Effectiveness of a Counseling Intervention after a Traumatic Childbirth: A Randomized Controlled Trial

Abstract: Adverse childbirth experiences can evoke fear and overwhelming anxiety for some women and precipitate posttraumatic stress disorder. The objective of this study was to assess a midwife‐led brief counseling intervention for postpartum women at risk of developing psychological trauma symptoms. Method : Of 348 women screened for trauma symptoms, 103 met inclusion criteria and were randomized into an intervention (n = 50) or a control (n = 53) group. The intervention group received face‐to‐face counseling within 72 hours of birth and again via telephone at 4 to 6 weeks postpartum. Main outcome measures were posttraumatic stress symptoms, depression, self‐blame, and confidence about a future pregnancy. Results : At 3‐month follow‐up, intervention group women reported decreased trauma symptoms, low relative risk of depression, low relative risk of stress, and low feelings of self‐blame. Confidence about a future pregnancy was higher for these women than for control group women. Three intervention group women compared with 9 control group women met the diagnostic criteria for posttraumatic stress disorder at 3 months postpartum, but this result was not statistically significant. Discussion : A high prevalence of postpartum depression and trauma symptoms occurred after childbirth. Although most women improved over time, the intervention markedly affected participants’ trajectory toward recovery compared with women who did not receive counseling. Conclusions : A brief, midwife‐led counseling intervention for women who report a distressing birth experience was effective in reducing symptoms of trauma, depression, stress, and feelings of self‐blame. The intervention is within the scope of midwifery practice, caused no harm to participants, was perceived as helpful, and enhanced women's confidence about a future pregnancy.     

An Innovative Nursing Approach to Caring for an Obstetric Patient With Rape Trauma Syndrome

Rape trauma syndrome (RTS) is a posttraumatic stress disorder that can be triggered by routine procedures experienced during childbirth. An explanation of the signs and symptoms of RTS is provided, including how to avoid retraumatization during intrapartum care. A case report is presented from a provider perspective to illustrate the seriousness of this disorder and the importance of delivering respectful care. A new approach to obstetric routines is warranted to avoid further traumatizing the woman with RTS.     

A Quasi‐experimental Outcomes Analysis of a Psychoeducation Intervention for Pregnant Women with Abuse‐related Posttraumatic Stress

ObjectiveTo test the effectiveness of a trauma‐specific, psychoeducational intervention for pregnant women with a history of childhood maltreatment on six intrapartum and postpartum psychological outcomes.DesignQuasi‐experimental study comparing women from a single‐group, pretest–posttest pilot intervention study with women matched from a prospective observational study.SettingRural and university‐based prenatal clinics.ParticipantsPregnant women entered the study by responding to an advertisement or by referral from a maternity care provider. Women could take part whether or not they met posttraumatic stress disorder diagnostic criteria. Outcomes data exist for 17 pilot intervention study participants and 43 matched observational study participants.InterventionsParticipants in the observational study received usual care. Participants in the pilot intervention study received usual care plus the intervention, a fully manualized, self‐study program supported by weekly phone tutoring sessions with a health professional.Main Outcome MeasuresThe National Women's Study PTSD Module, the Peritraumatic Dissociation Experience Questionnaire, the Perception of Care Questionnaire, the Postpartum Depression Screening Scale, the Postpartum Bonding Questionnaire, and a semantic differential appraisal of the labor experience.ResultsParticipants in the intervention study had better scores on all measures. Differences in means between participants in the intervention study and participants in the observational study equated to medium effect sized for dissociation during labor, rating of labor experience, and perception of care in labor and small effect sizes for postpartum posttraumatic stress disorder (PTSD) symptoms, postpartum depression symptoms, and motherinfant bonding.ConclusionThis trauma‐specific intervention reaches and benefits pregnant women with a history of childhood maltreatment.     

