Strengths and weakness of midwifery care from the perspective of women.

Background: Since users of healthcare services can be regarded as experts by experience, their views and judgements on quality of care are of paramount importance to care-providers who seek to improve or evaluate their services. Aim: To explore client experiences of midwifery care, and to propose recommendations regarding the development of quality assessment and improvement programmes. Method: As part of a larger study to monitor midwifery care in the Netherlands, women's views on the care they received were explored and described. Data were obtained from 358 women visiting a representative sample of 57 midwifery practices in the Netherlands. They completed a written questionnaire approximately six weeks after the birth of their baby. This questionnaire addressed various aspects of prenatal, perinatal and postpartum periods and contained two open-ended questions. The responses to the open-ended questions were analysed by clustering coherent responses into quality of care themes derived from previous research into this area. Results: Courtesy and professional competence in midwifery care were most valued by women. Especially appreciated were a personal approach, especially during birth, a midwifery practice that is easily accessible by telephone and having enough time during appointments. Most weaknesses were found in the dimensions of organisation, policy and information. With respect to improving the quality of care from the perspective of pregnant women, clients reported that midwives should focus on continuity of care, a thorough evaluation of care and reducing the time women spend in the waiting room. Conclusion: The strengths and weaknesses of midwifery care identified in this study, as perceived by the women who use maternity services, could contribute to the improvement of client satisfaction and to the ability of midwives to provide client-centred care. (aut. ref.