Antenatal cardiotocography in primary midwife-led care: Women's satisfaction

Elise M. Neppelenbroek, Anouk J. M. Ammerlaan, Olivier W. H. van der Heijden, Marit S. G. van der Pijl, Anouk Kaiser, Ank de Jonge, Corine J. M. Verhoeven

Research output: Contribution to journalArticleAcademicpeer-review

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Background: In the Netherlands, antenatal cardiotocography (aCTG), used to assess fetal well-being, is performed in obstetrician-led care. To improve continuity of care, an innovation project was designed wherein primary care midwives perform aCTGs for specific indications. The aim of this study was to examine the satisfaction and experiences of pregnant women who received an aCTG in primary midwife-led care and explore which factors were associated with high satisfaction. Methods: Data were collected through a self-administered questionnaire based on the Consumer Quality Index. The primary outcome was general satisfaction on a 10-point scale, with a score above nine indicating participants were “highly satisfied”. Results: In total, 1227 women were included in the analysis. The study showed a mean general satisfaction score of 9.2. Most women were highly satisfied with receiving an aCTG in primary midwife-led care (77.4%). On the Consumer Quality Index, the mean satisfaction level varied from 3.98 (SD ± 0.11) for the subscale “client satisfaction” to 3.87 (SD ± 0.32) for the subscale “information provision” on a 4-point scale. Women at between 33 and 36 weeks' gestation were more likely to be highly satisfied (adjusted OR [aOR] = 3.35). Compared with a completely comfortable position during the aCTG, a mostly comfortable or somewhat comfortable level had decreased odds of being associated with a ranking of highly satisfied (aOR 0.24 and 0.19, respectively). Conclusions: This study shows that pregnant women are satisfied with having an aCTG in midwife-led care. Providing aCTG in midwife-led care can increase access to continuity of care.
Original languageEnglish
Pages (from-to)798-807
Number of pages10
Issue number4
Early online date2023
Publication statusPublished - Dec 2023


  • antenatal cardiotocography
  • midwife-led care
  • satisfaction
  • value-based health care
  • women's experiences

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