Birth setting,labour experience,and postpartum psychological distress

Objectivealthough psychosocial risk factors have been identified for postpartum depression (PPD) and perinatal posttraumatic stress disorder (PTSD), the role of labour- and birth-related factors remains unclear. The present investigation explored the impact of birth setting, subjective childbirth experience, and their interplay, on PPD and postpartum PTSD.Methodin this prospective longitudinal cohort study, three groups of women who had vaginal births at a tertiary care hospital, a birthing center, and those transferred from the birthing centre to the tertiary care hospital were compared. Participants were followed twice during pregnancy (12–14 and 32–34 weeks gestation) and twice after childbirth (1–3 and 7–9 weeks postpartum).Resultssymptoms of PPD and PTSD did not significantly differ between birth groups; however, measures of subjective childbirth experience and obstetric factors did. Moderation analyses indicated a significant interaction between pain and birth group, such that higher ratings of pain among women who were transferred was associated with greater symptoms of postpartum PTSD.Conclusion and implications for practicewomen who are transferred appear to have a unique experience that may put them at greater risk for postpartum psychological distress. It may be beneficial for care providers to help prepare women for pain management and potential unexpected complications, particularly if it is their first childbirth.     

Prevalence and Predictors of Women's Experience of Psychological Trauma During Childbirth

ABSTRACT: Background: The increased acceptance of the prevalence of trauma in human experience as well as its psychological consequences has led to revisions of diagnostic criteria for the disorder. The three purposes of this study were to examine the rates at which women experienced psychological trauma in childbirth, to explore possible causal factors, and to examine possible factors in the development of the disorder. Methods: One hundred and three women from childbirth education classes in the Atlanta metropolitan area completed a survey in late pregnancy and a follow‐up interview approximately 4 weeks after the birth. Results: The childbirth experience was reported as traumatic by 34 percent of participants. Two women (1.9%) developed all the symptoms needed to diagnose posttraumatic stress disorder, and 31 women (30.1%) were partially symptomatic. Regression analysis showed that antecedent factors (e.g., history of sexual trauma and social support) and event characteristics (e.g., pain in first stage of labor, feelings of powerlessness, expectations, medical intervention, and interaction with medical personnel) were significant predictors of perceptions of the childbirth as traumatic. The pain experienced during the birth, levels of social support, self‐efficacy, internal locus of control, trait anxiety, and coping were significant predictors of the development of posttraumatic stress disorder symptoms after the birth. Conclusions: These findings suggest several intervention points for health care practitioners, including careful prenatal screening of past trauma history, social support, and expectations about the birth; improved communication and pain management during the birth; and opportunities to discuss the birth postpartum. (BIRTH 30:1 March 2003)     

Thoughts and Emotions During Traumatic Birth: A Qualitative Study

ABSTRACT: Background: Previous research shows that 1 to 6 percent of women will develop symptoms of posttraumatic stress disorder after childbirth. The objective of this study was to examine thoughts and emotions during birth, cognitive processing after birth, and memories of birth that might be important in the development of postnatal posttraumatic stress symptoms. Methods: In a qualitative study, women with posttraumatic stress symptoms (n= 25) and without (n = 25) were matched for obstetric events to examine the nonmedical aspects of birth that made it traumatic. Women were interviewed 3 months after birth. Results: The following themes emerged for all women: thoughts during birth included mental coping strategies, wanting labor to end, poor understanding of what was going on, and mental defeat. More negative than positive emotions were described during birth, primarily feeling scared, frightened, and upset. Postnatal cognitive processing included retrospective appraisal of birth, such as taking a fatalistic view and focusing on the present, for example, concentrating on the baby. Memories of birth included not remembering parts of the birth and forgetting how bad it was. Women with posttraumatic stress symptoms reported more panic, anger, thoughts of death, mental defeat, and dissociation during birth; after birth, they reported fewer strategies that focused on the present, more painful memories, intrusive memories, and rumination, than women without symptoms. Conclusions: The results provide a useful first step toward identifying aspects of birth and postnatal processing that might determine whether women develop postnatal posttraumatic stress symptoms. Further research is needed to broaden knowledge of posttraumatic stress disorder before drawing definite conclusions (BIRTH 34:3 September 2007)     

Do Women Get Posttraumatic Stress Disorder as a Result of Childbirth? A Prospective Study of Incidence

Background: Recent research suggests that a proportion of women may develop posttraumatic stress disorder after birth. Research has not yet addressed the possibility that postpartum symptoms could be a continuation of the disorder in pregnancy. This study aimed to test the idea that some women develop posttraumatic stress disorder as a result of childbirth, and to provide an estimate of the incidence using a prospective design, which controls for the disorder in pregnancy. Method: This prospective study assessed 289 women at three time points: 36 weeks gestation and 6 weeks and 6 months postpartum. The prevalence of posttraumatic stress disorder was assessed by questionnaire at each time point, and the incidence was examined after removing women who had severe symptoms of posttraumatic stress disorder or clinical depression in pregnancy. Results: After removing women at the first time point, 2.8 percent of women fulfilled criteria for the disorder at 6 weeks postpartum and this decreased to 1.5 percent at 6 months postpartum. Conclusions: The results suggest that at least 1.5 percent of women may develop chronic posttraumatic stress disorder as a result of childbirth. It is important to increase awareness about the disorder and to give health professionals access to simple screening tools. Intervention is possible at several levels, but further research is needed to guide this intervention.     

