A direct comparison of patient-reported outcomes and experiences in alternative models of maternity care in Queensland, Australia.

We aimed to directly compare women's pregnancy to postpartum outcomes and experiences across the major maternity models of care offered in Queensland, Australia. We conducted secondary analyses of self-reported data collected in 2012 from a state-wide sample of women who had recently given birth in Queensland (response rate = 30.4%). Logistic regression was used to estimate the odds of outcomes and experiences associated with three models (GP Shared Care, Public Midwifery Continuity Care, Private Obstetric Care) compared with Standard Public Care, adjusting for relevant maternal characteristics and clinical covariates. Of 2,802 women, 18.2% received Standard Public Care, 21.7% received GP Shared Care, 12.9% received Public Midwifery Continuity Care, and 47.1% received Private Obstetric Care. There were minimal differences for women in GP Shared Care. Women in Public Midwifery Continuity Care were less likely to have a scheduled caesarean and more likely to have an unassisted vaginal birth, experience freedom of mobility during labour and informed consent processes for inducing labour, vaginal examinations, fetal monitoring and receiving Syntocinon to birth their placenta, and report highest quality interpersonal care. They had fewer vaginal examinations, lower odds of perineal trauma requiring sutures and anxiety after birth, shorter postpartum hospital stays, and higher odds of a home postpartum care visit. Women in Private Obstetric Care were more likely to have their labour induced, a scheduled caesarean birth, experience informed consent processes for caesarean, and report highest quality interpersonal care, but less likely to experience unassisted vaginal birth and informed consent for Syntocinon to birth their placenta. There is an urgent need to communicate variations between maternity models across the range of outcome and experiential measures that are important to women; build more rigorous comparative evidence for Private Midwifery Care; and prioritise experiential and out-of-pocket cost comparisons in further research to enable woman-centred informed decision-making.

A scoping review of evidence comparing models of maternity care in Australia.

OBJECTIVES: To synthesize available evidence comparing outcomes and experiences of care received in different maternity models in Australia and identify the information gaps hindering women's decisions between alternative models. DESIGN: A literature search was conducted to identify published research over the last twenty years that directly compared clinical and/or experiential outcomes of women in different maternity models of care in Australia. Outcome measures of included articles were identified and assessed to evaluate current comparative information available to women and health professionals. The quality of included studies was assessed using Joanna Briggs Institute (JBI) critical appraisal tools for randomised controlled studies (RCTs) and cohort studies. Quantitative data were extracted and synthesised for further analysis. SETTING/PARTICIPANTS: Published studies comparing at least two maternity care models providing antenatal, intrapartum and postpartum care in Australia. RESULTS: Eight studies (five RCTs and three observational studies) met inclusion criteria. Seven studies compared the outcomes of public midwifery continuity care and standard public care and one compared the outcomes of public midwifery continuity care, standard care and private obstetric care. There was no evidence directly comparing all broadly categorised available models in Australia. Data for clinical outcomes were collected from hospital records and experiential data were self-reported. Seven out of eight studies used data collected from single public hospital settings and one study included data from two tertiary hospitals. Women in public midwifery continuity models were more likely to have unassisted vaginal births, continuity of care and satisfaction and lower use of interventions (i.e., episiotomy, induction of labour, use of analgesia) and neonatal admission in intensive care units (ICU), compared with those in standard public models (and private obstetric care in one study). CONCLUSION: This scoping review reveals lack of reliable direct comparison of clinical and experiential outcomes across the multiple available public and private maternity models of care in Australia. Quality alignment between women's needs and their maternity model of care can prevent under or over specialised care and avoidable health system costs. Comprehensive information comparing all available maternity care models can guide gatekeeper health professionals and women to choose the best model according to women's needs and preferences. There is a need for research providing more comprehensive and ecological comparisons between available models of maternity care to inform such decision making support. Moreover, women's experiential data across maternity model of care comparisons could be used more consistently to better represent the relative outcomes of alternative models from a consumer-centred perspective.