Comparing birth experiences and satisfaction with midwifery care before and after the implementation of Canada's first Alongside Midwifery Unit (AMU)

Abstract

Background: Globally, midwifery-led birthing units are associated with favourable clinical outcomes and positive birth experiences. As part of our evaluation of Canada's first Alongside Midwifery Unit (AMU) at Markham Stouffville Hospital, we sought to explore and compare birth experiences and satisfaction among midwifery clients who gave birth on the AMU with midwifery clients who gave birth on the traditional obstetric unit prior to AMU implementation.

Methods: We conducted a structured, online, cross-sectional survey of midwifery clients in the six months before, and up to 18 months after, opening of the AMU at Markham Stouffville Hospital, Ontario Canada. The survey contained validated measures of satisfaction including personal capacity and participation; perceived safety, control, and security; professional support; and satisfaction. Descriptive statistics and tests of significance were completed in SPSS.

Results: A total of 193 responses were included in our analyses (pre-AMU n = 47, post-AMU n = 146). All participants had positive experiences in the four domains assessed. Compared to those who gave birth with midwives on the Labour unit, those who gave birth on the AMU indicated more positive experiences for some measures. Perceptions pertaining to being an active participant in care, to security and sense of control were more positive among those who gave birth on the AMU.

Conclusion: The AMU in Ontario is associated with high levels of satisfaction during birth, particularly the perception of being actively engaged in decision making, having a sense of control and safety, and having confidence in the care provider team. Care received on the AMU does not compromise birth experiences or satisfaction and may be associated with greater autonomy and agency for the person giving birth.

Fig 1. AMU evaluation study components.

Fig 2. Participants’ perception of own capacity during labour and birth, pre- and post-AMU implementation.

Chi-square test (*p<0.05).

Fig 3. Participants’ perceptions of participation during labour and birth, pre- and post-AMU implementation.

Chi-square test (*p<0.05).

Fig 4. Participants’ perceptions of control and security during labour and birth, pre- and post-AMU implementation.

Independent Samples t-test (*p<0.05).

Fig 5. Participants’ perceptions of professional support during labour and birth, pre- and post-AMU implementation.

Chi-square test (*p<0.05).

Fig 6. Canadian Maternity Experiences Survey (CMES).

Chi-square test (*p<0.05).