Providing woman-centred care in complex pregnancy situations.

OBJECTIVE

Midwifery philosophy and practice is grounded in providing woman-centred care. The available evidence was reviewed to better understand how to provide Woman-centred midwifery care in complex pregnancy situations. Complexity in this context is defined as psychosocial or biomedical risk factors that place the mother and/or her baby at increased risk for adverse outcomes.

DESIGN

A comprehensive integrative review was undertaken to identify peer reviewed research in English over the last 5 years. The quality of the studies was assessed using the Critical Appraisal Skills Programme Tool.

SETTING/PARTICIPANTS: Published studies which discussed enablers and barriers to woman-centred care for pregnant women with complex needs. 13 papers met the inclusion criteria for this review.

FINDINGS

This review identifies that Organisational and Professional power differentials create barriers to woman-centred care and provoke professional boundary tensions. For a woman with a complex pregnancy, this places her at risk for 'falling through the gaps' between maternity services, models of care and health providers.

KEY CONCLUSIONS

Women, birth and midwifery care are still largely constrained within a biomedical model of maternity care. Whilst barriers to woman-centred care have been identified, for women with complexity in pregnancy there appear to be few solutions when care requires multi-specialist input and crossing the boundaries and silos of healthcare.