title: Women's Suggestions for Improving Midwifery Care in The Netherlands.
abstract: BACKGROUND
  The experience of the care a woman receives during pregnancy and childbirth has an immediate and long-lasting effect on her well being. The involvement of patients and clients in health care has increased over the last decades. The Dutch maternity care system offers an excellent opportunity to explore and involve women's suggestions for the improvement of midwifery care in the current maternity care model.
  
  
  METHODS
  This qualitative study is part of the "DELIVER" study. Clients were recruited from 20 midwifery practices. Purposive sampling was used to select the practices. The clients received up to three questionnaires, in which they could respond to the question; "Do you have any suggestions on how your midwife could improve his/her provision of care?" The answers were analyzed with a qualitative thematic content analysis, using the software program MAXQDA.
  
  
  RESULTS
  Altogether, 3,499 answers were provided. One overarching concept emerged: clients' desire for individualized care. Within this concept, suggestions could be clustered around 1) provider characteristics: interpersonal skills, communication, and competence, and 2) service characteristics: content and quantity of care, guidance and support, continuity of care provider, continuity of care, information, and coordination of care.
  
  
  CONCLUSIONS
  Informed by the suggestions of women, care to women and their families could be improved by the following: 1) more continuity of the care provider during the prenatal, natal, and postnatal periods, 2) more information and information specifically tailored for the person, 3) client-centered communication, and 4) a personal approach with 5) enough time spent per client.
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Carien I
authors.initials: CI
authors.lastname: Baas
authors.affiliation: Department of Obstetrics and Gynecology, Staff-Specialist Maternal and Fetal medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jan Jaap H M
authors.initials: JJ
authors.lastname: Erwich
authors.affiliation: Netherlands institute for health services research (NIVEL), Utrecht, The Netherlands.
authors.forename: Therese A
authors.initials: TA
authors.lastname: Wiegers
authors.affiliation: Department of Midwifery Science, EMGO+VUMc, Amsterdam, The Netherlands.
authors.forename: T Paul
authors.initials: TP
authors.lastname: de Cock
authors.affiliation: Department of Midwifery Science, EMGO+VUMc, Amsterdam, The Netherlands.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
mesh_terms: D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods / Q000458:organization & administration / Q000592:standards; D020380:Needs Assessment; D009426:Netherlands; D057240:Patient Preference / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D011785:Quality Assurance, Health Care / Q000379:methods; D011795:Surveys and Questionnaires
keywords: midwifery care; women's experiences; women-centered care