Investment in the peace of mind? How private services change the landscape of maternity care in Poland

For over two decades midwifery research advocated for the continuity of care and the ability to establish a relationship between care providers and care users as an important features of quality maternity services. In many countries, while unavailable though public services, continuity of care became commercialized and can be access through private services. In Poland, private prenatal consultations and dedicated midwifery care allow women to access continuity and establish personal relationships with care providers. In this study, we explore, how accessing these private services, impact on the rates of medical interventions and type of care women receive during labour and birth. We analyse data collected through an online questionnaire from 4402 first-time mothers in healthy pregnancy who had given birth in Poland between 2020 and 2021. We show that while private consultation did not translate into any significant differences in care, women who accessed private dedicated midwifery services experienced more attentive and less medicalized care, namely were more likely to give birth in vertical position, move freely during labour and less likely to experience emergency caesarean section. However, private dedicated midwifery care did not shield them from negative experience. While private care offers benefits for women who can afford it, it also contributes to inequalities in access to quality care and puts women with less social and financial resources in a vulnerable position. Efforts should be made to develop a more universal and equitable model of care that allows for building personal relationships between maternity care providers and women.