A mirage of change: family-centered maternity care in practice.

Background: Since the 1970s, the movement to "humanize" birth in North America has evolved into "family-centered maternity care," which has focused on providing evidence-based maternity care that is responsive to the needs of women and their families. The objective of this research was to explore women's birth experiences within the context of the numerous changes that have occurred in perinatal care and to determine how information and knowledge acquired about pregnancy and birth influenced women's birth experiences.

Methods: Semi-structured interviews were conducted in prenatal health clinics in Montreal and Vancouver with 36 women before and after birth.

Results: Most study participants were unaware of the range of available providers and birth settings. Of the women who were more aware of their options, those selecting a birth center or home birth and midwives had different notions of risk than those who planned a hospital birth. Study participants felt generally well informed, but thought that information sharing, collaborative decision making, or both were inadequate during labor and birth within the hospital setting.

Conclusions: Despite positive changes in recent years, family-centered maternity care in Canada still needs to be improved. Women's ability to use their acquired prenatal knowledge to feel satisfied by their birth experience continues to be undermined by a system of care that does not prioritize women's informed choice. Further systemic change is required to align maternity care with the needs of Canadian birthing women and their families.