Women's Experiences of Community-Based Midwifery Care Provided by Independent Midwives in Turkey: A Qualitative Study Based on the World Health Organization Positive Childbirth Experience Framework.

Abstract

Introduction: Midwife-led birth models are gaining increasing acceptance because of their potential to promote respectful, woman-centered, and positive birth experiences. However, evidence regarding women's lived experiences of midwife-led births in Turkey is limited. This study aimed to investigate women's experiences, perceptions, and thoughts regarding midwife-led births in Turkey within the World Health Organization (WHO) Positive Birth Experience Framework.

Methods: A qualitative descriptive design was employed. Semistructured interviews were conducted with 9 women from different regions of Turkey who experienced childbirth under the care of independent midwives. Purposive sampling ensured variation in age, parity, and birth setting. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis informed by the WHO Positive Birth Experience Framework.

Results: Three main themes emerged from the analysis: (1) continuous and autonomous one-on-one midwife support from pregnancy through the postpartum period (4 subthemes); (2) a woman-centered, noninterventionist, and empowering birth experience (3 subthemes); and (3) advocating for an independent midwife model with a critical perspective on the health care system (3 subthemes). Women described midwife-led care as empowering, respectful, and emotionally supportive, emphasizing continuous presence, effective communication, trust, and shared-decision-making. Positive experiences were facilitated by individualized care and calm birth environments. However, participants also reported systemic barriers, limited institutional support, and unequal access to independent midwife-led services.

Discussion: In general, women's experiences of midwife-led births were strongly aligned with the WHO Positive Birth Experience Framework, particularly in terms of emotional security, participation in the decision-making process, and perceived safety. However, structural constraints within the health care system may hinder the wider implementation and sustainability of midwife-led models. Strengthening continuity of care and institutional recognition of independent midwifery practice are essential.