Childhood Abuse History,Posttraumatic Stress Disorder,Postpartum Mental Health,and Bonding: A Prospective Cohort Study

Introduction: Research is needed that prospectively characterizes the intergenerational pattern of effects of childhood maltreatment and lifetime posttraumatic stress disorder (PTSD) on women's mental health in pregnancy and on postpartum mental health and bonding outcomes. This prospective study included 566 nulliparous women in 3 cohorts: PTSD‐positive, trauma‐exposed resilient, and not exposed to trauma. Methods: Trauma history, PTSD diagnosis, and depression diagnosis were ascertained using standardized telephone interviews with women who were pregnant at less than 28 gestational weeks. A 6‐week‐postpartum interview reassessed interim trauma, labor experience, PTSD, depression, and bonding outcomes. Results: Regression modeling indicates that posttraumatic stress in pregnancy, alone, or comorbid with depression is associated with postpartum depression (R²= .204; P < .001). Postpartum depression alone or comorbid with posttraumatic stress was associated with impaired bonding (R²= .195; P < .001). In both models, higher quality of life ratings in pregnancy were associated with better outcomes, while reported dissociation in labor was a risk for worse outcomes. The effect of a history of childhood maltreatment on both postpartum mental health and bonding outcomes was mediated by preexisting mental health status. Discussion: Pregnancy represents an opportune time to interrupt the pattern of intergenerational transmission of abuse and psychiatric vulnerability. Further dyadic research is warranted beyond 6 weeks postpartum. Trauma‐informed interventions for women who enter care with abuse‐related PTSD or depression should be developed and tested.     

Cesarean Section and Postnatal Sexual Health

ABSTRACT: Background: Cesarean delivery avoids perineal trauma and has therefore often been assumed to protect sexual function after childbirth. We sought to examine this assumption by using data from a study of women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births. Methods: A cross‐sectional study was conducted of 796 primiparous women, employing data from obstetric records and a postal survey 6 months after delivery. Results: Any protective effect of cesarean section on sexual function was limited to the early postnatal period (0–3 months), primarily to dyspareunia‐related symptoms. At 6 months the differences in dyspareunia‐related symptoms, sexual response‐related symptoms, and postcoital problems were much reduced or reversed, and none reached statistical significance. Conclusions: Outcomes from this study provide no basis for advocating cesarean section as a way to protect women's sexual function after childbirth. (BIRTH 32:4 December 2005)     

Why Do Some Women Change Their Opinion About Childbirth Over Time?

Abstract: Background : The current investigation is a follow‐up of a study on women's memory of childbirth, which showed that 60 percent made the same assessment of their overall birth experience at 1 year after delivery as they did at 2 months postpartum, and 24 percent had became more negative and 16 percent more positive. The study purpose was to gain some understanding of what factors make some women change their assessment over time. Methods : Data from a longitudinal cohort study of 2,428 women who completed questionnaires in early pregnancy, at 2 months, and at 1 year after birth were analyzed. Two subsamples were studied: 1,451 women who said childbirth was a positive experience at 2 months and 151 who said it was a negative experience. Comparisons were made, within each sample, between those who made the same assessment at 1 year and those who had changed their view, with respect to psychosocial background, labor outcomes, infant health outcomes during first year, and experiences of intrapartum care. Results : Changing the assessment from positive to less positive, mostly to “mixed feelings,” was associated with difficult childbirth, such as painful labor and cesarean section; dissatisfaction with intrapartum care; and psychosocial problems, such as single status, depressive symptoms, and worry about the birth in early pregnancy. Changing the assessment from negative to less negative was associated with less worry about the birth in early pregnancy and a more positive experience of support by the birth‐attending midwife. Conclusions : This study supported the view that measures of satisfaction with childbirth soon after delivery may be colored by relief that labor is over and the happy birth of a baby. More negative aspects may take longer to integrate. Supportive care may have long‐term effects and may protect some women from a long‐lasting negative experience.     

