Woman-centred maternity care

Introduction: postdate pregnant women with one previous caesarean section that are planned for vaginal birth after caesarean sections are faced with adverse pregnancy outcomes. This trial was conducted to determine the effect of serial membrane sweeping from 38 weeks gestation in pregnant women planned for vaginal birth after caesarean section. Methods: this randomized controlled trial (RCT) was conducted on 90 women at 38 weeks with one previous caesarean section. In the study group, membranes sweeping commenced at 38 weeks and repeated weekly till labour onset. If no labour onset at 41 weeks and 3 days, elective caesarean section was done. In the control group, patients awaited labour onset till 41 weeks and 3 days, after which elective caesarean section was done. Data collected were analyzed using the Statistical Package for Social Sciences (SPSS ver. 22). All analyses were done at p<0.05. Results: labour onset before 41 weeks and 3 days was statistically significantly higher in the study group compared to the control group (RR= 1.5; 95% CI: 1.1 -2.0; P=0.006). Likewise, successful vaginal birth after caesarean section was statistically significantly higher in the study group (RR=1.7; 95% CI: 1.2-2.5; P = 0.001). Conclusion: serial membrane sweeping from 38 weeks gestation has significant beneficial effect on labour onset and successful vaginal delivery in women with one previous caesarean section.

Background/Problem: To integrate midwife-led care in Belgian maternity services, understanding whether midwives are primed of executing the change is needed.

Aim: To explore Belgian midwives’ readiness for midwife-led care and understand the underlying processes.

Methods: A mixed-methods sequential study: 1) A survey including 414 practising midwives and 2) individual interviews with 12 (student) midwives. General linear model analysis was used to examine the trend between
knowledge, self-efficacy and performance mean scores - indicators of midwife-led care readiness - proposed in a 27-item questionnaire. The Readiness Assessment Framework served as a template for qualitative thematic analysis.

Findings: Template analysis illustrated the underlying mechanisms of midwifery-led care readiness: Governmental and institutional steering and rule-making functions, regulation and reimbursement, awareness of
midwife-led care among stakeholders, capacity to extend primary care postpartum services to antenatal and intrapartum care and healthcare professionals’ lack of awareness of available data of women’s experiences and midwife-led care efficacy in Belgium. These qualitative findings contribute to the understanding of the significant trend with decreasing function for knowledge, self-efficacy and performance mean scores of 25 midwife-led care readiness indicators, and the two non-significant indicators referring to a physiological postpartum period.

Discussion/Conclusion: In determining midwife readiness for midwife-led care, we observed adequate knowledge mean scores, associated with low self-efficacy and even lower midwife-led care performance mean scores. Our
findings suggest limited readiness for MLC in antenatal and intrapartum care. Belgian midwives are the domain experts of postpartum

This study examines how the extension of the period of parental leave, from 60 days to 180 days that occurred in the Maldives in 2019, affected the family dynamics of mothers and their children. Purposive sampling technique was used to collect data from seven full-time working mothers, who had experienced both shorter and longer parental leave. The data was collected through semi-structured interviews. The most prominent finding was the higher level of involvement of father in taking care of the child with mothers reporting substantial strengthening in mother-child bond and the husbandwife relationship as parents during the longer parental leave. This research adds a new dimension to the discussion of the impact of longer parental leave legislation on family consolidation outcomes. It also has implications for the development of family policies that support the needs of both mothers and fathers during the first months of an infant's life.

Humanised midwifery care is a fundamental human right and need. This exploratory online survey presents a collective perception of meaningful standards of humanised midwifery care for excellent daily practice obtained from an international multi-actor group of maternity service users and providers. After performing a literature review, 137 key elements of humanised midwifery were extracted, listed, and rephrased into criteria. The criteria were distributed, and participants added 38 criteria. The perceived level of humanised midwifery performance was scored from 1 (low/substandard) to 10 (excellent). The 9-10 scores benchmarked humanised midwifery care excellence. 312 care professionals benchmarked 42 criteria, and 277 pregnant and postpartum women benchmarked 23 criteria showing a 30 % overlap. A total set of 50 criteria emerged, promoting humanised midwifery excellence. The benchmarking criteria suggest a shared conceptual thinking of person-centeredness and meaningfulness and provide a practical paradigm for the provision and receipt of humanised midwifery care.

