How do pregnant women measure quality?

What do women care about when giving birth? A study Maurer et al. (2016) conducted a focus group study of 41 pregnant women in North Carolina. They found that women valued the following aspects of quality.

  • Providing individualized care that focuses on, and has respect for, each woman’ s health, needs, and personal preferences for labor, delivery, and breastfeeding.
  • Timely and effective communication. For example, a high quality provider “takes time to answer my questionsand makes you feel comfortable”; poor communication would include not returning calls or taking 24 hours or longer to return a phone call.
  • Coordinating care needs before, during, and after delivery and across providers. For example, one individual stated I was constantly bombarded with different people coming into the room. The nurses from the hospital, doctors from the hospital, doctors from the doctors office, lactation consultant, photographer, who knocked on the door multiple times, and I just said nomultiple times. I mean, it was just one thing after another. People coming in to get blood work in the middle of the night. And repetitive, you know, a nurse from the hospital would come in and do an exam, and the doctors office comes in and does an exam of the same thing.
  • Providing education for the woman before and after birth through classes or training and information about options during delivery.
  • Availability of lactation consultants.
  • Having knowledgeable providers, including the skill level of the nursesor doctors being up to date on the latest innovations and recommendations.
  • Having physical space and support for family members, such as places for partners to sleep.
  • Having updated equipment and technology.

The patients were less familiar with clinical quality measures such as bilirubin screening, avoiding infections in newborns, or the use of steroids when the baby is born prior to 34 weeks. When presented with these clinical outcomes, it was difficult for these patients to determine the relative importance of each one; thus, one mother wrote of her ranking that “I just ranked things having to do with the babies much more important than anything else.”

Nevertheless, the authors found that expectant mothers are a highly engaged groups.

Of our total survey respondents, 40 percent reported having read comparative quality information and 28 percent having used comparative quality information to choose a hospital…respondents were more aware of efforts related to newborn health, such as breastfeeding or preventing jaundice, and less aware of measures related to care during labor and delivery, such as episiotomy

Providing information on quality of care to expectant mothers has the potential to allow women to identify hospitals that provide high quality of care; although pregnant women are among the most highly engaged patient populations it remains to be seen how influential publicly-reported clinical quality measure will be relative to the good, ol’ fashioned word of mouth.


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