Patient participation in value-based maternity care in the southwestern Netherlands

This research shows that the degree of patient participation in value‑based maternity care in the southwestern Netherlands is still limited, particularly at the organizational level within hospitals. A systematic review indicates that hospitals mainly rely on low‑level forms of participation, such as questionnaires and interviews; higher‑level forms such as co‑design or advisory roles are scarcely used. In obstetric practice, I identified five ways in which patients contribute to their own safety, but also four clear negative effects: increasing anxiety, tension in the patient–professional relationship, excessive responsibility placed on patients, and additional time pressure for professionals.

Follow‑up research mapped out 18 concrete actions to reduce these negative effects, ranging from improved information provision and cultural change to structural adjustments and technological support.
In addition, a Q‑methodology study revealed four distinct perspectives among pregnant women regarding care during childbirth, with shared core values: respect, personal attention, and clear information.
Finally, a retrospective study showed that women living in deprived neighborhoods and women with limited social support report significantly less positive care experiences. This underscores the need to actively reduce inequality in maternity care.

Conclusion: Patient participation offers valuable opportunities to improve maternity care, but participation is not yet sufficiently embedded, and true co‑production with patients has not been achieved. Targeted actions are needed to prevent negative effects and to ensure structural attention to diversity, equity, and meaningful partnership with patients.