Dossier n. 175/2009 [Abstract] Birth path and perceived quality. Bibliographic analysis

The Emilia-Romagna regional law n. 26/1998 on birth assistance, maternity houses and home birth focuses the attention on care path for mother and child and on different care opportunities offered by regional public and private structures.

A Regional technical-scientific advisory Commission on birth path was established to favour the implementation of the law; it not only deals with all care aspects concerning pregnancy and birth but also considers opinions of those “living the birth path” and their perceptions on services received.

A group within the Commission was dedicated to study “perceived quality on birth path”, in order to promote the adoption of tools at regional level to monitor and listen to perceptions of all the actors involved in the care process (women, health personnel, family, friends, associations, etc.). The starting point is: what concept of quality are we referring to? what image can we use to present “a whole (path) and not only some parts of it (pregnancy, birth, etc.)” for a complex system like the birth path?

The attempt to face and answer these questions determines some unavoidable steps; Chapter 1 presents a theoretical and methodological synthesis of quality perceived by users (nearly always mothers) towards the healthcare services received from the decision of having a baby till its birth and beyond; the synthesis is based on national and international databases to study the researches conducted, the tools used, the elements to focus on “perception”.

The second Chapter deals with the construct of perceived quality in national and international researches, to analyse the efforts to systematize and “objectivise” some aspects of perception and evaluation by people that used the service. Also perceived quality becomes a measurable object.

Chapter 3 describes methodology and technical elements adopted in the survey, to identify useful tools for more and more reliable scientific researches. Instruments are developed through integrated criteria that carefully consider the personal experience of the woman (mainly of Caucasian origin; only a few studies analyse foreign users) during pregnancy and childbirth. From a theoretical point of view, quality evaluation is based on the presence and intensity of the correspondence between offered services (protocols) from one side and satisfaction and psycho-physical status of mother and child (health outcomes) from the other. Many surveys also explore variables that can influence this relationship (age, socio-economical status, pregnancy, courses attended, …).

The knowledge of the factors influencing satisfaction and quality perception - in terms of offered service (protocols), analysed elements (variables), measured results (outcomes) – has certainly increased in the last decades; on the contrary, a global vision of care continuity in a “qualitatively perceived” care path is still lacking.

A new theoretical perspective on this “complex, unbreakable path” is therefore presented in the last Chapter, integrating the actual model of perceived quality and introducing a new view centred on experience narration, analysis of users’ needs, points of view of the different actors of the birth path (mothers, health professionals, relatives/friends).

The strong bond in the birth path between woman, child, health professional and context (local services, hospital, social and familial community) becomes the new and unusual element that needs to be investigated through the direct listening of interested people; it represents the new analysis pathways to be followed with tools of co-participation in the construction of the “perceived sense” of the birth path.