in other jurisdictions, at the turn of this century midwives in the Netherlands lagged in research-based practice. Dutch professional and academic organisations recognised the need to proactively undertake RCB. This paper describes how a large national research project, the DELIVER study, contributed to RCB in Dutch midwifery.

METHODS

Applying Cooke's framework for RCB, we analysed the impact of the DELIVER study on RCB in midwifery with a document analysis comprising the following documents: annual reports on research output, websites of national organizations that might have implemented research findings, National Institute for Public Health and the Environment (RIVM)), midwifery guidelines concerning DELIVER research topics, publicly available career information of the PhD students and a google search using the main research topic and name of the researcher to look for articles in public papers.

RESULTS

The study provided an extensive database with nationally representative data on the quality and provision of midwifery-led care in the Netherlands. The DELIVER study resulted in 10 completed PhD projects and over 60 publications. Through close collaboration the study had direct impact on education of the next generation of primary, midwifery care practices and governmental and professional bodies.

DISCUSSION

The DELIVER study was intended to boost the research profile of primary care midwifery. This reflection on the research capacity building components of the study shows that the study also impacted on education, policy, and the midwifery profession. As such the study shows that this investment in RCB has had a profound positive impact on primary care midwifery in the Netherlands.

Perinatal factors related to pregnancy and childbirth satisfaction: a prospective cohort study

BACKGROUND

Satisfaction of pregnancy and childbirth is an important quality measure of maternity care. Satisfaction questionnaires generally result in high scores. However, it has been argued that dissatisfaction relies on a different construct. In response to a worldwide call for obstetric care that is more woman-centered, we identified and described the contributors to suboptimal satisfaction with pregnancy and childbirth.

METHODS

A prospective subcohort of 739 women from a larger cohort (Expect Study I, n = 2614) received a pregnancy and childbirth satisfaction questionnaire. Scores were transformed to a binary outcome whereby a score <100 points corresponded with less satisfied women. We performed a multiple logistic regression analysis to define independent perinatal factors related to suboptimal satisfaction.

RESULTS

Decreased perceived personal well-being, antenatal anxiety, and obstetrician-led care during labor were all independently associated with suboptimal pregnancy and childbirth satisfaction. No difference in satisfaction was found between antenatal care led by a midwife or an obstetrician, but midwife-led antenatal care reduced the odds of suboptimal satisfaction compared to women who were transferred to an obstetrician in the antenatal period. Antenatal anxiety was experienced by 25% of all women and is associated with decreased satisfaction scores.

DISCUSSION

Screening and treatment of women suffering from anxiety might improve pregnancy and childbirth satisfaction, but further research is necessary. Women's birthing experience may improve by reducing unnecessary secondary obstetric care.

Maternal Satisfaction and Factors Associated with Institutional Delivery Care in Central Ethiopia: a Mixed Study

BACKGROUND

Women satisfaction recognized as an important outcome of the maternal health care delivery system. Despite the Ethiopian federal ministry of health implemented compassionate, respectful, and caring as one of the health sector transformation agendas to increase health service utilization, the level of maternal satisfaction of institutional delivery is still low. This study aimed to assess maternal satisfaction and factors associated with institutional delivery care in central Ethiopia.

METHODS

Community-based cross-sectional study, which involved quantitative study supplemented with qualitative methods were employed. Mothers were proportionally allocated to each selected kebele according to the number of their size. Data were collected by a face-to-face interview using a standardized questionnaire to determine the level of maternal satisfaction with birth care. The result was presented using texts, percentages, and tables. Bivariate and multivariate logistic regressions were performed between dependent and independent variables at 95% confidence intervals and a P-value < 0.05 to show a significant association. In the qualitative part, data were transcribed carefully and analyzed thematically.

RESULTS

The overall a total of 451 respondents participated in this study making a response rate of 98%. The level of maternal satisfaction was 36.6% in this study. Spontaneous vaginal deliveries (SVD) (AOR: 7.33, CI: 2, 26.79), being attended by female sex health workers (AOR: 1.54, CI: 1.04, 2.28), receiving ambulance service to arrive at health facilities (AOR: 7.84, CI: 2, 61.63), utilizing of maternal waiting areas AOR: 1.72, CI: 1.09, 2.66), and respectful care (AOR=1.55, CI: 1.03, 2.34) were factors associated with maternal satisfaction. From qualitative study, three themes and ten categories have emerged.

CONCLUSION

Maternal satisfaction towards the delivery service was low. SVD, being attended by female sex health workers, ambulance service, cleaned delivery room, and respectful care were factors associated with maternal satisfaction. The health facilities in the study areas need to work on improving health facility cleanliness, health workers' compassionate and respectful care, and providing ambulance service as a main means of transportation for laboring mothers.

Midwife-led care and obstetrician-led care for low-risk pregnancies: A cost comparison

OBJECTIVE

Low-risk pregnant women cared for by midwives have similar birth outcomes to women cared for by physicians, although experiencing fewer medical procedures. However, limited research has assessed cost implications in the United States. Using national data, we assessed costs and resource use of midwife-led care vs obstetrician-led care for low-risk pregnancies using a decision-analytic approach.

METHODS

We developed a decision-analytic model of costs (health plan payments to clinicians) and use of medical procedures during childbirth (epidural analgesia, labor induction, cesarean birth, episiotomy) and outcomes of care (birth at preterm gestation) that may differ with midwife-led vs obstetrician-led care. Model parameters for obstetric procedures were generated using Listening to Mothers III data, a national survey of women who gave birth in US hospitals in 2011-2012 and other published estimates. Cost estimates came from published or publicly available information on health insurance claims payments.

RESULTS

The costs of childbirth for low-risk women with midwife-led care were, on average, $2262 less than births to low-risk women cared for by obstetricians. These cost differences derive from lower rates of preterm birth and episiotomy among women with midwife-led care, compared with obstetrician-led care. Across the population of US women with low-risk births each year (approximately 2.6 million), the model predicted substantially fewer preterm births (167 259 vs 219 427 for midwife-led vs obstetrician-led care) and fewer episiotomies (170 504 vs 415 686, for midwife-led vs obstetrician-led care).

CONCLUSIONS

A shift from obstetrician-led care to midwife-led care for low-risk pregnancies could be cost saving.

Post-partum duration of satisfaction with childbirth

AIM

Satisfaction with childbirth has become increasingly important among healthcare providers. We evaluated whether satisfaction levels change with time (up to 3 months after delivery).

METHODS

A prospective study of nulliparous women was designed to evaluate their levels of satisfaction with childbirth and care during birth in the maternity unit of a county hospital in Sundsvall, Sweden. Patient satisfaction with birth and health care was measured twice, during the first week after birth and 3 months later, with the Childbirth Experience Questionnaire (CEQ). Maternal and labor information were collected with a form filled in by the patients and completed with information from the patients' records.

RESULTS

A total of 78 primiparous women participated in the study and answered the questionnaire in the first week after labor, and 63 of them completed the study by answering the same questionnaire 3 months after delivery. The total CEQ score did not change after 3 months, but the scores for the subscales 'professional support' and 'participation' decreased 3 months after labor (P = 0.008 and P = 0.001, respectively). A visual analogue scale predicted the total CEQ scores at both 1 week (P < 0.001) and 3 months (P = 0.003).

CONCLUSION

Our results indicate that satisfaction with labor and birth among primiparous women was unchanged 3 months after labor.