Overview:
Various evidence-based (EB) clinical guidelines are available on pre- and postnatal care, but their implementation into practice is often a challenge. Quality indicators are standardized, EB measures of the quality of care, facilitating the implementation of EB recommendations.

Aims and Objectives:
To develop quality indicators for Belgian midwives in low risk antenatal and postnatal care.

Method:
We use a 7-step plan from Plessers et al (2019) and a Rand-modified Delphi method. Recommendations and concept indicators were selected from guidelines, existing indicator sets and Belgian reports. Their quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Recommendations were double blinded and SMART (Specific, Measurable, Achievable, Relevant, Time-bound) screened and evaluated by a multidisciplinary expert panel (two Delphi’s and one consensus meeting). In a third Delphi, this panel evaluated the quality indicators for feasibility and relevance on a 9-point Likert scale. Also implementation barriers were identified.

Results:
Seven guidelines and one report were included, consisting of 764 recommendations in perinatal care. After screening for applicability and relevance for the Belgian healthcare system, 394 recommendations were SMART screened, resulting in 113 recommendations. After evaluation by the multidisciplinary panel, 45 key recommendations were identified: 1 perinatal, 28 prenatal and 16 postnatal recommendations. Based on these selected recommendations, we defined 54 concept indicators (4 perinatal, 28 prenatal and 22 postnatal indicators). In total 20 quality indicators were assessed as feasible and relevant (8 prenatal and 11 postnatal indicators) for which indicator sheets are developed.

Conclusion:
The implementation of quality indicators in midwifery care offers an evidence-based approach, facilitates an integrated view on perinatal care and promotes a healthy start for woman and child. Monitoring and benchmarking these quality indicators can assist health care providers, organisations and governmental agencies to improve the quality of perinatal care.