BACKGROUND:
Shared decision-making (SDM) is a key element of respectful, woman-centred maternity care. The Mother’s Autonomy in Decision Making (MADM) scale is a validated tool to assess women’s experiences of being involved in decisions. Less is known about how midwives and obstetricians perceive their own support of SDM—and whether these perceptions align with women's views.

OBJECTIVES:
(1) To compare women’s MADM scores with those reported by midwives and obstetricians. (2) To examine differences between professional groups.

METHODS:
This cross-sectional survey (2025) was conducted in Austria as part of a project on respectful maternity care. Postnatal women (n= 544), midwives (n= 128), and obstetricians (n= 50) completed the 7-item MADM scale. Professionals received an adapted version to enable self-assessment of their involvement in shared decision-making with women. All items were rated on a 6-point Likert scale (1 = strongly agree; 6 = strongly disagree). Descriptive and group comparisons were performed.

RESULTS:
Women’s MADM scores (median = 33) were significantly lower than those of midwives (median = 37, p <.001) and obstetricians (median = 36, p <.001). No significant difference was found between midwives and obstetricians (p = .712). Categorized by patient autonomy level, 50% of women were in the high (78% midwives; 66% obstetricians), 24% in the moderate (21% midwives; 34% obstetricians), 17% in the low (1% midwives; 0% obstetricians) and 9% in the very low (0% midwives; 0% obstetricians) category.

CONCLUSIONS:
Women reported lower perceived involvement in decision-making than professionals assumed they provided. The findings suggest that enhancing SDM could be one factor contributing to improved maternity care.

KEY MESSAGE:
Bridging the perception gap on shared decision-making between women and professionals is essential for strengthening woman-centred, respectful maternity care. Woman centered 1 (including three-minute presentation competition)