What determines quality in maternity care? Comparing the perceptions of childbearing women and midwives

BACKGROUND: In the current climate of consumer orientation in health care services, a clear need has emerged to understand the extent of consumer focus among primary health care professionals. Few studies have compared the beliefs of health care staff with those of patients. This study sought to identify and compare the perceptions of women and midwives concerning women's beliefs about what constitutes quality in maternity services. METHODS: Focus groups were conducted from July 1994 to June 1997 with 38 pregnant and postnatal women, and 47 midwives who were based in two large maternity units in Yorkshire, England. Transcriptions of data were analyzed to identify broad themes. RESULTS: Ten dimensions of quality were identified. Similarities between midwives and women included beliefs about the importance of the relationship between the two parties, desired attributes of staff, and the environment of care. Key differences included underestimating the importance of information antenatally and postnatally, the importance of continuity during labor, need for control and confidence in adjusting to the maternal role, and involvement of the woman's partner in the delivery of care. CONCLUSIONS: An understanding of the concerns of women by maternity care staff is important in the development of a woman-focused service, in line with current policy recommendations, and has implications for risk management and improving the service quality for those who provide and experience the service