# Women’s Satisfaction with Midwifery-Led Continuity of Care: Insights from Antenatal, Intrapartum, and Postnatal Experiences in the Sidama Region, Ethiopia. A Non-Randomized Control Trial

## TL;DR

Midwifery-led continuity of care significantly improves women's satisfaction during pregnancy, childbirth, and postpartum in Ethiopia.

## Contribution

This study provides empirical evidence on the effectiveness of midwifery-led care in a low-income setting like Ethiopia.

## Key findings

- Midwifery-led care led to higher satisfaction scores compared to shared care across all care stages.
- The greatest satisfaction improvement was observed during postnatal care with an adjusted mean difference of 0.44.
- Women in midwifery-led care reported better continuity and support, suggesting a more personalized approach.

## Abstract

Evidence from high-income countries indicates that midwifery-led continuity of care improves maternal satisfaction and health outcomes throughout pregnancy and postpartum. In Ethiopia, low maternal satisfaction with care indicates systemic problems, including ineffective communication and substandard service quality. This study aimed to evaluate how midwifery-led continuity care impacts maternal satisfaction during antenatal, intrapartum, and postpartum care in the Sidama region’s general hospitals in Ethiopia.

A prospective non-randomized controlled trial was conducted from October 2023 to June 2024 in four general hospitals in the Sidama region of Ethiopia. A total of 478 low-risk women were allocated into two groups: midwifery-led continuity of care (n = 239 and shared care n = 239). Quantitative data were gathered through face-to-face interviews to evaluate maternal satisfaction, and average satisfaction scores between groups were analyzed using bootstrapping linear regression.

Women in the midwifery-led continuity of care reported significantly higher satisfaction with continuity of care compared to shared care, with an adjusted mean difference of 0.28 (95% CI 0.13-0.40; P < .001). Specifically, during antenatal care, the adjusted mean difference was 0.20 (95% CI 0.06-0.33; P < .003), intrapartum care was 0.31 (95% CI 0.17-0.45; P < .001), and postnatal care was 0.44 (95% CI 0.29-0.59; P < .001).

Women receiving midwifery-led continuity of care reported higher satisfaction levels, making this model a viable alternative for improving satisfaction in maternity services by offering a more personalized and supportive approach to care.