Women's Satisfaction with Birth Center Care: A Randomized,Controlled Study

This randomized, controlled trial compared women's satisfaction with care at an in-hospital birth center with standard obstetric care in Stockholm. Subjects were 1230 women with an expected date of birth between October 1989 and February 1992, who expressed interest in birth center care, and who were medically low risk. The intervention was the random allocation of maternity care at the birth center or standard obstetric care. Birth center women expressed greater satisfaction with antenatal, intrapartum, and postpartum care, especially psychological aspects of care. Of these women, 63 percent thought that the antenatal care had raised their self-esteem, versus 18 percent of the control group. Eighty-nine percent of the experimental group would prefer birth center care for any future birth, and 46 percent of the control group would prefer standard care. Birth center care successfully meets the needs of women who are interested in natural childbirth and active involvement in their own care, and are concerned about the psychological aspects of birth.     

Pregnant Women's Perceptions of Their Nurse's Role During Labor and Delivery

Background: Little has been studied about pregnant women's perceptions of their nurse's role during labor and delivery. The objective of this study was to determine nulliparous pregnant women's expectations of their nurse's role during labor and delivery as expressed during the last trimester of pregnancy. Method: Nulliparous women in childbirth classes were asked on a questionnaire, “What do you think your nurse's role will be during labor and delivery? You may list as many things as you wish.” Results: Fifty‐seven completed surveys were collected. The women listed a total of 174 items. Approximately 29 percent of the nursing tasks listed by the nulliparous women were related to providing them with physical comfort and emotional support, 24 percent related to providing informational support, almost 21 percent were related to providing technical nursing care, and 21 percent related to monitoring of the baby, mother, or labor progress; approximately 5 percent related to indirect care (outside the room). Conclusion: The expectations of women in our study were in contrast with findings from two previous work sampling studies, in which nurses provided much less time giving women physical comfort, emotional support, and informational support than would have been expected by women in our study. Fulfilling women's expectations about childbirth can increase women's satisfaction with their birth experiences. Further studies can help maternity caregivers learn more about women's expectations.     

The Patient Observer: Eye-Movement Desensitization and Reprocessing for the Treatment of Posttraumatic Stress following Childbirth

Abstract: Background: No standard intervention with proved effectiveness is available for women with posttraumatic stress following childbirth because of insufficient research. The objective of this paper was to evaluate the possibility of using eye-movement desensitization and reprocessing treatment for women with symptoms of posttraumatic stress disorder following childbirth. The treatment is internationally recognized as one of the interventions of choice for the condition, but little is known about its effects in women who experienced the delivery as traumatic. Methods: Three women suffering from posttraumatic stress symptoms following the birth of their first child were treated with eye-movement desensitization and reprocessing during their next pregnancy. Patient A developed posttraumatic stress symptoms following the lengthy labor of her first child that ended in an emergency cesarean section after unsuccessful vacuum extraction. Patient B suffered a second degree vaginal rupture, resulting in pain and inability to engage in sexual intercourse for years. Patient C developed severe preeclampsia postpartum requiring intravenous treatment. Results: Patients received eye-movement desensitization and reprocessing treatment during their second pregnancy, using the standard protocol. The treatment resulted in fewer posttraumatic stress symptoms and more confidence about their pregnancy and upcoming delivery compared with before the treatment. Despite delivery complications in Patient A (secondary cesarean section due to insufficient engaging of the fetal head); Patient B (second degree vaginal rupture, this time without subsequent dyspareunia); and Patient C (postpartum hemorrhage, postpartum hypertension requiring intravenous treatment), all three women looked back positively at the second delivery experience. Conclusions: Treatment with eye-movement desensitization and reprocessing reduced posttraumatic stress symptoms in these three women. They were all sufficiently confident to attempt vaginal birth rather than demanding an elective cesarean section. We advocate a large-scale, randomized controlled trial involving women with postpartum posttraumatic stress disorder to evaluate the effect of eye-movement desensitization and reprocessing in this patient group. (BIRTH 39:1 March 2012)     

Prevalence and risk factors of childbirth-related post-traumatic stress symptoms

Background

There is evidence that traumatic birth experiences are associated with psychological impairments. This study aimed to estimate the prevalence of childbirth-related post-traumatic stress symptoms and its obstetric and perinatal risk factors among a sample of Iranian women.

