School of Nursing, Midwifery and Social Sciences, CQUniversity, 42-52 Abbott Street & Shields Street, Cairns, QLD 4870, Australia.
School of Nursing, Massey University Wellington, PO Box 756, Wellington 6140, New Zealand; Adjunct Associate Professor, CQUniversity, Australia.
Midwifery. 2021 Nov;102:103060. doi: 10.1016/j.midw.2021.103060. Epub 2021 Jun 12.
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.
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.
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.
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.
产科学的理念和实践是以提供以妇女为中心的护理为基础的。对现有证据进行了综述，以便更好地理解如何在复杂妊娠情况下提供以妇女为中心的助产护理。这里的“复杂”是指可能增加母婴不良结局风险的心理社会或生物医学危险因素。
全面的综合回顾，以确定过去 5 年中以英语发表的同行评审研究。使用批判性评价技能计划工具评估研究的质量。
设置/参与者：讨论有复杂需求的孕妇以妇女为中心的护理的促进因素和障碍的已发表研究。有 13 篇论文符合本综述的纳入标准。
本综述表明，组织和专业权力差异造成了以妇女为中心的护理障碍，并引发了专业边界紧张。对于复杂妊娠的妇女来说，这使她面临在产妇服务、护理模式和卫生提供者之间“脱节”的风险。
女性、分娩和助产护理仍然在很大程度上受到以生物医学为基础的产妇护理模式的限制。虽然已经确定了以妇女为中心的护理障碍，但对于妊娠复杂的妇女来说，当护理需要多专科投入并跨越医疗保健的界限和孤岛时，似乎几乎没有解决办法。
