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Background Maternal satisfaction with maternity care is an important indicator of quality maternity services. Continuity of midwifery models of care are increasing in Australia and while several instruments have been developed to measure satisfaction with maternity care most of these have not been validated and there are none that are appropriate to continuity of midwifery maternity care models. Aim To develop a questionnaire to measure women’s satisfaction with maternity services provided in a continuity of midwifery care service model. Methods A modified Delphi technique was used. A heterogenous panel of eight experts provided feedback over four rounds. The starting point for the questionnaire was informed by two systematic literature reviews focusing on available instruments for measuring maternal satisfaction with maternity care and what women value continuity of midwifery models of care. Findings The Continuity of Midwifery Care Satisfaction Survey (COMcareSS) was developed after four rounds of feedback with the expert panel. The survey comprises nine domains and fifty-nine questions. The domains include demographics, maternity care outcomes, facilities, the midwife/woman relationship, building capacity-empowerment, decision making and involvement, personalised care, advice care and support and general. Conclusions Consumer satisfaction is an important indicator of quality care. This is the first instrument to be developed that is appropriate to continuity of midwifery models of care. The important next step is to pilot test the instrument to establish its validity and reliability.

The birth plan was introduced in the 1980s to facilitate communication between maternity care providers and women and increase agency for childbearing women in the face of medicalised birth. Forty years on, the birth plan is a heterogeneous document with uncertainty surrounding its purpose, process, and impact. The aim of this review was to synthesise the evidence and improve understanding of the purpose, process and impact of the birth plan on childbearing women's experiences and outcomes.This systematic review followed the PRISMA guidelines. A comprehensive search strategy was designed and applied to electronic databases CINAHL, MEDLINE, PsychINFO, Cochrane Library, Scopus, and ClinicalTrials.gov. Articles were appraised using the Crowe Critical Appraisal Tool and a five-step integrative approach to analysis followed.Eleven articles were identified, all quantitative in nature. It is clear that the general purpose of birth plans is communication, with decision making a key factor. Even though the processes of birth planning were varied, having a birth plan was associated with generally positive birth outcomes.Despite the heterogeneity of birth plans, birth plans were associated with positive outcomes for childbearing women when developed in collaboration with care providers. The act of collaboratively creating a birth plan may improve obstetric outcomes, aid realistic expectations, and improve satisfaction and the sense of control.

This chapter presents midwifery as unique amongst the healthcare professions because it mostly focuses on physiological processes and a period of transition in the life of a woman and her family. Thus, midwives work across a childbearing continuum and the health-ease dis-ease continuum. The “midwifery model of care” and its approach to childbearing focuses on wellness rather than illness and works closely with women to help them mobilize their own resources to move towards greater health. But the contrasting pathogenic approach to maternity care is still ubiquitous in contemporary healthcare provision with over-medicalization of childbirth and overuse of interventions, which can also cause more harm than good.While there is resonance between midwifery practice and salutogenesis, research examining the relationship is still in its infancy. Few researchers explicitly draw on salutogenic theory. Of these, few studies and scoping reviews are described in more detail. They suggest that there is an alignment between salutogenesis and midwifery practice.The chapter concludes by stressing that salutogenesis, with its focus on health rather than pathology, offers a promising way forward to underline that much of midwifery work is health promotion and must be operationalized accordingly in midwifery practice.