Quality of intrapartum care assessed by women with fear of birth who received care in a midwifery continuity model in a rural area of Sweden- a longitudinal cohort study

BACKGROUND: The advantages of midwifery continuity models of care during pregnancy, birth, and the postnatal period demonstrated in ‘low-risk’ women may also benefit those with fear of birth. The purpose of the study was to explore women’s assessment of the quality of intrapartum care when participating in a midwifery continuity of care (MCoC) project in a rural area of Sweden. An additional aim was to explore if the care differed between women who had a known midwife during labour and birth, versus not. METHODS: A prospective longitudinal cohort study including 142 women with fear of birth who participated in an MCoC project was performed. Data was collected via two online questionnaires, gathering background data and birth related information. The instrument ‘Quality from the Patients’ Perspective’ was used to assess the perceived reality and the subjective importance of intrapartum care content. RESULTS: Deficiencies between perceived reality and subjective importance were found in the following aspects of intrapartum care: perception of control (50%), involvement in decision-making (26%), access to preferred pain relief (26%), breastfeeding support (23%), and information about labour progress (22%). The midwife’s presence, involvement of the partner, possibilities to talk through the birth and breastfeeding support was rated better than expected. No major differences were found in the quality of intrapartum care, in relation to continuity. A total of 75% had a known midwife during labour and birth and were more likely to have had labour induced (aOR 5.31, 95% CI 1.68–16.79), to have used the method ‘Give birth without fear’ (aOR 3.21, 95% CI 1.05–9.83), and to have received an epidural (aOR 3.85, 95% CI 1.51–9.82), compared to women without a known midwife assisting. CONCLUSION: The quality of intrapartum care was assessed both deficient and excessive. Few differences were found between women who had a known midwife or not, but women with fear of childbirth who experienced continuity with a known midwife were exposed to more interventions, following Swedish regime to encourage women to have a vaginal birth. Aligning care content with women’s needs and values remains essential to improve satisfaction and outcomes in intrapartum care.