Satisfaction and the three C's: continuity, choice and control. Women's views from a randomised controlled trial of midwife-led care


Correspondence: Ms V. A. Hundley, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen AB9 2ZA, UK.


Objective 1. To explore whether there are differences in women's satisfaction with care in a midwife-managed delivery unit compared with that in a consultant-led labour ward. 2. To compare factors relating to continuity, choice and control between the two randomised groups.

Design A pragmatic randomised controlled trial.

Setting Aberdeen Maternity Hospital, Grampian.

Sample 2844 women, identified at booking as low risk, were randomised in a 2:1 ratio between the midwives’ unit and the labour ward.

Main outcome measures Satisfaction, continuity of carer, choice, and control.

Results Satisfaction with the overall experience did not differ between the groups. Satisfaction with how labour and delivery was managed by staff was slightly higher in the midwives’ unit group, but this did not reach the 0.1% level of significance. Women allocated to the midwives’ unit group saw significantly fewer medical staff and were less likely to report numerous individuals entering the room. They were more likely to report having had a choice regarding mobility and alternative positions for delivery and were significantly more likely to have made their own decisions regarding pain relief.

Conclusions The issues surrounding the measurement of satisfaction with childbirth need further investigation. Until this area is clarified it would be unwise to use an overall measure of satisfaction as an indicator of the quality of maternity service provision. In particular, the current measures are not sensitive enough to examine the specific factors which affect women's satisfaction. Further research is required to assess which factors are important to women if they are to have a positive experience of childbirth and how these priorities change over time.