From Midwife-Dominated to Midwifery-Led Antenatal Care: A Meta-Ethnography.

Bente Dahl,Terese Elisabet Bondas,Kristiina Heinonen

doi:10.3390/ijerph17238946

Abstract

Provision of antenatal care includes risk identification, prevention and management of pregnancy-related diseases, but also health education, health promotion, support and guidance to smooth the transition to parenthood. To ensure good perinatal health, high-quality, free and easily accessed antenatal care is essential. The aim of this study was to identify, integrate and synthesize knowledge of midwives’ experiences of providing antenatal care, attending to clients’ individual needs whilst facing multiple challenges. We conducted a meta-ethnography, which is a seven-step grounded, comparative and interpretative methodology for qualitative evidence synthesis. A lines-of-argument synthesis based on two metaphors was developed, based on refutational themes emerging from an analogous translation of findings in the included 14 papers. The model reflects midwives’ wished-for transition from a midwife-dominated caring model toward a midwifery-led model of antenatal care. Structural, societal and personal challenges seemingly influenced midwives’ provision of antenatal care. However, it emerged that midwives had the willingness to change rigid systems that maintain routine care. The midwifery-led model of care should be firmly based in midwifery science and evidence-based antenatal care that emphasize reflective practices and listening to each woman and her family. The change from traditional models of antenatal care towards increased use of digitalization no longer seems to be a choice, but a necessity given the ongoing 2020 pandemic.

Highlights

Good perinatal health has a major impact on public health, including the health of individuals, society and future generations [1]
The studies described midwives’ experiences related to offering antenatal care (ANC) and developing a relationship with the women in their care. They described the importance of engaging fathers, providing parenthood education, caring for minority ethnic women, communication and the use of information and communications technology (ICT)
We developed the lines-of-argument synthesis of two metaphors of a midwife-dominated model of care shifting toward a midwifery-led model of care based on the refutational findings of midwives’

Summary

Introduction

Good perinatal health has a major impact on public health, including the health of individuals, society and future generations [1]. To ensure good perinatal health, high-quality, free, and accessed antenatal care (ANC) is vital. According to the World Health Organization (WHO), antenatal care can be defined as ‘The care provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best health conditions for both mother and baby during pregnancy. The components of ANC include: risk identification; prevention and management of pregnancy-related or concurrent diseases; and health education and health promotion’ The organization of antenatal care is an important part of maternity care. It varies throughout the world but is generally provided within.

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