Health Care Providers' Perceptions of Quality of Childbirth and Its Associated Risks in Poland

Abstract

Objective: To describe Polish maternity care providers' cognitive frames of quality of childbirth and how they relate to providers' perceptions of childbirth using Baranowska's model of quality of care.

Design: Mixed-methods, cross-sectional.

Setting: Twenty-four hospitals and outpatient clinics that provide maternity care located in two central districts of Poland.

Participants: Obstetricians or resident physicians in obstetrics (n = 50) and midwives (n = 676) who were actively engaged in the provision of maternity care.

Methods: Participants completed a survey that included two tasks. The first was a sentence completion technique that we used as a projective method to investigate participants' preconceived attitudes about quality of childbirth. Depending on the number of perspectives (as in Baranowska's model) included in the statements, participants' perceptions were categorized as strongly narrowed (zero perspectives), narrow (one perspective), intermediate (two perspectives), or holistic (three perspectives). In the second task, we asked participants to choose one statement out of three that best represented their beliefs about childbirth.

Results: Participants had mostly intermediate (n = 436, 60%) or narrow (n = 183, 25%) perceptions of quality of childbirth. Those with less work experience tended to have more encompassing perspectives. More than half of the participants perceived childbirth as a physiologic process requiring no medical interventions (n = 385, 53%). Only 9% (n = 65) of the participants reported that childbirth is always associated with great risk. There was a main effect of work experience on the number of perspectives included in the definition of quality of childbirth with F(2, 720) = 5.532, p = .004. Participants with less work experience included more perspectives in their statements. There were no statistically significant differences in the perception of quality of childbirth between obstetricians and midwives, with F(1, 724) = .000, p = 0.991, or between participants from different workplaces, with F(3, 719) = 1.742, p = .157.

Conclusion: Only a small share of participants had holistic perceptions of quality of childbirth consistent with Baranowska's model. This may not only contribute to the medicalization of maternity care in Poland, but it also contrasts with participants' declarations that childbirth is a physiologic process with no need for medical interventions. Considering the greater rates of medical interventions in maternity care in Poland, the latter finding requires further research.

Keywords: childbirth; health care providers; quality of care; risk perception.