Measuring Constructed Preferences: Towards a Building Code

Abstract

Aim. To examine women’s experiences of care in labour and identify the issues most important to them. Background. Ireland has the highest birth rate in the EU. This is predicted to continue to rise over the coming years. This will increase the demand for maternity care within existing or diminishing resources. In light of these pressures, maternity care providers are keen to ensure services meet the needs and expectations of women. Method. The study design was exploratory and descriptive, using a routine hospital evaluation survey with a convenience sample of pregnant women, who received care in labour at a large maternity hospital in Dublin over a three-month period. Women, on transfer from the delivery ward between one to two hours post-delivery, were asked to complete a short questionnaire about what they thought was good about the labour and the care they received; what aspect of their care could have been improved; and how they could have been better prepared for labour. Data were entered into NVivo 9.0 for content analysis. The collection and analysis of this data was pre-approved by the hospital ethics committee. Findings. Of the 1654 women approached, 360 women returned completed questionnaires, providing a response rate of 21.7%. Almost half of the 360 women who participated were primiparous. Just over half of participants (53%, n=191) reported they were happy with their experience or referred to positive experiences. A number of factors were identified that contributed to a positive experience for women. These were based on a trusting and supportive relationship between the woman and her caregiver, in particular, her midwife. A total of 32 women (8.8%) identified issues related to their expectations for labour, including pain relief and the care environment. Women with positive experiences made reference to staff being helpful and caring; good-quality and timely care; adequate pain relief; accurate information on what to expect in labour; good guidance and support in labour; and women feeling they could trust the caregiver to provide safe care. Women referred frequently to the relationship they had with the midwife providing their care and the skills and attributes of midwives. Conclusions. Women’s perceptions of care are strongly influenced by their expectations, which in turn are mediated by previous experiences, their preparation for labour, and the support that they receive from their caregiver in labour. Midwives were seen to have a vital role in supporting and guiding women through labour. Also, the importance of education during the antenatal period, to enable women to prepare adequately for labour and participate effectively in decision-making, was highlighted.