Women’s views on midwifery continuity of care when residing far from a labour ward in Sweden – A qualitative study

PROBLEM: Access to labour wards remains a challenge for women in rural Sweden due to closures, raising concerns regarding accessibility, safety, and equity. While midwifery continuity of care (MCoC) offers a promising solution, it is largely unavailable in rural areas. BACKGROUND: MCoC have been shown to improve perinatal outcomes and birth experience. Existing research has primarily focused on urban women, making it essential to explore the perspectives of rural women to capture diverse needs. AIM: To explore women's views on MCoC when residing far from a labour ward in Sweden. METHODS: This qualitative descriptive study used inductive content analysis of semi-structured interviews with 17 women in Sweden who each lived at least 60 min from a labour ward. FINDINGS: The analysis generated the overarching theme 'Striving for empowered choices in contexts of constraint', highlighting how rural women navigate Sweden's limited maternity care system and demand more woman-centred options. Women valued MCoC for fostering trust, autonomy, and individualised support, but noted significant gaps and indicated that MCoC would have been chosen if available. Distance shaped both access and expectations, prompting some to seek alternatives such as doulas or home births. These actions reflected both a critique of standard care and a commitment to maintaining control over childbirth. DISCUSSION AND CONCLUSIONS: Findings underscore the need for more flexible and responsive maternity care models for women residing far from labour wards. Expanding MCoC access and supporting women's autonomy in navigating limited services are key to ensuring equitable, woman-centred care across geographical contexts.