The Cyprus public Maternity services consist of five maternity units that refer to approximately 140 beds, delivery rooms and prenatal clinics. The number of registered practicing midwives in the public sector is 171 . According to the 2007 annual report of the Ministry of Health of Cyprus , midwives fulfill the International Confederation of Midwives "Definition of the Midwife"  and the requirements of the European Directive 2005/36/EC that regulates the midwifery profession . The birth rate in Cyprus is 11.6  with high medicalization of childbirth as only 50.6% of the women in Cyprus give birth without an obstetric intervention .
Patient safety has been placed high on the societal agenda in the last decade although Premium non nocere ('first do no harm') has been a maxim of healthcare professionals for many centuries. The World Health Organization , has defined patient "unsafety" as "a process or act of omission or commission that resulted in hazardous healthcare conditions and/or unintended harm to the patient".
Timely emergency obstetric services, adequate communication and skilled personnel working as a team in a good and safe environment are recommended in order to prevent the 15% of pregnant women in all population groups who experience potentially fatal complications . Maternal morbidity and mortality which can also be prevented in functioning health care systems are defined as the best indicators of overall health system performance evaluation; therefore, sustaining and scaling-up essential health interventions and addressing critical gaps in maternal care and maternity staff practices that are essential to improve women's health [8–10].
Evidence from WHO and the recent Healthcare Commission investigation reports [11–16]; suggested that a poor working relationship between healthcare professionals, including lack of support and possible bullying, can lead to dysfunctional teams which can further compromise women's and neonates health. Effective systems of communication between the multidisciplinary team members and each discipline have been major recommendations of the "Safer Childbirth" program [17, 18].
The WHO Regional Office for Europe identified that prevention, identification, and management of risk in obstetrics demand multidisciplinary and multiprofessional team training such as "Acute Life-Threatening Events Recognition and Treatment", transparent clinical governance, multidisciplinary team work, communication as keystone of good clinical practice, adequate staffing levels, standardized practices, and auditing systems . In environments with established interprofessional team training and support from senior clinical and management leaders, teambuilding and safety attitudes are positive . The overall safety climate reduces the rate of adverse obstetric events, so the assessment and improvement of the safety climate is the first step to reduce patient risk (injury, liability losses) and create a culture of safety . Attitude represents the degree of an individual's like and dislike of an item ; while a good safety climate is characterized by a collective commitment of care and concern, whereby employees share similar positive perceptions about organizational safety features . To conduct this initial assessment, the SAQ-Labor version which has been used in several studies [20, 21, 24, 25] was considered as a valid measurement tool. Whereas safety attitudes are necessary, they are not sufficient enough to improve clinical performance and perinatal safety  as leadership and teamwork are essential ingredients [27, 28].
The growing overall aversion of potentially unsafe situations and the explicit focus of healthcare professionals on the quality of care, underpins the need of this study; to evaluate the safety attitudes and teamwork climate in the care of birthing mothers and neonates in the public maternity units of Cyprus. Additionally, more than eight out of ten citizens in Cyprus feel it is likely they will be harmed by hospital care .
The European Network for Patient Safety (EUNetPaS) that was officially inaugurated on February 28, 2008 in Utrecht sought to establish a covering network for all 27 EU member states to encourage and strengthen cooperation in the field of patient safety. According to the latest report by EUNetPas, Cyprus is among the countries that still have not adopted a tool for measuring patient safety, making this survey a pioneer in this field . In the Eurobarometer survey, the issue of patient safety is quite visible in figures, as 50% of the respondents in the 27 EU member states replied that they "feel they would suffer from an adverse event" if hospitalized. However, only 9% believe that it is very likely to happen. Of particular interest are the figures for Cyprus, where 81% feel that risk. Greece was ranked first by 83% and Latvia by 75%, while Austria and Germany are among the countries where citizens feel that this is unlikely to happen with 19% and 31% respectively .
Taking the above into consideration and keeping in mind that safety culture and teamwork climate have not been examined within the population of midwives in Cyprus, a research study was undertaken to assess the safety climate as measured by a validated safety attitude tool.
The aim of the study was to explore the factors that affect the safety attitude and teamwork climate of Cyprus maternity units and Cypriot midwives.