Introduction: Childbirth is a transformative experience, yet many women worldwide encounter negative birth events that affect maternal wellbeing and mental health. The choice of birth setting significantly impacts outcomes, with midwifery-led units often associated with lower intervention rates and higher satisfaction levels. The recent introduction of midwifery-led units in Spain presents a unique opportunity to explore the impact of this model within a medicalized healthcare context. This study aims to understand the factors influencing women's perceptions of childbirth following the introduction of the first midwifery-led unit in the Spanish Healthcare System. Methods: This qualitative study employs a phenomenological approach within the constructivist paradigm. Four virtual focus groups were conducted with 19 women who gave birth in a hospital offering both an obstetric unit and an midwifery-led unit. Data were analyzed using thematic analysis. Results: Three main themes emerged: ‘Shaping birth expectations’, highlighting the influence of social factors, family dynamics, and previous experiences on women’s childbirth expectations; ‘The childbirth essentials’, focusing on fundamental characteristics related to the model of care; and ‘Navigating the protective factors’, considering the central role of midwives in providing compassionate and respectful care. Conclusions: This study highlights the crucial role of expectations, care models, and midwifery roles in shaping childbirth experiences. The findings advocate for transforming Spain's medicalized healthcare system by integrating midwifery-led care units. By adopting a more biopsychosocial approach, healthcare providers and policymakers can promote respectful, individualized care, ultimately enhancing positive childbirth experiences for all women.
