Woman-centred care and the socially disadvantaged woman: an Interpretative Phenomenological Analysis

Research Doctorate - Doctor of Philosophy (PhD)Woman-centred care, a midwifery philosophy underpinning maternity care, is defined as care that focuses on the individual woman’s needs, providing her with choice, continuity of care and control over maternity services. While woman-centred care is currently the dominate discourse related to midwifery practice, debates concerning the meaning and effectiveness of woman-centred care in practice are occurring. A preliminary step in resolving debates regarding woman-centred care and midwifery practice is to develop an understanding of how the recipients and providers of woman-centred care interpret their experiences. Aim of study: The purpose of this study was to generate understanding of woman-centred care as experienced by socially disadvantaged women, registered midwives and student midwives who observe midwife-woman interactions during maternity care encounters. The research question presented was - How do socially disadvantaged childbearing women, registered midwives, and student midwives understand woman-centred care?” Research approach: Interpretative Phenomenological Analysis was used to gain an understanding of woman-centred care as experienced by midwives working with socially disadvantaged women, the women for whom the care is provided, and student midwives observing maternity encounters involving socially disadvantaged women. Interpretative Phenomenological Analysis is an approach to qualitative, experiential research informed by concepts and debates from three key areas of the philosophy of knowledge: phenomenology, hermeneutics and idiography. The midwifery concept and maternity care philosophy, woman-centred care, was used to guide the interpretative process when analysing the recounted experiences of participants. Data was collected primarily through focus groups with women, midwives and student midwives over multiple sites in Australia. Findings: There are two major findings from this study. Firstly, that woman-centred care is largely absent within the maternity care encounters of socially disadvantaged women. Participating women understand that midwives are not available for socially disadvantaged women. When the midwife is unavailable, the woman does not feel valued or safe to engage in their maternity care. The second finding is that socially disadvantaged women have a different understanding of what constitutes woman-centred care than midwives have. While women spoke of the actions and interactions within individual maternity care encounters as being either woman-focused or not, midwives and students spoke of models of care and conditions that either support or hinder woman-centred care. Conclusion: It is time for midwives to consider how care described by the woman as woman-centred can be implemented within every maternity care encounter and every midwifery context. Midwives need to focus on the conditions which may or may not support them to adopt elements of care perceived, by women, to be woman-centred. Women want a midwife that is available for them. In order for the midwife to be available for the woman and create the conditions in which the woman is able to feel valued and safe, the midwife must equally have available the resources and conditions in which they can feel valued in their midwifery choices and safe in their midwifery voices. Local Health District management needs to make available support systems and resources that enable midwives to be available for socially disadvantaged women. Midwifery practice and education needs to incorporate the concepts being available, being valued and being safe into midwifery and maternity care discourse so that all midwives understand that the provision of woman-centred care is possible in all midwifery contexts and is achievable for socially disadvantaged women