Experiences and outcome of caseload midwifery - a mixed methods study

Experiences and outcome of caseload midwifery - a mixed methods study

Background: Caseload midwifery is a model of care focusing on continuity, ensuring that childbearing women receive their antenatal, intrapartum and postnatal care from one, or only a few, known caseloading midwives with whom they can develop a relationship.
In Denmark, caseload midwifery is expanding, but no Danish studies have addressed the outcomes of labour or the experiences of women and their partners. International research has demonstrated that caseload midwifery is rewarding for pregnant women and midwives, and improves labour outcomes, but there are also contradictory statements about midwives’ experiences.

Aim: The overall aim of this mixed methods study was to expand the understanding of the complexity of caseload midwifery by integrating findings from both qualitative and quantitative studies. The mixed methods research question was:
Research question: What are the experiences and outcomes of caseload midwifery in the Danish context?
Methodology and methods: This investigation used a multistage mixed methods design. The overall convergent phase included parallel questions and independent analyses of qualitative and quantitative data, followed by an integration of findings at the level of interpretation. The exploratory sequential phase supplemented the convergent design as findings in study 1 informed the approach in the subsequent collection of quantitative data in study 2.
Initially, the researcher explored midwives’ experiences through participant observations in antenatal clinics, followed by interviews with caseload midwives (Study 1). This study inspired a survey on burnout that used a validated questionnaire (Study 2). Thereafter, the researcher conducted participant observations during labour to explore couples’ experiences, followed by interviews (Study 3). Concurrently, Study 4, a register-based cohort study, involved the collection of three years of data from the obstetric database (Study 4).

Results: The findings from the four studies were integrated during interpretation, and two major themes emerged: “A positive cycle in caseload midwifery,” and “A negative cycle in caseload midwifery.” The integration of findings from the four studies was a result of narrative weaving and illustrated in joint displays.
Conclusion: Both midwives and couples experienced significant well-being. The midwives experienced high job satisfaction and low levels of burnout compared to standard care. The women appreciated caseload midwifery and their partners also benefitted from it, as they all felt that the midwives acknowledged and treated them as individuals. This good relationship led to a positive cycle in which mutual recognition and consideration supported the sense of coherence.
However, the experience of working in caseload midwifery seemed to depend on the midwives’ ability to handle the strong obligation always to perform well. Moreover, the balance between the couples’ wishes and the midwives’ professional knowledge might be difficult to maintain if the relationship is too close. Together with the midwives’ perceived obligation to be there for all of their women this could lead to a negative cycle with the result of a more active approach to labour followed by impaired neonatal outcome.