Women's needs and expectations in midwifery care - Results from the qualitative MiCa (midwifery care) study. Part 1: Preconception and pregnancy.

Midwifery services play an important role in healthcare provision, birth preparation and prevention. Knowledge on women's expectations, preferences and needs regarding midwifery care is crucial not only for clinical care during preconception and pregnancy and research, but also for educational purposes. This descriptive qualitative study aimed to investigate the expectations, preferences and the needs of women concerning midwifery care in Germany. Experienced researcher team conducted interviews with women who have the desire to get pregnant and online focus groups with women in early and late pregnancy. A purposeful recruitment strategy with maximum variation sampling was applied to reach diversity in the sample regarding age, previous children and socioeconomic background. A total of 26 women participated. In the qualitative content analysis according to Mayring, seven main categories were developed for both preconceptional phase and pregnancy: (a) care by midwife, (b) care by obstetrician, (c) involvement of family, (d) need for information, (e) physical aspects, (f) psychological aspects and (g) orientation in healthcare system. One additional category referenced (h) organisation and bureaucracy in pregnant women. Women appreciated the personalised experience provided by midwives leading to trust and empowerment. Women's experiences with midwifery care varied. They reported contradictory information they received about services and care options. They valued interprofessional cooperation, continuity of care, structured information and personalised counselling. Midwives play an important role in healthcare provision, birth preparation and prevention. In order to depict the care situation quantitatively, to personalise care and to optimise healthcare models, a tool to assess the quality of healthcare and to evaluate women's needs and benefits of midwifery care will be developed based on the findings of this study. From the public health perspective, deficits in the German healthcare system concerning insufficient intra-sectoral communication, time pressure and low remuneration should be resolved in further research steps and policy action.