Next comes the interesting stuff (depending who you ask, I suppose). I did an informal literature survey trying to answer the question "What do maternity care consumers in the US say they want from their care?"
This question was intended to be an answerable proxy for the un-researched question I really wanted to know the answer to: "What kind of quality measurements do US maternity care consumers want?" (And the followup question, "Are those desires being met by current quality measurements in maternity care?")
(SPOILER ALERT:
No.)
The scope of the paper needed to be fairly circumscribed, but interestingly, limiting the data to US only was almost too much - I ended up with under a dozen papers, several of which were not general populations (people who gave birth at home, grand multiparae).
Nevertheless, I was able to draw out some recurring themes from across these studies, most of which were survey- or interview-based. Here's the cheat-sheet version.
Maternity care consumers care about:
- the character of the relationship with their provider: this person should be a good listener and communicator, and be validating and supportive. She should enable shared decision making and personalize each interaction.
- experiencing control: the concept meant different things in different studies, but consumers generally wanted to experience control in their maternity care. For example, this could mean feelings of personal security or decision-making responsibility, or the ability to determine the course of labor and birth.
- having enough information: consumers wanted to be given enough information to participate in decision-making, and they wanted to receive information from all of their care providers, including labor and delivery nurses.
- patient-centered care: consumers wanted their care to be organized and delivered in a patient-centric way. For example, providers should listen carefully, show respect, and spend enough time on each visit.
- safety: interestingly, the desire for safety was mentioned only in the articles studying people giving birth at home and grand multiparae.
Next time: What do we make of the fact that (most of) these concerns are essentially not at all addressed by current quality measurement?
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