Evaluation of one-to-one midwifery: women's responses to care.

Background: One-to-one midwifery was a demonstration project introduced into a London-based maternity service in 1993 to put into practice the new government policy for maternity services in England. Evaluation was integral to the development of the project.

Methods: The evaluation of women's responses was conducted between August 1994 and August 1995 based on a longitudinal, self-completion questionnaire, interviews, and focus groups.

The use of clinical audit in evaluating maternity services reform: a critical reflection.

The clinical evaluation described here, using a casenote study, was part of a larger study evaluating the changes made to part of the maternity services in one NHS Trust, in response to the recommendations of Changing Childbirth (Department of Health 1993a). Results of the audit showed no evidence of a lowering of clinical standards within the study group and provided reassurance that a radical change in the model of care, with greatly enhanced continuity of career, an emphasis on community-based and midwifery-led care, and some reductions in labour interventions, could be implemented without compromising safety of care. The audit process raised a number of methodological problems which will need to be addressed in developing audit approaches which are able to reflect quality of care.

Recent developments in HMO malpractice liability: Chase v. Independent Practice Association.

The court's decision in Chase demonstrates that an HMO or independent practice association need not incur liability for the negligence of a physician if the arrangement between the entity and the physicians who provide services on its behalf is properly structured and maintained. IPA's successful defense of this lawsuit was based upon: (1) careful structuring of an independent relationship with the medical group, including appropriate wording in the contract establishing the relationship; and (2) careful maintenance of the relationship consistent with the terms of the contract to avoid giving patients any reason to believe that an agency relationship existed.

Legalization of midwifery and the issue of home births.

The issue of legalization of midwifery is distinct from that of sanctioning of home births. Ontario should seriously consider establishing midwifery as an independent profession for nondomiciliary care. I hope that such a decision would not be considered in isolation from the rest of the health care system.