Midwife all the way

Title

Midwife all the way

Background

In Sweden, midwives are the primary caregivers during pregnancy, intrapartum- and postnatal care. In general, continuity during antenatal care is high where the majority of women meet no more than two midwives during the routine antenatal check-ups. Nevertheless, care across the antenatal, intrapartum, and postnatal periods remains fragmented in Sweden and women seldom meet a known midwife when giving birth. Continuity models of midwifery care, such as caseload midwifery, ensure that childbearing women receive care throughout pregnancy, childbirth, and the postnatal period from one, or a few, midwives, with whom they can develop a relationship. Continuity models of midwifery care are recommended to all women by the World Health Organization (WHO) to promote a positive birth experience. Research has shown several benefits of the model compared to standard care such as lower rates of interventions during birth and more spontaneous vaginal births, higher satisfaction among women, less burnout among midwives and lower costs for care.
There are few alternatives to standard care during childbirth care and continuity with the same midwife throughout pregnancy, birth and postnatal period is rare in Sweden. There is a lack of knowledge of implementing similar forms of care in Sweden and study its effects, especially in rural areas. In connection to a planned reorganization of childbirth care in a rural city, a possibility was given to try a new way of working.

Aim

The aim of the project was to develop a new working model based on an action research approach that utilizes the staff’s competence and ensures the care of future parents during pregnancy, childbirth and the postnatal period by increasing the possibility of continuity with a known midwife.

Methods

The recruitment of the parents-to-be was carried out consecutively at the antenatal clinics in the area. Data were collected from the couples by questionnaires, in mid-pregnancy and two months after birth, and by interviews. The project midwives have been followed by interviews during the course of the project. Midwives in antenatal clinics not involved in the project and midwives in the maternity wards have been interviewed. Register data has been collected. The project period was between February 2017 – June 2019. The analysis of data is ongoing.

Relevance

The project will provide new knowledge about how continuity models affect care during childbirth and the birth outcome. This knowledge is important for the health care system to better plan the care and meet the needs of the parents. The project’s approach is to find a work model that creates safety for future parents in a part of Sweden where there is a long distance to the maternity ward. The project may also form the basis for others interested in the country who want to start similar care models.

Research principal

Uppsala University

Foundation

Swedish Association of Local Authorities and Regions (SKR), Kamprad Family Foundation

Contact

Project manager: Ingegerd Hildingsson, Professor, Uppsala University, Mid Sweden University. Research group: Birgitta Larsson, PhD, Sophiahemmet University
Annika Karlström, PhD, Mid Sweden University