Maternity service professionals' perspectives of "the Good, the Bad, and the Possible" in Australian maternity services: a content analysis

OBJECTIVE: In 2019, the Australian government released a strategy for maternity care: Woman-centred care strategic directions for Australian maternity services (WCC Strategy), with mixed responses from providers and consumers. A public lecture and expert panel held in March 2021, titled "The Good, the Bad, and the Possible," facilitated critique and feedback on the WCC Strategy and the Australian maternity system. The aim of this article was to report the findings of a qualitative analysis of participants' views regarding the current perceptions of Australian maternity care. METHODS: A content analysis of responses to questions posed during the lecture and the commentary provided by participants was undertaken, utilizing a predetermined framework of "the Good, the Bad, and the Possible." RESULTS: Approximately 700 participants, mainly from Australia, attended the event. The majority were midwives. Under the guiding framework, the category "When it works well" captured "the Good" aspects of maternity care. Under "the Bad," major categories included "the system is broken," "roadblock to maternity service reform," and "not being seen or heard." Suggestions for improvement, and hope that these will be enacted, were encompassed in "the Possible" categories: "what is needed" and "we're in this together." CONCLUSION: Participants identified widespread maternity system issues resulting in women's needs not being met. Midwives indicated feeling invisible, as their repeated attempts at improvement were thwarted. Hierarchical power imbalances and medical privilege were suggested to be obstructions to respectful partnerships and expansion of midwifery models of care, preventing women from accessing safe birth options of their choice.