Problem/Background: In midwifery practice we espouse a woman centred care approach to practice, yet in midwifery education no valid instrument exists with which to measure the performance of these behaviours in midwifery students.

Aim: To develop and validate an instrument to measure woman centred care behaviours in midwifery students.

Method: We identified four core concepts; woman’s sphere, holism, self-determination and the shared power relationship. We mapped 18 individual descriptive care behaviours (from the Australian National Competency Standards for the Midwife) to these concepts to create an instrument to articulate and measure care behaviours that are specifically woman centred.

Review by expert midwifery clinicians ensured face, content and construct validity of the scale and predictive validity and reliability was tested in a simulated learning environment. Midwifery students were video recorded performing a clinical skill and the videos were reviewed and rated by two expert clinicians who assessed the woman centred care behaviours demonstrated by the students (n=69).

Findings/ Discussion: Test and re-test reliability of the instrument was high for each of the individual raters (Kappa 0.946 and 0.849 respectively p <.001). However, when raters were compared there were differences between their scores suggesting variation in their expectations of woman centred care behaviours (Kappa 0.470, p<.001). Midwifery students who had repeated exposures to higher levels of simulation fidelity demonstrated higher levels of woman centred care behaviours.

Conclusion: The WCCS has implications for education and the wider midwifery profession in recognising and maintaining practice consistent with the underlying philosophy of woman centred care.

Objective: The objective of this review was 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’ (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 into themes and subthemes. Initial pre-determined subsets of woman centred care in clinical practice, maternity service and education were used as a framework to further identify subthemes and synthesize the findings. Analysis revealed 10 subthemes synthesized under three 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 the pre-determined subsets of 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 may be contributing 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.

Research aim: The aim of this study is to elicit expert opinion and gain consensus in order to develop a definition of woman-centred care by using the Delphi methodology.

Recruitment of experts: The International Confederation of Midwives (ICM) is a global, accredited, non-governmental organization (NGO) that works closely with the World Health Organization (WHO), United Nations Population Fund (UNFPA) and United Nations Children’s Emergency Fund (UNICEF) and other NGOs worldwide to achieve common goals in the care of mothers and children. The ICM supports and represents over 500,000 midwives and works to strengthen professional associations of midwives throughout the world. Currently there are 132-member associations representing 113 countries that are organised into six regions and encompass all continents; making this association the ideal source for recruitment of global Expert Midwives ( ICM, 2107).

Recruitment of the Delphi Surveys is complete and all midwifery members who serve on the ICM Research, Regulation, and Education, Standing Committees were contacted via email and their participation invited. Secondly, to ensure a global reach, invitations for Expert Panel membership was  sought from each the six regions of the ICM (Africa, Americas, Western Pacific, Eastern Mediterranean, South East Asia, and Europe). Additionally, researchers who had published primary research directly related to the concept of woman-centred care were individually contacted and asked to participate.

Subsequent surveys: After each survey the Expert Midwives were  re-surveyed and asked to state the extent to which they agree or disagree (using a five-point Likert scale) with statements collated from the preceding survey, as well as being asked to rank each statement in terms of importance for defining woman-centred care. Each survey was analysed using SPSS® and results recirculated detailing the level of consensus reached.

Results and analysis: Results of surveys two and three were analysed using a variety of techniques; firstly, response rates were reported. Secondly, the percentage of participants choosing each level of agreement for each statement were presented, then the median, range and interquartile range of the Likert scale responses for each statement was calculated. Finally, a weighted Kappa statistic (along with 95% confidence interval) was calculated to determine the level of agreement. Similar techniques were used to describe the rankings of important ratings. 

Findings: A panel of 59 expert midwives representing 22 countries participated. Fifty-nine statements about woman-centred care, of which 63% of statements reached the 75% a priori agreement level, were developed and categorised under four emergent themes: defining characteristics of woman-centred care (n = 17), the role of the midwife in woman-centred care (n = 19), woman-centred care and systems of care (n = 18), woman-centred care in education and research (n = 5). Discussion Participants agreed that woman-centred care should be provided by any health care professional in any health care setting. Systems of maternity care should provide holistic care tailored for the individual woman rather than subject her to routine practices and policies. Although continuity of care is important to midwifery practice, it was not reported as a core characteristic of woman-centred care.

Conclusion: This is the first study to investigate the concept of woman-centred care as it is experienced globally by midwives. The findings of this study will be used to contribute to the development of an internationally informed evidence-based definition of woman-centred care.

Developing an evidence-based international definition of woman-centred care to inform practice.

Introduction and Aim: Woman-centred care is a fundamental concept used in national and international healthcare and midwifery practice. However, there is not an internationally-informed definition of woman-centred care, and this remains an identified gap in the evidence.  The aim of this study was to develop an evidence-based definition of woman-centred care informed by empirical literature and international midwifery practice for use in midwifery clinical practice, maternity services, education, and research.

Methods: A three-stage concept analysis was undertaken using an adapted theoretical and colloquial evolutionary model. Stage-1 examined the empirical literature on woman-centred care and identified theoretical attributes, antecedents, and consequences. Stage-2 examined the colloquial language of international midwives in our recent Delphi study to identify the colloquial attributes, antecedents, and consequences of woman-centred care. Both theoretical (Stage-1) and colloquial (Stage-2) understandings of the concept were used in Stage-3 to construct an evidence-based, internationally informed midwifery definition of the concept of woman-centred care.

Results: Antecedents of woman-centred care are education, models of care and the midwife characteristics. Attributes of woman-centred care are choice and control, empowerment, and relationships. Consequences are shared and informed decision making which supports the woman in navigating complex health systems and improves the health outcomes of both the woman and neonate.

Conclusion: The use of a shared unambiguous evidence-based international definition of woman-centred care is essential for translation of this fundamental concept to practice. The emergent evidence informed definition of woman-centred care will be presented on conclusion of this presentation.  

Evidence based definition of Woman-centred care: 

“Woman-centred care ensures the woman has choice and control in her childbearing experience. Relationships built on reciprocal trust and respect foster empowerment, which recognises the woman’s innate ability to meet her own needs. This is upheld through evidence-based shared and informed decision-making that supports the woman to navigate complex health systems and ultimately improves health outcomes for both the woman and neonate”.