Evaluation of satisfaction with care in a midwifery unit and an obstetric unit: a randomized controlled trial of low-risk women.
Satisfaction with birth care is part of quality assessment of care. The aim of this study was to investigate possible differences in satisfaction with intrapartum care among low-risk women, randomized to a midwifery unit or to an obstetric unit within the same hospital.



Randomized controlled trial conducted at the Department of Obstetrics and Gynecology, Østfold Hospital Trust, Norway. A total of 485 women with no expressed preference for level of birth care, assessed to be at low-risk at onset of spontaneous labor were included. To assess the overall satisfaction with intrapartum care, the Labour and Delivery Satisfaction Index (LADSI) questionnaire, was sent to the participants 6 months after birth. To assess women's experience with intrapartum transfer, four additional items were added. In addition, we tested the effects of the following aspects on satisfaction; obstetrician involved, intrapartum transfer from the midwifery unit to the obstetric unit during labor, mode of delivery and epidural analgesia.



Women randomized to the midwifery unit were significantly more satisfied with intrapartum care than those randomized to the obstetric unit (183 versus 176 of maximum 204 scoring points, mean difference 7.2, p = 0.002). No difference was found between the units for women who had an obstetrician involved during labor or delivery and who answered four additional questions on this aspect (mean item score 4.0 at the midwifery unit vs 4.3 at the obstetric unit, p = 0.3). Intrapartum transfer from the midwifery unit to an obstetric unit, operative delivery and epidurals influenced the level of overall satisfaction in a negative direction regardless of allocated unit (p < 0.001).



Low-risk women with no expressed preference for level of birth care were more satisfied if allocated to the midwifery unit compared to the obstetric unit.



The trial is registered at www.clinicaltrials.gov NCT00857129 . Initially released 03/05/2009.
Department of Obstetrics and Gynecology, Østfold Hospital Trust, Sarpsborg, Norway.
Stine
S
Bernitz
Department of Obstetrics and Gynecology, the University Hospital of North Norway, Tromsø, Norway.|Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway.
Pål
P
Øian
Unit for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.|Faculty of Dentistry, University of Oslo, Oslo, Norway.
Leiv
L
Sandvik
Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway. ellen.blix@hioa.no.|Faculty of Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. ellen.blix@hioa.no.
Ellen
E
Blix
D000328:Adult; D015360:Analgesia, Epidural; D000773:Anesthesia, Obstetrical; D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008880:Midwifery / Q000592:standards*; D009774:Obstetrics / Q000592:standards*; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards*; D036801:Parturition; D017060:Patient Satisfaction; D010360:Patient Transfer; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D012307:Risk Factors
Birth care unit; Intrapartum care; Low-risk birth; Satisfaction