Does model of care affect women's health and wellbeing in the perinatal period in Sweden?
Self-rated health before, during and after pregnancy is important for women's quality of life and promotes bonding between mother and child. However, diverse aspects of care models influence women's experiences during pregnancy. This study aimed to investigate low-risk women's self-rated health during the perinatal period in relation to different models of care in Sweden.
A retrospective study was conducted of computerised obstetric data from 167 523 women with low-risk pregnancies during 2010–2015. Descriptive analysis was used, as well as group comparisons and ordinal regression analysis, to establish links between self-rated health before, during and after pregnancy and sociodemographic characteristics.
The majority of women, regardless of model of care, rated their health as very good or good before, during and after pregnancy. During pregnancy, primiparous women, those who attended <7 midwife visits and those followed up by a private centre were more likely to rate their health as good. Women who had more than four midwives, were under the age of 30 years or foreign-born had increased risk of rating their health as bad. Postnatally, women who used private care, primiparous women and those aged 25–29 years were at lower risk of rating their health as bad.
Women attending private healthcare services tended to rate their health as better. Vulnerable groups of women need special attention from healthcare authorities.
Diverse aspects of care models have been shown to influence women's perception of pregnancy. One such model is the ‘continuity of care’ model, which is used in Sweden (Waldenström, 1998) and elsewhere around the world, including in the UK (Jenkins et al, 2014). In the Swedish context, the goal in providing continuity of maternal healthcare is to allow the same midwife to follow up with a pregnant woman during both the antenatal period and the postpartum visit.
Leahy-Warren et al (2021) reported that most women in the UK felt that they did not have a choice in the model or location of their maternity care, but felt they were involved enough in decision making, especially during birth. In Ireland, women who are able to access private maternity care have reported higher levels of choice and control than those who attend public maternity care, which has been shown to be the most influential factor in almost all choice and control measures (Leahy-Warren et al, 2021).
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