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

INTRODUCTION Childbirth is a transformative experience, yet many women worldwide encounter negative birth events that affect 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. This study aims to understand the factors influencing women's perceptions of childbirth following the introduction of the first midwifery-led unit in the Spanish Healthcare System. METHODS This qualitative study employs a phenomenological approach within the constructivist paradigm. Four virtual focus groups were conducted with 19 women who gave birth in a hospital offering both an obstetric unit and an midwifery-led unit. Data were analyzed using thematic analysis. RESULTS Three main themes emerged: 'Shaping birth expectations', highlighting the influence of social factors, family dynamics, and previous experiences on women's childbirth expectations; 'The childbirth essentials', focusing on fundamental characteristics related to the model of care; and 'Navigating the protective factors', considering the central role of midwives in providing compassionate and respectful care. CONCLUSIONS This study highlights the crucial role of expectations, care models, and midwifery roles in shaping childbirth experiences. The findings advocate for transforming Spain's medicalized healthcare system by integrating midwifery-led care units. By adopting a more biopsychosocial approach, healthcare providers and policymakers can promote respectful, individualized care, ultimately enhancing positive childbirth experiences for all women.