Background: Facilitation of mutual participation, respectful and egalitarian relationship between the mother and the midwife during childbirth is a critical aspect. This article delineated the criteria that would facilitate the implementation of woman-centred care in childbirth units of the Limpopo Province in South Africa, following a concept analysis described in Part 1. Empirical referents or indicators were used to measure the concept woman-centred care and to validate its existence in reality. These empirical referents were referred to as measurable properties that further verified the concept. Objective: The objective of this article was to formulate criteria that would facilitate implementation of woman-centred care in childbirth units of Limpopo Province in South Africa. Method: Criteria to facilitate the implementation of woman-centred care were formulated by the gathering of information about the topic under review and the use of resources to define the key elements of the criteria which were integrated into the Batho Pele principles. The criteria were then validated by selecting with a vested interest in the successful development and implementation of the criteria. Results: Criteria were formulated to facilitate the implementation of woman-centred care that was integrated within the framework of Batho Pele principles. Conclusion: These formulated criteria for woman-centred care will be used as an institutional self-evaluation tool to enhance implementation of the Batho Pele principles in childbirth units. These criteria will give direction and provide guidelines for the performance of midwifery staff and will also help supervisors to guide staff to improve performance.

Woman-centred care' in childbirth is a process in which a woman makes choices and is involved in and has control over her care and relationship with her midwife. The aim of this paper is to study the concept of woman-centred care through analysis in the context of childbirth. The attributes, antecedents and consequences of this concept are identified, and a model case, a borderline case and a contrary case constructed to achieve conceptual clarity. A concept analysis was undertaken as described by Walker and Avant (2011), with an extensive exploration of domain-specific literature and evidence from various disciplines. It was established from the concept analysis that 'woman-centred care' was complex and experienced individualistically. The analysis indicated that mothers' participation is supposed to be based on a more collaborative relationship and partnership. Participation is exhibited by open communication and the mother's involvement in decision-making, consultation and collaboration with the attending midwife, further characterised by mutual respect and the midwife listening to the mother's views. There is also an exchange of complete and unbiased information, recognition and honouring of cultural diversity and making of informed choices. Through an inductive discovery approach and drawing on inferences, attributes were clustered in an attempt to identify the apparent essence of the concept. From the results of the concept analysis described in this study, the researchers recommend the formulation of criteria that could facilitate implementation and evaluation of womancentred care and its empirical referents in the context of the Batho Pele principles (Part 2).

Objective: To reach consensus between care providers and childbearing women about the midwife's relevant and appropriate domains and elements to support transition to motherhood.

Methods: A modified web-based Delphi study was conducted in Flanders (Belgium). After performing a systematic literature review, searching the grey literature and an online poll, a set of 79 items was generated. In two rounds, the items were presented to an expert panel of (1) care providers from various disciplines providing services to childbearing women and (2) to pregnant women and postpartum women up to 1year postpartum. Consensus was defined when 70% or more of the experts scored ≥6, 5% or less scored ≤3, and a standard deviation of ≤1.1.

Findings: In the first Delphi round, 91 experts reached consensus on 24 items. Seventeen round one items that met one or two consensus objectives were included in round two and were scored by 64 panel experts, reaching consensus on three additional items. The final 27 items covered seven domains: attributes, liaison, management of care from a woman-centred perspective, management of care from the midwife's focus, informational support, relational support, and the midwife's competencies.

ConclusionS: The shared understanding between childbearing women and care providers shows that the midwife's transitional support is multifaceted. Our findings offer midwives a standard of care, criteria, guidance, and advice on how they can support childbearing women during transition to motherhood, beyond the existing recommendations and current provision of transitional care.

For decades, national paid maternity leave policies of 12 weeks or more have been established in every industrialized country except the United States. Despite women representing 47% of the current U.S. labor force, only 16% of all employed American workers have access to paid parental leave through their workplace. As many as 23% of employed mothers return to work within ten days of giving birth, because of their inability to pay living expenses without income. We reviewed recent studies on the possible effects of paid maternity leave on the mental and physical health of mothers and children. We found that paid maternity leave is associated with beneficial effects on (1) the mental health of mothers and children, including a decrease in postpartum maternal depression and intimate partner violence, and improved infant attachment and child development, (2) the physical health of mothers and children, including a decrease in infant mortality and in mother and infant rehospitalizations...

