Objective: to explore, in-depth, the views of midwives working in maternity services about birth setting, models of care and philosophy of care.
Design: an Appreciative Inquiry approach was adopted utilising focus group interviews as the method of data collection.
Setting: 15 focus group interviews were conducted at 14 sites in England.
Participants: a purposive sample of 120 midwives and six student midwives who were serving women in different birth settings (home, free-standing maternity units, midwife-led units, and traditional obstetric units) participated, in 2001/2002.
Findings: the main themes generated by the midwives were: cultural changes; midwifery leadership; appropriate role models; training in normality; appropriate responsibility of care divisions; choice for women; equity of care provision between women considered to be at high or low risk; and staff morale.
Key conclusions and implications for practice: this study highlighted the consistency of views amongst midwives working in different settings. Midwives wanted support to practice autonomously in an environment that facilitated equity of care for women and job satisfaction for midwives. Suggestions were put forward by midwives on how to improve maternity services. A unified approach is required to develop these suggestions into strategies, that will remove the identified barriers and promote normality.