BACKGROUND:
Continuity of midwifery models of care are producing excellent clinical outcomes. While consumer satisfaction is acknowledged as an important indicator of quality; there is no consistency in the way satisfaction is measured and captured.

OBJECTIVES:
To develop a valid, reliable standardised questionnaire for use in measuring maternal satisfaction within continuity models of midwifery care.

METHODS:
A sequential, mixed methods approach was used. A systematic integrative review of instruments used to measure maternal satisfaction, identified the need for an instrument focusing on continuity of midwifery care. A systematic review of qualitative studies with meta-synthesis was undertaken, to understand what women value in the continuity of midwifery care models. Next a Delphi technique with representation from midwifery, obstetrics and service users, was employed to develop a questionnaire focusing on maternal satisfaction, which was then validated using factor analysis. Ethical approval was sought and granted prior to the commencement of the research by the Ethics committees governing the clinical services involved in recruiting the participants.

RESULTS:
The ‘Continuity of Midwifery Care Satisfaction Survey’ (COMcareSS) was developed and found to be valid and reliable. Cronbach's alpha coefficient for the scale was 0.96 suggesting some redundancy in items. In factor analysis, only one factor could feasibly be attempted. This accounted for 76 % of variation in responses.

CONCLUSIONS:
Continuity of midwifery care is central to midwifery practice. This tool provides a means for services to seek robust feedback on the continuity of midwifery care models they offer.

KEY MESSAGE:
The development of a reliable and valid tool specifically designed to measure maternal satisfaction with midwifery continuity of care models, the COMcareSS, is a timely contribution both nationally and internationally. Continuity of care - outcomes 1