Women’s experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China

Liu et al. BMC Pregnancy and Childbirth (2021) 21:151 https://doi.org/10.1186/s12884-021-03638-3 RESEARCH ARTICLE Open Access Women’s experience and satisfaction with midwife-led maternity care: a crosssectional survey in China Ying Liu1, Tengteng Li1, Nafei Guo1, Hui Jiang1* , Yuehong Li2, Chenying Xu2 and Xiao Yao2 Abstract Background: Low risk pregnancy ending in a vaginal birth is best served and guided by a midwife. Utilizing a midwife in such cases offers many emotional and economic advantages and does not increase the risks for mother or neonate. However, women’s experience and satisfaction of midwife-led maternity care is rarely reported in China. The primary objective of this study is to describe the experience of Chinese women receiving midwife-led maternity care, and to report their satisfaction level of the experience. Methods: The study is a cross-sectional survey of 4192 women who had natural birth from March–June 2019 in a maternity care center, Shanghai, China. We used a self-administered questionnaire addressing items related to women’s experience during childbirth, as well as their satisfaction with midwife-led maternity care. We also included demographic and perinatal characteristics of each participant. Descriptive statistics and correlations analysis between groups of different experience and satisfaction were used. Results: In this sample, 87.7% of women had a Doula and a family member present during childbirth. Epidural anesthesia was used in 75.6% and episiotomy was needed in 23.2%. Free positioning during the first stage of labor and free positioning during the second stage of labor and delivery were adopted in 84.3 and 67.9% of the cases, respectively. Moderate to severe perineal pain and moderate to severe perineal edema were reported in 43.1 and 12.2% of the participants, respectively. High satisfaction level was found when there was midwife-led prenatal counseling and presence of Doula and family member, Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during the first stage of labor, and midwifes’ postpartum guidance. Negative satisfaction was seen with perineal pain and edema. Conclusion: Women in this survey generally had high satisfaction with midwife-led maternity care. This satisfaction is probably felt because of the prenatal counseling by the midwife and allowing a Doula and a family member in the room during childbirth. Other intangible factors to improve the satisfaction level were Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during first stage of labor, and early skin to skin contact. Keywords: Maternity care, Midwife, Pregnancy, Vaginal delivery, China * Correspondence: 1 Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai 201204, China Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Liu et al. BMC Pregnancy and Childbirth (2021) 21:151 Background Natural birth guided by a midwife is the optimal service for low-risk pregnancy without increasing the risks for mothers and neonates [1]. Two studies in Shanghai found women’s choices of delivery, are influenced by complex internal and external factors [2, 3]. Vaginal delivery is motivated by factors such as fast recovery, immediate breastfeeding, and powerful bonding [4]. In addition, women delivering vaginally reported greater fulfillment and less distress than those delivering by cesarean section (C-S) even many years post-delivery [5]. Wang reported that labor pain and lack of social support during childbirth were the major reasons for women to request a C-S [6]. These factors may explain the high CS rates in China which remains 41.1–45.6% (nationwide from 2012 to 2016) [7]. Women tend to view the C-S as a way to avoid pain, when in fact a C-S is not devoid of pain and carries many adverse maternal and neonatal outcomes [8, 9]. All across the World, there is a growing interest for midwife or a team of midwives leading the planning, organization, and delivery of care, with some consultation from obstetricians [10–12]. This midwifeled team compared to obstetrician-led maternity care was associated with lower maternal and neonatal mortality, lower C-S rate, lower and better postpartum wellbeing [10, 12–14]. In the scope of midwifery, according to the framework for quality maternal and newborn care, effective practice for childbearing women and infants includes education, information, health promotion and public health; assessment, screening and care planning; promotion of normal process and prevention of complications; first-line management of complication and so on [12]. Maternity care in China is predominantly hospitalbased and obstetrician-led [15]. With the Chinese modernization campaign in the 1980s, a medical model had been widely used and led to medicalization and hospitalization of childbirth throughout China [16]. By 2018, hospital delivery rate approaches 100% especially in large cities such as Shanghai and Beijing. As the largest developing and the largest population country, China bears a substantial burden of maternity care and faces a serious shortage of obstetricians, obstetric nurses, and midwives. This fact prompted the National Health Commission of the People’s Republic of China to release the Maternal and Child Safety Action Plan (2018–2020) in May 2018. This action plan aimed at advocating women-centered hospital delivery services and establishing a safe and comfortable delivery environment for women. In China, there is no nationally recognized registration system of midwives [17]. Midwife only certified by some local health bureau. Midwifery is a branch of nursing, and all midwives have to be a registered nurse with Page 2 of 10 nursing licenses [15, 18]. Midwives are main (...truncated)