Changing childbirth: lessons from an Australian survey of 1336 women

OBJECTIVE: To investigate the views and experiences of care in labour and birth of a representative sample of women who gave birth in Victoria, Australia in 1993. DESIGN: Cross-sectional survey mailed to women 6-7 months after giving birth. POPULATION: All women who gave birth in a two week period in Victoria, Australia in September 1993, except those who had a stillbirth or neonatal death. RESULTS: After adjusting for parity, the risk status of the pregnancy, and social and obstetric factors, specific aspects of care with the greatest negative impact on the overall rating of intrapartum care were: caregivers perceived as unhelpful (midwives: adjusted OR 12.03 95% CI 7.8-18.6, doctors: adjusted OR 6.76 95% CI 4.4-10.3); and having an active say in decisions only sometimes, rarely or not at all (adjusted OR 8.90 95% CI 4.9-16.1). In a separate regression analysis including parity, risk status, obstetric and social factors, but not specific aspects of care, factors associated with dissatisfaction with intrapartum care included: participation in shared antenatal care programme (adjusted OR 1.89 95% CI 1.2-3.0) and being of nonEnglish speaking background (adjusted OR 1.70 95% CI 1.1-2.6). The following factors lowered the odds of dissatisfaction: attending a birth centre (adjusted OR 0.34 95% CI 0.1-1.0) and knowing the midwives before going into labour (adjusted OR 0.68 95% CI 0.5-0.9). CONCLUSION: The survey demonstrates the potential for 'new' models of care to have either positive or negative effects on women's experiences of care. Evaluation of innovations in perinatal care taking into account women's views is a prerequisite for improvements in maternity care.