Beyond the numbers: A phenomenological analysis of women's childbirth experiences in Spain's evolving healthcare system

Background: Childbirth is a transformative experience, yet a considerable percentage of women worldwide encounter negative birth events, affecting maternal wellbeing and mental health. The choice of birth setting significantly impacts outcomes, with midwifery-led units often associated with lower intervention rates and higher satisfaction levels. The recent introduction of midwifery-led units in Spain presents a unique opportunity to explore the impact of this model within a medicalized healthcare context. Aim: To capture the depth and diversity of women's voices, understanding factors influencing their perceptions of childbirth experiences following the introduction of the first midwifery-led unit in the Spanish Healthcare System. Methods: A qualitative study with a phenomenological approach within the constructivist paradigm. Four focus groups were conducted including nineteen women who gave birth in a hospital with both an obstetric and a midwifery-led unit. Findings: Three main themes were identified; 'Shaping birth expectations', highlighting the profound influence of cultural and social contexts on women's childbirth expectations; 'The childbirth essentials', incorporating fundamental characteristics related to the model of care; and 'Navigating the protective factors', considering the pivotal role of midwives in delivering compassionate and respectful care. Conclusion: These findings offer valuable insights into childbirth experiences, advocating for a transformation of the medicalized healthcare system in Spain through the integration of midwifery-led units. By prioritising women's voices and addressing systemic inequalities, healthcare policymakers can enhance maternal care practices and foster positive childbirth experiences for all women. Keywords Childbirth expectations; Childbirth experience; Maternity care; Midwifery care; Patient-centred care; Qualitative method ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Academia de Ciencies Mediques i de la Salut de Catalunya i de Balears ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of Fundacio Unio Catalana Hospitals - Unio Foundation (registration number CEI 21/03) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors