BackgroundRecent evidence indicates that continuity models of maternity care result in improved clinical and psychosocial outcomes, but their causal mechanisms are poorly understood. The recent Lancet Series on Midwifery’s Quality Maternal and Newborn Care Framework describes five components of quality care and their associated characteristics. As an initial step in developing this Framework into an evaluation toolkit, we transformed its components and characteristics into a topic guide to assess stakeholder perceptions and experiences of care provided and received. The main purpose of this study was to assess the feasibility of this process.MethodsWe conducted twelve focus groups in two Scottish health board areas with 13 pregnant women, 18 new mothers, 26 midwives and 12 obstetricians who had experience of a range of different models of maternity care. Transcripts were analysed using a six-phase approach of thematic analysis. We mapped the identified themes and sub-themes back to the Framework.ResultsThe emerging themes and sub-themes demonstrated the feasibility of using the QMNC framework as a data collection tool, and as a lens for analysing the data. Of the four emerging themes, only Organisation Culture / Work Structure’ mapped directly to a single Framework component. The others—‘Relationships’; ‘Information and support’; and ‘Uncertainty’–mapped to between two and five components, illustrating the interconnectedness of the Framework’s components. Some negative sub-themes mirrored positive Framework characteristics of care. Some re-phrasing and re-ordering of the topic guides in later focus groups ensured we could cover all aspects of the Framework adequately.ConclusionAdapting the Quality Maternal and Newborn Care Framework enabled us to focus on aspects of care which worked well and which didn’t work well for these key stakeholders. Identifying ‘what works for whom and why’ in different models of care is a necessary step in reinforcing and replicating the most effective models of care.

Several boreal fens belong to the patterned fen category, which is composed of two compartments, the pool (or hollow), and the string (or hummock) compartments. Both compartments are distributed perpendicular to the mire slope and drainage flow. The surface of patterned fens is repeatedly invaded by water, which is known to affect the original pool–string pattern through the creation and enlargement of pools, a process caused by the action of aqualysis. Aqualysis refers to the destruction of the vegetation cover by flooding of low-elevated strings or lawns causing the formation and enlargement of pools. It is argued here that the nature and composition of the pool structure (number and size) reveal the state of development of patterned fens of the boreal environment. Quantitative and spatial data for pool size structure in 24 fens of northern Quebec, including 4881 pools, were used for the assessment of patterned fen development. Among the main factors influencing patterned fen development, area and slope contribute to the construction of the peatland surface. Also, watershed area, alternating strings and hollows, and peat thickness all facilitate pool creation and expansion. The construction of the pool structure of most fens has been a long process of ecosystem building. This probably explains why most sloping fens, i.e, moderate- and steep-sloping fens, are today at an equilibrium stage characterized by the coexistence of pools of all sizes with the smallest pools being the most numerous. In contrast, most low-sloping fens have developed toward a lacustrine stage with a bimodal distribution of small and very large pools. Boreal patterned fens of all developmental stages will be subject to increased pool size and number in the near future if more humid climatic conditions prevail.