title: Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial.
abstract: BACKGROUND
  Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum.
  
  
  METHODS
  Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating.
  
  
  RESULTS
  Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88% in the caseload group and 74% in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95% CI 2.79, 4.03), intrapartum care (OR 2.14; 95% CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95% CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95% CI 2.64, 3.85).
  
  
  CONCLUSIONS
  For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007).
authors: Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia. D.Forster@latrobe.edu.au.|The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia. D.Forster@latrobe.edu.au.
authors: Della A
authors: DA
authors: Forster
authors: Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia. H.McLachlan@latrobe.edu.au.|School of Nursing and Midwifery, La Trobe University, Bundoora, 3086, Australia. H.McLachlan@latrobe.edu.au.
authors: Helen L
authors: HL
authors: McLachlan
authors: Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia. m.davey@latrobe.edu.au.
authors: Mary-Ann
authors: MA
authors: Davey
authors: School of Nursing and Midwifery, Monash University, Clayton, 3800, Australia. maryanne.biro@monash.edu.
authors: Mary Anne
authors: MA
authors: Biro
authors: The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia. tanya.farrell@thewomens.org.au.
authors: Tanya
authors: T
authors: Farrell
authors: Deakin Health Economics, Deakin University, Burwood, 3125, Australia. lisa.gold@deakin.edu.au.
authors: Lisa
authors: L
authors: Gold
authors: Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia. m.flood@latrobe.edu.au.
authors: Maggie
authors: M
authors: Flood
authors: Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia. t.shafiei@latrobe.edu.au.
authors: Touran
authors: T
authors: Shafiei
authors: Department of Women's and Children's Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden. ulla.waldenstrom@ki.se.
authors: Ulla
authors: U
authors: Waldenström
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008880:Midwifery / Q000379:methods*; D017060:Patient Satisfaction; D018743:Perinatal Care / Q000379:methods; D011181:Postnatal Care / Q000379:methods / Q000523:psychology*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000523:psychology*; D011795:Surveys and Questionnaires; D014739:Victoria