Woman-centred care: An integrative review of the empirical literature.

OBJECTIVE

The objective of this review is to explore, review and synthesize the empirical literature that reports on the concept of woman centred care.

DESIGN

Integrative review of the empirical literature on the concept of woman centred care.

DATA SOURCES

A comprehensive search strategy was conducted using the phrase 'woman-centred care' 'women-centred care' (and all associated spelling variants) in the relevant databases including PubMed, Cumulative Index to Nursing and Allied Health, Intermid, Scopus, Informit and Web of Science. A concurrent search using the phrase 'patient-centred care' (and associated spelling variants) was also conducted, to ensure all studies about care of a woman in pregnancy, labour and postpartum were captured.

REVIEW METHOD

A comprehensive five stage integrative review methodology was used to review primary studies which addressed woman-centred care as either an intervention or an outcome. The quality of included studies was assessed using the appropriate Critical Appraisal Skills Programme tool.

RESULTS

Initial searching located 1205 papers. Seventeen studies met the inclusion criteria (qualitative n=12 and quantitative n=5). The studies were conducted in Australia (n=5), Ireland (n=1), Japan (n=2), Netherlands (n=2), New Zealand (n=1), South Africa (n=1), Sweden (n=1), Switzerland (n=1), United Kingdom (n=1), and the United States of America (n=2). The quality of the studies varied. NVivo software was employed to abstract and synthesize the data. Analysis revealed 10 subthemes synthesized under three pre-determined main themes of clinical practice (choice and control, empowerment, protecting normal birth, relationships and the individual midwife), maternity service (model of care, continuity of care and maternity care systems) and education (registered practitioners and student midwives).

CONCLUSIONS

This review integrates the empirical literature to illuminate the concept of woman-centred care as it currently applies to clinical practice, maternity service, and education. The concept of woman- centred care is intertwined in the themes and subthemes identified in the studies. There is wide variation in how woman-centred care is interpreted and this contributes to the confusion and tokenism with which it is discussed in health policy documents and frameworks. Further research is also warranted in the development of a universal definition of woman-centred care and in how woman-centred care behaviours are developed in practitioners.