gms | German Medical Science

Background: Currently, maternity care in Germany is experiencing a major structural transition. A continuous rise of liability insurance fees as well as an increasing centralisation and privatisation of maternity care have triggered a shortage of health service coverage in many places [1]. At the same time, an individualization of care in terms of family-centredness has been protracted.

Aims: This study aims to identify a) the most prominent shortcomings that women describe in their care experience and b) the areas of care where a daily commitment shows a particularly positive effect.

Methods: The study is a part of the Babies Born Better (B3) User Survey. It is a mixed-method online-survey based on convenience sampling. Currently, the survey is available in 23 languages and is represented through country coordinators in 31 countries. The German language version of the survey was launched on 1st March 2014 and since then continuously collects data. German data from the first six months was analysed using descriptive statistics, bivariable associations and geo-mapping.

Results: The German language sample counted 3050 responses in the first six months of data collection. Respondents particularly valued the availability of their midwife and the time that the midwife spent with them (40.6%, n=1002) as well as the extent of personal autonomy, which they were able to maintain (36.3%, n=897). Furthermore, the overall care experience was positively influenced by the provision of antenatal care through midwives (5.4%, n=133) and by the involvement of an independent midwife for birth (6.5%, n=160). Exclusively positive accounts of care were associated with multiparity (χ²=25.70, df=4, p<0.001), uncomplicated pregnancy (χ²=12.37, df=1, p<0.001) and out-of-hospital birth (χ²=85.968, df=4, p<0.001). Major critique was voiced with respect to a lack of midwives, particularly in community services (7.1%, n=175) and an inadequate inter-professional collaboration (7.7%, n=191).

Relevance: Due to the convenience sample the generalizability of findings is limited. The sample significantly over-represents the views of women who gave birth in an out-of-hospital setting. With this in mind, the B3 User Survey in Germany reflects the current crisis in health and maternity services with a continuously declining availability of community care. The themes, which women highlighted as being important for a positive care experience are well described in the literature and centre in the provision of a safe and calm atmosphere [2][3]. However, this is rarely achieved due to staff shortages, insufficient continuity of care in hospital settings and radical cuts in community care. Already, some regions face a significant shortage or a complete lack of maternity services. Through this situation the freedom of choice of the place and the circumstances of birth is severely violated [4][5].

Recommendations: To halt the continuing incapacitation of women and their families, the maintenance of community health services and the improvement of inter-professional collaboration are mandatory. Furthermore, health professionals of all occupational groups are encouraged to foster a secure and calm atmosphere of care. This can only succeed, if health care systems recognize the individuality of women and families.

Ethical considerations: Ethical approval for this study was granted by the ethics committee of the University of Central Lancashire (UK).

Financing: The B3 User Survey was developed within the framework of the EU-funded COST Action (European Cooperation in Science and Technology) IS0907 (‘iresearch4birth‘). After completion of the Action on 13th June 2014, the work on the survey continued to be funded by the Hannover Medical School and the University of Central Lancashire. The analysis of the German language data was performed within the scope of a master thesis.