Women’s experiences of continuity of midwifery care in Australia: A randomised controlled trial

Objective: To compare the experiences of women who received a new model of continuity of midwifery care with those who received standard hospital care during pregnancy, labour, birth and the postnatal period. Design: A randomised controlled trial was conducted. One thousand and eighty-nine women were randomly allocated to either the new model of care, the St George Outreach Maternity Project (STOMP), or standard care. Women completed a postal questionnaire 8-10 weeks after the birth. Participants: Women in the trial were of mixed obstetric risk status and more than half the sample were born in a non-English speaking country. Results: Questionnaires were returned from 69 per cent of consenting women. STOMP women were significantly more likely to have talked with their midwives and doctors about their personal preferences for childbirth and more likely to report that they knew enough about aspects of labour and birth, particularly induction of labour, pain relief and caesarean section. Almost 80 per cent of women in the STOMP group experienced continuity of care, that is, one of their team midwives was present, during labour and birth. STOMP women reported a significantly higher ‘sense of control during labour and birth’. Sixty three per cent of STOMP women reported that they ‘knew’ the midwife who cared for them during labour compared with 21 per cent of control women. In a secondary analysis, women who had a midwife during labour who they felt that they knew, had a significantly higher sense of ‘control’ and a more positive birth experience compared with women who reported an unknown midwife. Postnatal care elicited the greatest number of negative comments from women in both the STOMP and the control group. Conclusion: The reorganisation of maternity services to enable women to receive continuity of care has benefits for women. The benefits of a known labour midwife needs further research.