Finding the right indicators for assessing quality midwifery care

Objective. To identify a set of indicators for monitoring the quality of maternity care for low-risk women provided by primary care midwives and general practitioners (GPs) in the Netherlands. Design. A Project Group (midwives, GPs, policymakers and researchers) defined a long list of potential indicators based on the literature, national guidelines and expert opinion. This list was assessed against the AIRE (Appraisal of Indicators through Research and Evaluation) instrument criteria, resulting in a short list of draft indicators. In a two-round Delphi survey, a multidisciplinary group of stakeholders reviewed the elaborated draft indicators, rating both the relationship between indicator and quality of care and the feasibility. Setting and Participants. A multidisciplinary expert panel consisting of 28 midwives, 2 GPs, 3 obstetricians and 3 maternity assistants, randomly selected from different regions in the Netherlands. Intervention. None. Main Outcome Measure. Set of quality indicators for midwifery care. Results. The Project Group generated a list of 115 potential indicators which was reduced to 35 using the AIRE criteria. The 35 draft indicators were discussed by a Delphi panel. In total, 26 indicators were recommended by the participants as relevant indicators of midwifery care, representing several levels of measurement. Eight structure indicators, 12 process indicators and 6 outcome indicators were addressing the various phases of midwifery care. Conclusions. We identified a set of quality indicators concerning midwifery care provision in a low-risk population. Practicing maternity care providers adopted the large majority (83%) of the draft indicators proposed as a feasible set of indicators, describing the structure, process and outcome. The input from multidisciplinary experts in the process of identifying the right indicators showed to be essential in all phases of development.