Women and healthcare providers’ perceptions of a midwife-led unit in a Swiss university hospital: a qualitative study

Abstract

BackgroundThe development of medical-led care in obstetrics over the past decades has contributed to improving outcomes for both mother and child. Although efficiency has improved in complex situations, unnecessary interventions are still practiced in low-risk pregnancies, contrary to international recommendations. A shift to a less interventionist model of care has encouraged many countries to review their policies on maternal health care and develop models such as the “midwife-led unit” (MLU) where the midwife plays a predominant role with a minimum of routine intervention. Existing research has provided convincing evidence that MLUs lead to better maternal and neonatal outcomes when compared to traditional models. They not only improve the level of satisfaction amongst women, but are also associated with reduced healthcare costs. This study aimed to explore the perceptions of women and healthcare providers regarding the creation of an MLU in a Swiss university hospital.MethodsA descriptive research study using qualitative methods was conducted among pregnant women and new mothers in a Swiss maternity unit, including also midwives and medical staff. Data collection was carried out through one-to-one interviews, focus groups, and telephone interviews (n = 63). After transcription, thematic analysis was performed.ResultsThe triangulation of perceptions of women and healthcare providers indicated support for the implementation of an MLU to promote physiological delivery. Most women welcomed the idea of an MLU, in particular how it could help in offering continuity of care. Healthcare providers were optimistic about the implementation of an MLU and recognised the need for some women to have access to a less interventionist approach. From the women’s perspective, barriers concerned the lack of awareness of midwives’ full scope of practice, while barriers for midwives and obstetricians were related to the challenge to develop a good interprofessional collaboration.ConclusionAlternative models to provide maternity care for low-risk women have been developed and evaluated widely in several countries outside Switzerland. This study showed that women and healthcare providers were favourable towards the development of a new care model, while taking into account the specific expectations and barriers raised by participants.

Satisfaction Level of New Mothers with Prenatal Care and the Healthcare Professionals Who Provide It

“…They wanted the midwives to listen to them and to treat them as individuals. According to these authors (24), most prenatal care activities were provided by the family doctor, followed by the obstetrician, and finally, the midwife. Nevertheless, in certain studies, the sample was composed of a majority of women with secondary school education (21).…”

“…The primary healthcare phase (ie with the family doctor, nurse-midwife and nurse) comprises six visits or consultations, which take place eight to nine, 16,24,28,36 and 38 weeks of the pregnancy. Their purpose is to monitor the weight and blood pressure of the pregnant women, since hypertension disorders during pregnancy are one of the four main causes of maternal mortality and perinatal morbidity (6).…”

Berufssituation der Hebammen in Einrichtungen mit und ohne hebammengeleitete Geburtshilfe in einem Schweizer Kanton

“…In hebammengeleiteten Betreuungsmodellen, in denen Hebammen eigenständig arbeiten und eine hohe Verantwortung tragen [2], können sie die erworbenen Kompetenzen einsetzen. In 2015 stellten Aubry et al [1] jedoch fest, dass die meisten Hebammen in der Schweiz in herkömmlichen Betreuungsmodellen beschäftigt sind, da die hebammengeleitete Geburtshilfe bisher nur vereinzelt eingeführt und von werdenden Müttern wenig genutzt wurde [1,18]. Eine Westschweizer Studie hingegen zeigte, dass sowohl Gesundheitsfachpersonen, als auch schwangere Frauen hebammengeleiteten Versorgungsmodellen offen gegenüber stehen [18].…”

“…In 2015 stellten Aubry et al [1] jedoch fest, dass die meisten Hebammen in der Schweiz in herkömmlichen Betreuungsmodellen beschäftigt sind, da die hebammengeleitete Geburtshilfe bisher nur vereinzelt eingeführt und von werdenden Müttern wenig genutzt wurde [1,18]. Eine Westschweizer Studie hingegen zeigte, dass sowohl Gesundheitsfachpersonen, als auch schwangere Frauen hebammengeleiteten Versorgungsmodellen offen gegenüber stehen [18]. In den letzten Jahren entwickelten sich diese Betreuungsmodelle in der Schweiz zu einem politisch aktuellen Thema [1,19].…”

Women, Midwives, and a Medical Model of Maternity Care in Switzerland

“…Proponents of private health care argue that the existence of such systems promotes choice. The reality, A recent study examining the views of women and midwives in relation to the establishment of a midwifery-led unit in Switzerland (Maillefer, de Labrusse, Cardia-Vonèche, Hohlfeld, & Stoll, 2015) also illustrates women's dependence on doctors and mistrust of midwives' competence. Women's reluctance to acknowledge midwives as lead professionals and preferring to stay with their gynecologist was recognized by the researchers as being a potential barrier to setting up a midwifery-led unit.…”