[Adherence of Antenatal Consultations by Midwives - A Quantitative Content Analysis]

Worldwide the use of medical interventions in childbirth is increasing, which holds true in Germany as well. In response, different approaches are being developed to enhance normal childbirth. Also, in Germany there is now an expert care standard to promote physiological childbirth, which mandates antenatal consultation conducted by midwives. The extent to which antenatal consultation based on this standard has been implemented and the degree of adherence (as intended by the developers) remain unclear. The aim of this study is to investigate who makes use of antenatal consultations, the topics and content of consultation documents and adherence to the antenatal consultation requirement in 2 hospitals.

Criteria for analyzing consultation documents were derived based on the content of the care standard and using the Delphi method by 3 experts who had participated in developing the expert care standard. A content analysis of the documents (hospital 1: n=92; hospital 2: n=62) used in antenatal consultation based on criteria identified in the standard was conducted.

Six criteria ("worries and anxieties," "agreements," "suggested topics," "all topics," "traceability of birth plan" and "options of birth plan") for analyzing consultation documents were identified. Especially primiparae women (77.2%) avail themselves of antenatal consultation. The variety of topics covered in antenatal consultation is broad. The documents in hospital 2 show high adherence to the standard to promote normal childbirth. The documents of hospital 1 show moderate adherence.

The investigation of adherence helps to determine implementation success and to identify areas needing revision and their modification. Implementation processes require further research to explain the differences in adherence.