Methods

This was a cross-sectional study carried out in Bushehr, Iran during a 3-months period from July to September 2009. Data were collected from all women attending eleven healthcare centers for postnatal care 6 to 8 weeks after childbirth. Those who had a traumatic delivery were identified and entered into the study. In order to assess childbirth-related post-traumatic stress, the Post-traumatic Symptom Scale-Interview (PSS-I) was administered. Data on demographic, obstetric and perinatal characteristics also were collected. Multivariate logistic regression was performed to examine the association between childbirth-related post-traumatic stress and demographic and obstetric and perinatal variables.

Results

In all, 400 women were initially evaluated. Of these, 218 women (54.5%) had a traumatic delivery and overall, 80 women (20%) were found to be suffering from post-partum post-traumatic stress disorder (PTSD). Multiple logistic regression analysis revealed that post-partum PTSD was associated with educational level, gestational age at delivery, number of prenatal care visits, pregnancy complications, pregnancy intervals, labor duration, and mode of delivery.

Conclusions

The findings indicated that the prevalence of traumatic birth experiences and post-partum PTSD were relatively high among Iranian women. The findings also indicated that obstetric and perinatal variables were independently the most significant contributing factors to women’s post-partum PTSD. It seems that a better perinatal care and supportive childbirth might help to reduce the burden of post-partum PTSD among this population.     

Labour experience and postpartum stress and depression: a quantitative and qualitative examination

Objectives: The purpose of this study was to examine the relationship between qualitatively and quantitatively assessed birth experiences and rates of post-birth distress and depressive symptoms three to four weeks postpartum. Both the rates of post-birth distress and depressive symptoms represented risk factors for subsequent mental health problems in the later postpartum period. Background: Childbirth is accompanied by various stress factors. However, little is known about the relationship between stressors occurring during birth (intrapartum) and the ways women cope with them and women’s development of depressive symptoms or acute stress reactions postpartum. Methods: One hundred and twenty-seven women from two longitudinal studies were interviewed 48–96 h after childbirth. Thirty birth interviews from both samples were additionally examined for qualitative themes related to women’s reported experience in connection with mental health adaptation (i.e. without symptoms (n = 10), symptoms of depression (n = 10) and acute stress reactions (n = 10)) at three to four weeks postpartum. Results: Women with depressive symptoms reported less intimate and helpful contact with their partners and baby during labour compared with women without symptoms or with acute stress reactions. Women with acute stress reactions had less confidence in themselves, and reported disorientation during the birth process, compared with women without symptoms or with depressive symptoms. Conclusions: Recognition of how women cope with intrapartum factors during labour could help to identify psychological distress shortly after delivery, and inform the introduction of timely and appropriate psychological support for affected women.     

Posttraumatic Stress Disorder in New Mothers: Results from a Two‐Stage U.S. National Survey

Abstract: Background: Prevalence rates of women in community samples who screened positive for meeting the DSM‐IV criteria for posttraumatic stress disorder after childbirth range from 1.7 to 9 percent. A positive screen indicates a high likelihood of this postpartum anxiety disorder. The objective of this analysis was to examine the results that focus on the posttraumatic stress disorder data obtained from a two‐stage United States national survey conducted by Childbirth Connection: Listening to Mothers II (LTM II) and Listening to Mothers II Postpartum Survey (LTM II/PP). Methods: In the LTM II study, 1,373 women completed the survey online, and 200 mothers were interviewed by telephone. The same mothers were recontacted and asked to complete a second questionnaire 6 months later and of those, 859 women completed the online survey and 44 a telephone interview. Data obtained from three instruments are reported in this article: Posttraumatic Stress Disorder Symptom Scale‐Self Report (PSS‐SR), Postpartum Depression Screening Scale (PDSS), and the Patient Health Questionnaire‐2 (PHQ‐2). Results: Nine percent of the sample screened positive for meeting the diagnostic criteria of posttraumatic stress disorder after childbirth as determined by responses on the PSS‐SR. A total of 18 percent of women scored above the cutoff score on the PSS‐SR, which indicated that they were experiencing elevated levels of posttraumatic stress symptoms. The following variables were significantly related to elevated posttraumatic stress symptoms levels: low partner support, elevated postpartum depressive symptoms, more physical problems since birth, and less health‐promoting behaviors. In addition, eight variables significantly differentiated women who had elevated posttraumatic stress symptom levels from those who did not: no private health insurance, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean birth, not breastfeeding as long as wanted, not exclusively breastfeeding at 1 month, and consulting with a clinician about mental well‐being since birth. A stepwise multiple regression revealed that two predictor variables significantly explained 55 percent of the variance in posttraumatic stress symptom scores: depressive symptom scores on the PHQ‐2 and total number of physical symptoms women were experiencing at the time they completed the LTM II/PP survey. Conclusion: In this two‐stage national survey the high percentage of mothers who screened positive for meeting all the DSM‐IV criteria for a posttraumatic stress disorder diagnosis is a sobering statistic. (BIRTH 38:3 September 2011)     

