Client-centred maternity care from women's perspectives: Need for responsiveness

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background
Client- or woman-centred care has become a major focus in improving Western maternity care systems. In measures to increase client-centredness, the perspectives of maternity care professionals and policymakers often predominate. However, to put women at the centre of maternity care, insights into their perspectives are important. Therefore, the aim of this study is to analyze the perspectives of women on maternity care and to provide recommendations on how to achieve client-centred care.
Methods
A qualitative study was conducted comprising six focus groups (N = 43) and 20 semi-structured interviews with women who had given birth less than one year ago in the North-West Netherlands region. For data analysis, a framework based on existing woman-centred care models and the patient-centred care model of Maassen et al. (2017) was applied.
Findings
The issues women addressed, underlined the importance of all four dimensions of the framework (client, interaction, professional and organization). Although women were in general positive about the maternity care services, there were differences regarding client-centredness between community-based primary care and secondary/tertiary hospital care. The latter was evaluated more negatively than primary care with regard to taking women's background into account, communicating openly, showing a caring attitude and providing continuous care by a cohesive team. Although primary care appeared to be better able than secondary/tertiairy care to adapt to clients’ preferences, the women described various cases throughout the care process where they did not feel heard. Besides a lack of flexibility to override existing protocols, activities and roles and tokenism regarding the use of satisfaction questionnaires and the birthplan were mentioned.
Conclusions and implications for practice
This study demonstrated that from women's perspective, client-centred maternity care means being responsive to their wishes and needs across all four (client, interaction, professional and organization) dimensions. Current measures often focus on the organizational dimension, integrating different divisions of care. To achieve client-centred care, future measures should foster responsiveness on all four dimensions. This entails empowering maternity care professionals to have a reflective interaction with (especially less educated) women, by acquiring conversational and reflexive skills, within a flexible care system adjusting to specific wishes and needs.
Original languageEnglish
Pages (from-to)76
Number of pages83
JournalMidwifery
Volume74
DOIs
Publication statusPublished - 25 Mar 2019

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Primary Health Care
Secondary Care
Patient-Centered Care
Tertiary Healthcare
Focus Groups
Tertiary Care Centers
Netherlands
Parturition
Interviews
Surveys and Questionnaires

Keywords

  • maternity care
  • women-centred care
  • patient perspectives
  • maternal health services
  • client-centred caer
  • responsiveness to needs

Cite this

@article{e5c500cd86af4e45b0cbf1a12086f31c,
title = "Client-centred maternity care from women's perspectives: Need for responsiveness",
abstract = "BackgroundClient- or woman-centred care has become a major focus in improving Western maternity care systems. In measures to increase client-centredness, the perspectives of maternity care professionals and policymakers often predominate. However, to put women at the centre of maternity care, insights into their perspectives are important. Therefore, the aim of this study is to analyze the perspectives of women on maternity care and to provide recommendations on how to achieve client-centred care.MethodsA qualitative study was conducted comprising six focus groups (N = 43) and 20 semi-structured interviews with women who had given birth less than one year ago in the North-West Netherlands region. For data analysis, a framework based on existing woman-centred care models and the patient-centred care model of Maassen et al. (2017) was applied.FindingsThe issues women addressed, underlined the importance of all four dimensions of the framework (client, interaction, professional and organization). Although women were in general positive about the maternity care services, there were differences regarding client-centredness between community-based primary care and secondary/tertiary hospital care. The latter was evaluated more negatively than primary care with regard to taking women's background into account, communicating openly, showing a caring attitude and providing continuous care by a cohesive team. Although primary care appeared to be better able than secondary/tertiairy care to adapt to clients’ preferences, the women described various cases throughout the care process where they did not feel heard. Besides a lack of flexibility to override existing protocols, activities and roles and tokenism regarding the use of satisfaction questionnaires and the birthplan were mentioned.Conclusions and implications for practiceThis study demonstrated that from women's perspective, client-centred maternity care means being responsive to their wishes and needs across all four (client, interaction, professional and organization) dimensions. Current measures often focus on the organizational dimension, integrating different divisions of care. To achieve client-centred care, future measures should foster responsiveness on all four dimensions. This entails empowering maternity care professionals to have a reflective interaction with (especially less educated) women, by acquiring conversational and reflexive skills, within a flexible care system adjusting to specific wishes and needs.",
keywords = "maternity care, women-centred care, patient perspectives, maternal health services, client-centred caer, responsiveness to needs",
author = "V. Petit and T.J. Schuitmaker-Warnaar and J.E.W. Broerse and S.R. Lips",
year = "2019",
month = "3",
day = "25",
doi = "10.1016/j.midw.2019.03.016",
language = "English",
volume = "74",
pages = "76",
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issn = "0266-6138",
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Client-centred maternity care from women's perspectives: Need for responsiveness. / Petit, V.; Schuitmaker-Warnaar, T.J.; Broerse, J.E.W.; Lips, S.R.

