Evaluation of satisfaction with midwifery care

Objective: to determine if there were differences in women's satisfaction with maternity care given by doctors and midwives. In addition a simple, six-question, satisfaction questionnaire was to be tested.

Design: a randomised controlled trial comparing two models of maternity care.

Setting: a tertiary referral centre in Alberta, Canada.

Participants: one hundred and ninety four women with a low-risk pregnancy were randomly assigned to either the midwife care, experimental group (n = 101), or the doctor care, control group (n = 93).

Interventions: a pilot midwifery programme was introduced into a maternity services delivery system that did not have established midwifery.

Measurements: women's satisfaction was measured, at two weeks postpartum, with the Labour and Delivery Satisfaction Index (LADSI), general attitudes toward the birth experience, also at two weeks postpartum; with the Attitudes about Labour and Delivery Experience (ADLE) questionnaire. Fluctuations in satisfaction were measured with a Six Simple Questions (SSQ) questionnaire at 36 weeks gestation and 48 hours, two and six weeks postpartum.

Findings: women in the midwife group reported significantly greater satisfaction and a more positive attitude toward their childbirth experience than women in the doctor group (p < 0.001). The SSQ demonstrated scores similar to the LADSI. Satisfaction in both groups was lowest at 36 weeks gestation and highest immediately postpartum.

Key conclusions: women experiencing low-risk pregnancies were more satisfied with care by midwives than with care provided by doctors. Satisfaction scores were high for both groups and may have been lower for women in the doctor group as a result of disappointment with caregiver assignment as all women had sought midwifery care. The SSQ measures similar dimensions to the LADSI but the agreement is not strong enough to recommend its use as a substitute at this time.

Implications for practice: the significantly higher satisfaction of the women with the care provided by the midwives together with better clinical outcomes reported elsewhere suggest that the option of midwifery care should be accessible as an option for all women in Canada. Further research is suggested to determine the usefulness of the SSQ.