title: Women and healthcare providers' perceptions of a midwife-led unit in a Swiss university hospital: a qualitative study.
abstract: BACKGROUND
  The development of medical-led care in obstetrics over the past decades has contributed to improving outcomes for both mother and child. Although efficiency has improved in complex situations, unnecessary interventions are still practiced in low-risk pregnancies, contrary to international recommendations. A shift to a less interventionist model of care has encouraged many countries to review their policies on maternal health care and develop models such as the "midwife-led unit" (MLU) where the midwife plays a predominant role with a minimum of routine intervention. Existing research has provided convincing evidence that MLUs lead to better maternal and neonatal outcomes when compared to traditional models. They not only improve the level of satisfaction amongst women, but are also associated with reduced healthcare costs. This study aimed to explore the perceptions of women and healthcare providers regarding the creation of an MLU in a Swiss university hospital.
  
  
  METHODS
  A descriptive research study using qualitative methods was conducted among pregnant women and new mothers in a Swiss maternity unit, including also midwives and medical staff. Data collection was carried out through one-to-one interviews, focus groups, and telephone interviews (n = 63). After transcription, thematic analysis was performed.
  
  
  RESULTS
  The triangulation of perceptions of women and healthcare providers indicated support for the implementation of an MLU to promote physiological delivery. Most women welcomed the idea of an MLU, in particular how it could help in offering continuity of care. Healthcare providers were optimistic about the implementation of an MLU and recognised the need for some women to have access to a less interventionist approach. From the women's perspective, barriers concerned the lack of awareness of midwives' full scope of practice, while barriers for midwives and obstetricians were related to the challenge to develop a good interprofessional collaboration.
  
  
  CONCLUSIONS
  Alternative models to provide maternity care for low-risk women have been developed and evaluated widely in several countries outside Switzerland. This study showed that women and healthcare providers were favourable towards the development of a new care model, while taking into account the specific expectations and barriers raised by participants.
authors.affiliation: University Hospital of the Canton of Vaud (CHUV), 1011, Lausanne, Switzerland. francoise.maillefer@hospvd.ch.
authors.forename: Françoise
authors.initials: F
authors.lastname: Maillefer
authors.affiliation: University of Applied Sciences in Western Switzerland (HES-SO, HESAV), 1011, Lausanne, Switzerland. claire.delabrusse@hesav.ch.
authors.forename: Claire
authors.initials: C
authors.lastname: de Labrusse
authors.affiliation: Association Actions en Santé Publique, 1200, Geneva, Switzerland. voneche@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Cardia-Vonèche
authors.affiliation: Maternity Hospital, University Hospital of the Canton of Vaud (CHUV), 1011, Lausanne, Switzerland. patrick.hohlfeld@chuv.ch.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hohlfeld
authors.affiliation: Institute of Global Health, University of Geneva, 1202, Geneva, Switzerland. beat.stoll@unige.ch.
authors.forename: Beat
authors.initials: B
authors.lastname: Stoll
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D005260:Female; D017144:Focus Groups / Q000379:methods; D006282:Health Personnel / Q000523:psychology; D006301:Health Services Needs and Demand; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008427:Maternal Health Services / Q000458:organization & administration / Q000592:standards; D008880:Midwifery / Q000379:methods / Q000592:standards; D017146:Models, Organizational; D009721:Nurse Midwives / Q000523:psychology / Q000592:standards; D057240:Patient Preference; D057184:Practice Patterns, Nurses' / Q000592:standards / Q000706:statistics & numerical data; D011247:Pregnancy; D058996:Quality Improvement; D012938:Social Perception; D013557:Switzerland