Background: Midwife-led continuity of care (MLCC) is an evidence-based care model positively influencing the health and wellbeing of women and their families. Despite the evidence, a sustainable future of the model is uncertain. The aim of this paper is to give an example of a theoretical exercise that enhances the understanding of the trends and developments impacting MLCC's future state.

Methods: The industrial complex theory scaffolded the theoretical approach. The intuitive logics scenario development methodology was used to structure the key variables that influence the utility of MLCC. Dimensionally structured scenarios representing the probable, possible and probable MLCC futures were written.

Results: Thirteen key variables that greatly impact the future MLCC, with varying degrees of certainty were identified. A theoretical framework representing two underlying meta dimensions of MLCC was constructed: identity system of midwife-led continuity of care (fixed vs fluid) and embodied orientation to the world (reasoning vs meaning making). Within the framework, four different storylines of possible, plausible prospective futures emerged: Sense & sensibility, The birth of mothers, Too many sisters and One-stop-shop.

Conclusion: The paper is an example of how to approach the future of MLCC, the method serving as a tool to establish a theoretical truth of how its future state may unfold, the scenarios facilitating a dialogue among stakeholders and informing the public.

Background: Equipping midwives and nurses with confidence to provide bereavement care to parents who have experienced a perinatal loss is vital and impacts on the efficacy of the care received by grieving parents. In education and clinical practice environments there are shortages of bereavement care questionnaires specifically designed to measure midwives' and nurses' confidence and psychosocial factors that impact on their confidence to provide bereavement care. Aim: The purpose of the study was to develop a valid and reliable perinatal bereavement care confidence scale (PBCCS). Methods: The PBCCS was developed in 4 phases. Phase 1: Questionnaire development, 44 questions were formulated from the literature. Phase 2: Face and content validation of the PBCCS by an Expert Panel. Phase 3: A pilot study was conducted and included 10 cognitive pre-testing interviews and test-retest reliability assessment with a cohort of 26 midwives. Phase 4: Construct validity was assessed using factor analysis with 277 midwives and nurses. In order to avoid confusion with terminologies, the term midwife was used for both nurses and midwives who provided care to bereaved parents and participated in the study. Internal consistency reliability measurement was assessed with Cronbach's alpha. Ethical approval of the study was obtained from four maternity hospitals in Ireland. Results: The PBCCS has 43 items. Bereavement care knowledge (15 items, 3 sub-scales). Bereavement care skills (9 items, 2 sub-scales). Self-awareness (8 items, 2 sub-scales). Organisational support (11 items, 2 subscales). The internal consistency reliabilities ranged from 0.753 to 0.871 except for one subscale 0.663. Conclusions: The PBCCS is a valid and reliable tool with good psychometric properties which can be used to measure midwives' confidence and the psychosocial factors thatimpact on their confidence to provide bereavement care.

Objective: This study aims to explore women’s traumatic childbirth experiences in order to make maternity care professionals more aware of women’s intrapartum care needs to prevent traumatic experiences. Methods: A qualitative exploratory study with a constant comparison/ grounded theory design was performed. Thirty-six interviews were conducted with women who had given birth in a Dutch birth setting. Findings: Four themes, playing a profound role in the occurrence of traumatic birth experiences, emerged: 1 Midwife-LED care – Maternity care professionals’ unilateral decision making during intrapartum care. 2. Alienation – Women’s experiences of feeling distant and estranged from the childbirth event and the experience. 3. Situatedness – The difference of the impact of interventions in situations when complications or emergencies are present in contrast to when interventions are performed without an emergency reason. 4. Discrepancies Paradoxes between expectations (ought self) and re...