Maternal adjustment five months after birth: the impact of the subjective experience of childbirth and emotional support from the partner

: Recent research suggests that negative childbirth experiences may cause maternal maladjustment. The impact of intranatal emotional distress, intranatal physical discomfort and postnatal emotional evaluation of birth on symptoms of posttraumatic stress and depression is investigated with regard to the moderating role of emotional support from the partner.

Subjective childbirth experience measured with the German version of the Salmons Item List, obstetric characteristics and postnatal emotional support from the partner were assessed in 374 women six weeks after childbirth. Trauma symptoms and postnatal depression were measured five months after childbirth.

Postnatal emotional partner support acts as a moderator of the effect of the subjective childbirth experience on the development of symptoms of avoidance, intrusive thoughts and depression. The direct influence of emotional partner support is stronger regarding symptoms of depression and hyperarousal than regarding avoidance and intrusive thoughts. No direct association between intranatal physical discomfort/labour pain and later maternal adjustment could be found.

Women with a negative childbirth experience and poor emotional support from their partner are at increased risk for psychological maladjustment in the first five months after birth.     

Women's decision-making autonomy in Dutch maternity care

Background

A positive childbirth experience is an important outcome of maternity care. A significant component of a positive birth experience is the ability to exercise autonomy in decision-making. In this study, we explore women's reports of their autonomy during conversations about their care with maternity care practitioners during pregnancy and childbirth.

Method

Data were obtained from a cross-sectional survey of women living in The Netherlands that asked about their experiences during pregnancy and childbirth, including their role in conversations concerning decisions about their care.

Results

A total of 3494 women were included in this study. Most women scored high on autonomy in decision-making conversations. During the latter stage of pregnancy (32+ weeks) and in childbirth, women reported significantly lower levels of autonomy in their care conversations with obstetricians as compared with midwives. Linear regression analyses showed that women's perception of personal treatment increased women's reported autonomy in their conversations with both midwives and obstetricians. Almost half (49.1%) of the women who had at least one intervention during birth reported pressure to accept or submit to that intervention. This was indicated by 48.3% of women with induced labor, 47.3% who had an instrumental vaginal birth, 45.2% whose labor was augmented, and 41.9% of women who had a cesarean birth.

Conclusions

In general, women's sense of autonomy in decision-making conversations during prenatal care and birth is high, but there is room for improvement, and this appeared most notably in conversations with obstetricians. Women's sense of autonomy can be enhanced with personal treatment, including shared decision-making and the avoidance of pressuring women to accept interventions.     

Does Team Midwife Care Increase Satisfaction with Antenatal,Intrapartum, and Postpartum Care? A Randomized Controlled Trial

Background: Although policymakers have suggested that improving continuity of midwifery can increase women's satisfaction with care in childbirth, evidence based on randomized controlled trials is lacking. New models of care, such as birth centers and team midwife care, try to increase the continuity of care and caregiver. The objective of this study was to evaluate the effect of a new team midwife care program in the standard clinic and hospital environment on satisfaction with antenatal, intrapartum, and postpartum care in low‐risk women in early pregnancy. Methods: Women at Royal Women's Hospital in Melbourne, Australia, were randomly allocated to team midwife care (n = 495) or standard care (n = 505) at booking in early pregnancy. Doctors attended most women in standard care, and continuity of the caregiver was lacking. Satisfaction was measured by means of a postal questionnaire 2 months after the birth. Results: Team midwife care was associated with increased satisfaction, and the differences between the groups were most noticeable for antenatal care, less noticeable for intrapartum care, and least noticeable for postpartum care. The study found no differences between team midwife care and standard care in medical interventions or in women's emotional well‐being 2 months after the birth. Conclusion: Conclusions about which components of team midwife care were most important to increased satisfaction with antenatal care were difficult to draw, but data suggest that satisfaction with intrapartum care was related to continuity of the caregiver.