Background Health literacy is an essential component of healthcare as it affects relationships with patients, compliance and outcomes. This study focuses on pregnant women in the maternity unit setting and investigates whether or not they understand the care being provided to them. It also identifies where understanding is lacking, outlines some reasons why and suggests solutions to this problem.

Methods This was a mixed methods design study which incorporated a quantitative and qualitative aspect. Questionnaires assessing understanding of antenatal, intrapartum and postnatal issues were completed by pregnant women attending antenatal clinics in Cork University Maternity Hospital in June 2014. Follow up interviews were conducted 6 to 8 weeks after these women had delivered their babies. Interviewees were selected based on mode of delivery, parity and educational level. The data provided by the questionnaires was analysed by themes using Microsoft Excel and VassarStats: Website for Statistical Computation. Chi-square test was performed to compare differences between primiparous and multiparous women. Interviews were transcribed and analysed thematically.

Results There were 199 completed questionnaires (66% response rate) and 8 women were selected for interview from a panel of 33 volunteers. The quantitative results illustrated that 63.8% (n = 127) of women always understood information given to them at the antenatal clinic. Half of women (49.7%; n = 99) reported that they got the most helpful information about pregnancy from family members. When asked to identify any complications of “induction of labour”, multiparous women were more likely than primiparious women to identify emergency caesarean section as a risk (39.0% vs. 20.9%; p = 0.007). Multiparous women were also more likely to expect to pain after having their baby than primiparous women (92.4% vs. 79.0%; p = 0.006).

At interviews, intrapartum issues had caused the most confusion. Women felt there was a lack of explanation around the induction process including the fact that induction can cause foetal distress leading to emergency caesarean section. This caused frustration and disappointment around the delivery experience for some of the interviewees. Postnatally, women felt that more time could be spent on breastfeeding and advice on what to expect physically when they went home.

Conclusion The findings from this study suggest that a standard of explanations regarding procedures and care needs to be maintained throughout pregnancy. Specialist clinics and/or classes may be useful to enhance women’s understanding by providing women with a forum to discuss any issues arising during the pregnancy and in the postnatal period.