Background: The philosophy of midwifery education is based on the 'Women-centred care' model, which provides holistic care to women. Continuity of care (CoC) is integral to the concept of holistic women-centred care and fundamental to midwifery practice. The objective of this study was to determine any differences in students' understanding of midwifery care philosophy between students who underwent the CoC learning model and those who underwent the fragmented care learning model. Method: We used a quasi-experiment design. This study was conducted by all final year midwifery students at two schools of midwifery in Indonesia. Fifty four students from one school attended 6 months of clinical training using the CoC learning model. The control group was comprised of 52 students from the other school. These students used the conventional clinical training model (the fragmented care learning model). The independent T-test using SPSS was used to analyse the differences between the two groups of students in terms of understanding midwifey care philosophy in five aspects (personalized, holistic, partnership, collaborative, and evidence-based care). Results: There were no significant differences between the groups before interventon. There were significant differences between the two groups after clinical training (p < 0.01). The mean post-clinical score of students using all five aspects of the CoC clinical learning model (15.96) was higher than that of the students in the control group (10.65). The CoC clinical learning model was shown to be a unique learning opportunity for students to understand the philosophy of midwifery. Being aligned with midwifery patients and developing effective relationships with them offered the students a unique view of midwifery practice. This also promoted an increased understanding of the philosophy of women-centred care. Zero maternal mortality rate was found in the experiment group. Conclusion: The results of this study suggest that clinical trainingwith a CoC learning model is more likely to increase students' understanding of midwifery care philosophy. This in turn improves the quality ofclinical care, thereby enhancing overall health benefits for women.

Background Τhe Baby Buddy Cyprus webapp was co-created with parents and health professionals within a Participatory Action Research framework. Baby Buddy can support the educational role of mother-child healthcare providers (HP); however, antenatal education (AE) may be currently perceived as a formal activity within the physical space of the antenatal class. We aimed to gain an understanding of in uences on midwives engaging in an educational role during routine appointments and propose, on the basis of the 'behaviour diagnosis', a potential intervention using the Behaviour Change Wheel (BCW) framework. Methods This is a formative research study guided by the COMB model and related Theoretical Domains Framework (TDF). Complimentary methods were used to collect information from in-training and registered midwives: focus group (N = 11), questionnaire survey (N = 24) and Nominal Group Technique during workshops (N = 40). Deductive content analysis of qualitative data and quantitative survey analysis, tapping on 6 COMB and 14 TDF domains, guided the design of a multicomponent intervention. Results AE is viewed as a core function of the professional role, yet neither supported nor prioritized by current practices. Problematic areas relate to organizational context, such as weak interprofessional collaboration and lack of policy, protocols and resources. In addition, medicalization of birth and related socio-cultural norms, pertaining to users and providers, are sustaining alienation of the midwife and conditions of power dynamics. AE was perceived as a means to enhance the autonomy of the profession but there are might be issues with procedural knowledge and the need for skill development was identi ed. Several intervention functions were identi ed as promising, however cognitive re-framing through strategic communication and modelling may also be needed both in terms of providing "credible models" for the role itself as well as re-framing AE through the concept of "making every contact count". Conclusions AE is currently perceived to be a 'bad t' with routine practice. The study proposed an intervention to enhance midwives' educational role and professional identity, while embedding Baby Buddy in clinical practice to facilitate the process. In addition to designing a theory-driven research-informed potential intervention, the process functioned as a participatory learning experience through collective re ection. Contribution To The Literature Digital tools and resources have the potential to transform antenatal education but only if adopted by healthcare providers as part of everyday clinical practice. Several barriers to being an effective educator have been described; yet, previous studies do not always incorporate an explicit process of translating the ndings into designing an intervention to affect change. This study describes all the stages of the Behaviour Change Wheel process from using mixed-methods to diagnose the issue among midwives in Cyprus to intervention mapping. Guided by Participatory Action Research, the process was also instrumental in cultivating a new shared awareness of the issue. Background The transition to parenthood is a "window of opportunity" for the establishment of health-promoting behaviours. The goal of antenatal education (AE) is to support expectant parents through this life-changing event [1, 2]. "Traditional" approaches to AE include structured programmes, of various duration and content, often in group sessions, mainly focusing on preparation for childbirth. Attendance is not always high; in Cyprus, only one in three women attend classes [3, 4]. Furthermore, their effectiveness has been questioned in terms of whether they address the real needs of expectant parents [5-8] and their inclusiveness with evidence of inequalities in access and outcomes [9-11]. While every contact with a healthcare provider can be a "teachable moment" [12], these encounters may not be as rewarding and the experience can be dependent on the quality of the user-provider communication [13, 14]. The WHO recommendations (2016) for a positive pregnancy experience and optimal maternal and newborn health refer to "Respectful Maternity Care" [15]. The framework recognizes informational and emotional support as a prerequisite, provided "by knowledgeable, supportive and respectful health-care practitioners with good clinical and interpersonal skills within a well-functioning health system". A range of reasons have been previously described as to why healthcare providers may not be actively engaging with expectant parents in an educational capacity during appointments, such as time and resource constraints but also lack of con dence in skills and competences [16-18]. New technologies are playing an increasingly important role and digital innovation can assist in the education role [19]. Baby Buddy Forward is a Participatory Action Research programme which assessed the cross-cultural transferability of the Baby Buddy app from the UK to Cyprus. The Baby Buddy Cyprus webapp was co-created through an iterative approach with the participation of over 800 parents-to-be and health professionals. Other than widening opportunities to evidence-based information, Baby Buddy offers a complimentary tool to assist healthcare providers in their educational role. However, the impact of digital technologies can only be maximized when embedded in local care pathways. Aim This formative study aims to (a) gain an understanding as to why midwives in Cyprus may not be actively engaging in an educational capacity during routine appointments and (b) propose an intervention guided by the Behaviour Change Wheel. While the issue concerns all maternal-child healthcare providers, antenatal education is a core part of midwives' professional role. Methods A range of methods can be utilized in the process of behaviour diagnosis [20]. The study reports on three complementary sources: focus group (study A), questionnaire survey (study B) and participatory learning workshop (study C). In all three, the COMB model and Theoretical Domains Framework (TDF) were adopted for informing data collection and analysis.

