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Women Birth. 2019 Jan 24. pii: S1871-5192(18)30339-1. doi: 10.1016/j.wombi.2019.01.003. [Epub ahead of print]

Dutch midwives' views on and experiences with woman-centred care - A Q-methodology study.

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Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Netherlands; Institute for Healthcare - School of Midwifery, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands; Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. Electronic address:
Sanquin Research, Plesmanlaan 125, 1066 CX Amsterdam, Netherlands.
Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Netherlands.



Woman-centred care is a philosophy for midwifery care management of the childbearing woman. There is no mutually recognised internalised way in midwifery to provide woman-centred care.


To reveal midwives' distinct perspectives about woman-centred care.


A Q-methodology study amongst 48 Dutch community-based midwives who rank-ordered 39 statements on woman-centred care, followed by semi-structured interviews to motivate their ranking. By-person factor analysis was used to derive latent views, representing midwives (factors) with similar attitudes towards woman-centred care. The qualitative data was used to aid interpretation of the factors.


Four distinct factors emerged: (1) the humane midwife, containing two twinning factors: (1+) The philosophical midwife, who is the woman's companion during childbearing in being an authentic individual human being; (1-) the human-rights midwife, who is the woman's advocate for achieving autonomy and self-determination regarding care during the childbearing period. (2) The quality-of-care midwife, who regards good perinatal health outcomes, responsive care and positive maternal experiences as benchmarks for the quality of woman-centred care. (3) The job-crafting midwife, who focuses on self-organisation while seeking balance between the childbearing woman, herself as a professional and an individual and as a colleague.


Each factor represented specific perspectives feeding into woman-centred practice. Although the humane midwife seems to represent the dominant and preferable perspective of woman-centred care, awareness and exploration of and reflection on the thoughts patterns represented by the four different perspectives, should be considered in education and professional development of (student)midwives of be(com)ing a woman-centred midwife.


Humane; Job-crafting; Midwifery; Q-methodology; Woman-centred care

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