84 Chapter 4 Data on women’s satisfaction, preferences and experiences are increasingly being considered as important parameters of good quality of care15-18 and such data are essential for achieving a client-centered, value-driven system.8 Evaluating women’s satisfaction and experiences can help to improve the implementation of aCTG monitoring in midwife-led care. Thus, the aim of this study was to determine the satisfaction of pregnant women who received an aCTG in primary midwife-led care. In addition, factors that influence a high level of satisfaction among pregnant women who have an aCTG in primary midwife-led care were investigated. METHODS Study Design We conducted a prospective study among women who received an aCTG in Dutch primary midwife-led care practices. The participants were given verbal and written information about the aim and procedures involved in the study and provided their written informed consent. Participation in the study was completely voluntary and women could withdraw their consent at any time during the study period (September 2016 – November 2020). Study Setting This study was embedded in a VBHC-based innovation project performed in three regions in the Netherlands (Zwolle, Nijmegen, and Amsterdam). Healthy pregnant women receiving care in midwife-led practices were offered an aCTG in midwife-led care, autonomously performed and assessed by a primary care midwife, for specific indications: reduced fetal movements, external cephalic version, or postdates pregnancy (41+0 – 41+6 weeks gestation). All three regions performed aCTGs for reduced fetal movements. For the indications “external cephalic version” and “postdates pregnancy”, an aCTG was only done by primary care midwives in the Nijmegen region. Pregnant women fulfilling the above criteria were offered an aCTG by their midwife, either at home, in the midwifery practice, in a community healthcare center nearby, or by a professional in obstetrician-led care in a hospital. We have described carrying out aCTGs in midwife-led care in detail elsewhere.12 Respondents and Data Collection Healthy women with a singleton pregnancy at between 28 and 42 gestational weeks who received an aCTG in primary care for one of the indications mentioned were invited to participate. During the study period, pregnant women from fifty midwifery
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