Experienced Continuity and Respect in Childbirth: A Cross‐Sectional Survey Comparing Midwife‐Led and Obstetrician‐Led Care
Renate Simmelink, Anna Martin‐Arribas, Brenda Hermsen, Marit van der Pijl, Jens Henrichs, Corine Verhoeven, Ank de JongeABSTRACT
Background
Midwife‐led continuity of care, in which one or a small team of midwives provide care throughout pregnancy, childbirth and the postpartum period, is associated with better perinatal outcomes and higher maternal satisfaction. In many settings, this care is limited to low‐risk women, with referrals to obstetrician‐led care disrupting continuity. This study investigated whether experienced continuity of care and respect during labor differ between women receiving midwife‐led care and those receiving obstetrician‐led care at labor onset.
Methods
Data were used from a cross‐sectional, national survey on maternity care experiences of women in the Netherlands, who gave birth between 2015 and 2018. Experienced continuity and respect were measured using the Nijmegen Continuity Questionnaire and the ReproQuestionnaire. Differences were examined using AN(C)OVAs, adjusting for maternal and birth characteristics. Effect sizes were calculated using partial eta squared ( η 2 ).
Findings
In total, 623 women were included, with 451 receiving midwife‐led care and 172 receiving obstetrician‐led care at labor onset. Women who started labor in midwife‐led care reported significantly higher experienced continuity than those in obstetrician‐led care, also when they were referred to obstetrician‐led care during labor. Effect sizes ( η 2 > 0.06) showed moderate‐to‐large effect sizes. Differences in perceived respect between women in midwife‐led care who were not referred, and women who were referred or started in obstetrician‐led care were statistically significant but small.
Conclusion
Our findings demonstrate differences of a substantial magnitude in experienced continuity of care, suggesting a need to enhance continuity in obstetrician‐led care. Future research should explore strategies to implement and sustain midwife‐led continuity models.