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

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.

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.

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.

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.