In: Midwifery, Vol. 74, 25.03.2019, p. 76.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Client-centred maternity care from women's perspectives: Need for responsiveness

AU - Petit, V.

AU - Schuitmaker-Warnaar, T.J.

AU - Broerse, J.E.W.

AU - Lips, S.R.

PY - 2019/3/25

Y1 - 2019/3/25

N2 - BackgroundClient- or woman-centred care has become a major focus in improving Western maternity care systems. In measures to increase client-centredness, the perspectives of maternity care professionals and policymakers often predominate. However, to put women at the centre of maternity care, insights into their perspectives are important. Therefore, the aim of this study is to analyze the perspectives of women on maternity care and to provide recommendations on how to achieve client-centred care.MethodsA qualitative study was conducted comprising six focus groups (N = 43) and 20 semi-structured interviews with women who had given birth less than one year ago in the North-West Netherlands region. For data analysis, a framework based on existing woman-centred care models and the patient-centred care model of Maassen et al. (2017) was applied.FindingsThe issues women addressed, underlined the importance of all four dimensions of the framework (client, interaction, professional and organization). Although women were in general positive about the maternity care services, there were differences regarding client-centredness between community-based primary care and secondary/tertiary hospital care. The latter was evaluated more negatively than primary care with regard to taking women's background into account, communicating openly, showing a caring attitude and providing continuous care by a cohesive team. Although primary care appeared to be better able than secondary/tertiairy care to adapt to clients’ preferences, the women described various cases throughout the care process where they did not feel heard. Besides a lack of flexibility to override existing protocols, activities and roles and tokenism regarding the use of satisfaction questionnaires and the birthplan were mentioned.Conclusions and implications for practiceThis study demonstrated that from women's perspective, client-centred maternity care means being responsive to their wishes and needs across all four (client, interaction, professional and organization) dimensions. Current measures often focus on the organizational dimension, integrating different divisions of care. To achieve client-centred care, future measures should foster responsiveness on all four dimensions. This entails empowering maternity care professionals to have a reflective interaction with (especially less educated) women, by acquiring conversational and reflexive skills, within a flexible care system adjusting to specific wishes and needs.

AB - BackgroundClient- or woman-centred care has become a major focus in improving Western maternity care systems. In measures to increase client-centredness, the perspectives of maternity care professionals and policymakers often predominate. However, to put women at the centre of maternity care, insights into their perspectives are important. Therefore, the aim of this study is to analyze the perspectives of women on maternity care and to provide recommendations on how to achieve client-centred care.MethodsA qualitative study was conducted comprising six focus groups (N = 43) and 20 semi-structured interviews with women who had given birth less than one year ago in the North-West Netherlands region. For data analysis, a framework based on existing woman-centred care models and the patient-centred care model of Maassen et al. (2017) was applied.FindingsThe issues women addressed, underlined the importance of all four dimensions of the framework (client, interaction, professional and organization). Although women were in general positive about the maternity care services, there were differences regarding client-centredness between community-based primary care and secondary/tertiary hospital care. The latter was evaluated more negatively than primary care with regard to taking women's background into account, communicating openly, showing a caring attitude and providing continuous care by a cohesive team. Although primary care appeared to be better able than secondary/tertiairy care to adapt to clients’ preferences, the women described various cases throughout the care process where they did not feel heard. Besides a lack of flexibility to override existing protocols, activities and roles and tokenism regarding the use of satisfaction questionnaires and the birthplan were mentioned.Conclusions and implications for practiceThis study demonstrated that from women's perspective, client-centred maternity care means being responsive to their wishes and needs across all four (client, interaction, professional and organization) dimensions. Current measures often focus on the organizational dimension, integrating different divisions of care. To achieve client-centred care, future measures should foster responsiveness on all four dimensions. This entails empowering maternity care professionals to have a reflective interaction with (especially less educated) women, by acquiring conversational and reflexive skills, within a flexible care system adjusting to specific wishes and needs.

KW - maternity care

KW - women-centred care

KW - patient perspectives

KW - maternal health services

KW - client-centred caer

KW - responsiveness to needs

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DO - 10.1016/j.midw.2019.03.016

M3 - Article

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