As the regulation of midwifery evolves, changes in delivery of midwifery services are inevitable. The purpose of the project Midwifery Care: Women's Experiences, Hopes and
Reflections is to document women's experiences of midwifery care and to determine if these experiences match the perceptions that midwives have about the care women want. In doing this, the project's objectives were to determine if midwifery care is responsive to the needs of women; to establish a benchmark against which further evaluations can be measured; to strengthen links between midwives in Manitoba and Saskatchewan; and to provide recommendations to policy makers regarding the implementation of midwifery.

Sixteen women were interviewed and asked to share their experiences with midwifery care and to provide policy recommendations regarding the implementation of midwifery. Two focus groups were held with a total of eleven midwives, one in Saskatchewan and the other in Manitoba. Midwives were asked what they thought women wanted to know about themselves as midwives and the care they offer.

Five dominant themes emerged from the interviews with women. Sub-categories were identified within these themes. Themes and subcategories were time spent with women - quality and quantity; personalized care and support - home visits, choices and responsibility; consultative, not directive care; self esteem and empowerment; respecting and strengthening family relationships; midwifery care and support in different contexts; style of care - holistic care; observant, hands-on and low-tech care; postpartum care; trust and safety; accessibility - finding a midwife; cost; and policy recommendations from women.

From focus groups midwives identified priorities they felt women wanted: individualized care and continuity of caregiver; women wanted to know about cost of care; the midwife's experience and training, the midwife's philosophy and scope of practice. Midwives also assumed that women wanted to know about the legality of midwifery and the political ramifications surrounding their choice of midwifery care.

There were more similarities than differences between midwives' assumptions regarding what women want and women's reported experiences. Midwives assumed women were concerned about cost. Women identified this issue as a difficulty for them and as a barrier to receiving midwifery care for some people. Midwives thought women wanted individualized care and continuity of caregiver. Women appreciated personalized care and midwives' style of care (the expression of a midwife's philosophy). Midwives assumed women wanted to know about midwives' scope of practice. This was identified by women as something that medical personnel, the public and policy makers need to know more about.

Summary of policy recommendations from women:

• that midwifery services should be publicly funded;
• that midwifery services should be available in rural and northern communities, as well as in urban centers;
• that the essence of midwifery care should be supported and maintained after regulation (In practical terms this translates into facilitating midwives' autonomy in implementing care; into ensuring reasonable workloads and flexibility in practice so that time can be spent providing personalized care; and into providing opportunity for women to have appointments and care in their homes); and
• that education and awareness campaigns regarding the value of midwifery services should be targeted at medical personnel, health administrators and the public.