Midwife-led maternity services and consumer 'choice' in an Australian metropolitan region.

OBJECTIVE

Identify the factors determining women's support for midwife-led maternity care in an Australian metropolitan region, and identify the implications for the role of midwives and for the expansion of options for childbearing women.

DESIGN

A two-stage research design was utilised. In the first stage a sample of women were surveyed regarding their choice of maternity service provider and site of provision of maternity services. In the second stage, in-depth interviews were used to collect the birthing narratives of a sample of 50 women involved in the first stage of the research.

SETTING

A metropolitan region of Adelaide, South Australia.

PARTICIPANTS

Women who had given birth to a live baby in the 1991 calendar year, who lived within a designated region and who gave birth at one of four hospitals in or near the region. In the first stage of the study, 519 women returned surveys, giving a response rate of 61.7%. Sixty-four per cent of these women expressed an interest in being involved in further research, and fifty of these were randomly selected for interview.

FINDINGS

Despite recent calls in Australia to increase the choices available to childbearing women, these choices are limited by, amongst other things, insufficient information about midwife-led maternity services. The work of midwives remains silenced and invisible to many women pregnant for the first time, who have little idea about what midwives can do. This research shows that women's main source of information about midwife care is developed through the actual experience of it, particularly in giving birth. This experience leads to an extremely positive recognition and appraisal of the work of midwives, such that the majority of women indicate that they would be happy with midwife care for subsequent births. First-time mothers are significantly disadvantaged in terms of choices available to them because of this lack of information about midwife-led maternity care.

IMPLICATIONS

In the interests of providing childbearing women with real choices for maternity care, strategic interventions to better publicise the role of midwives and of midwife-led services are needed.