A qualitative exploration of women's experiences of antenatal and intrapartum care: the need for a woman-centred approach in the Peruvian Amazon

Objective: To explore women’s experiences and perceptions of antenatal and intrapartum care in the Peruvian Amazon, including their perceived motivators, enablers and barriers to accessing care

Design: Interpretive descriptive qualitative study using semi-structured face-to-face interviews.

Setting: Primary healthcare centre, Iquitos, Peru.

Participants: Women (n = 20) attending the healthcare centre who had given birth in the past 6 months.

Measures: Interviews were conducted using a female interpreter, transcribed clean verbatim and thematically analysed.

Findings: Four core themes relating to antenatal care were interpreted. (1) Perceived knowledge of antenatal care and its importance: women generally understood the importance of care, mainly for their baby’s health rather than their own. (2) Appointments and information received: women wanted more appointments to facilitate greater depth of information relating to their pregnancy. (3) Interaction with healthcare practitioners: women felt they received inadequate attention, care lacked continuity and they were often uncomfortable with male practitioners. (4) Perceived motivators, barriers and enablers to accessing antenatal care: Knowledge of the importance of care acted as the main motivator. Few direct barriers were identified, other than employment. Free care and ease of access enabled attendance. Two core themes were interpreted relating to intrapartum care. (1) Expectations and preferences for labour and delivery: the need for a safe environment for childbirth was acknowledged. (2) Actual experiences of labour and delivery: for most women labour and delivery experiences were not as they had expected. Women objected less to male professionals during labour than antenatal care.

Conclusions and implications for practice: Women reported negative experiences of both antenatal and intrapartum care. There is clearly a need for a more woman-centred approach to care and service provision. Ideally, this would involve employing more staff, acknowledging the implications on resources, improving attitudes towards women, facilitating continuity of care, and allowing patient choice to give women greater involvement.