Background Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. Methods OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates &lt; 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807),...

INTRODUCTION In the Netherlands birth centres have recently become an alternative option as places where women with uncomplicated pregnancies can give birth. This article focusses on the job satisfaction of three groups of maternity care providers (community midwives, clinical care providers and maternity care assistants) working in or with a birth centre compared to those working only in a hospital or at home. METHODS In 2015, an existing questionnaire was adapted and distributed to maternity care providers and 4073 responses were received. Using factor analyses, two composite measures were constructed, a Composite Job Satisfaction scale and an Assessment-of-Working-in-or-with-a-Birth-Centre scale. Differences between groups were tested with Student's t-test and MANOVA with post hoc test and linear regression analyses. RESULTS The overall score on the Composite Job Satisfaction scale did not differ between community midwives or clinical care providers working in or with a birth centre and those working in a different setting. For maternity care assistants there was a small but significantly higher score for those not working in a birth centre. Maternity care assistants' overall job satisfaction score was higher than that of both other groups. In a linear regression analysis working or not working in or with a birth centre was related to the overall job satisfaction score, but repeated for the three professional groups separately, this relation was only found for maternity care assistants. CONCLUSIONS Job satisfaction is generally high, but, except for maternity care assistants, not related to the setting (working or not working in or with a birth centre).

Background Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. Methods OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates &lt; 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807),...

Professional is a character value that must be possessed by every profession included midwife. It is important to know what factors contribute to build the character of professional midwife, and what the most factor contribute to character professional midwife. The objective of this study was to analyze the factors contributing to professional midwife character of students in midwifery department. The subject of study were all students in midwifery department health polytechnic between August, 2018 and November, 2019, were included in this study a total of 353 students. Data was collected by filling out questionnaires, and data analysis used the Pearson Correlation test and multiple regression. The results showed that some of respondent characteristics (Program, Class Level, Ideals, Parents condition) have correlation with professional midwife character. Likewise the values of motivation, caring, professional wisdom, self-development, interpersonal competence and professional competence have a correlation with professional midwife character. Other factors, professional character building in learning process, institutional culture, extracurricular activities and student organizations have correlation with professional midwife character. And of all these factors, professional competence is the most contributing factor to professional midwife character. The conclusion from this study that the factor that most contributes to the character of professional midwives is professional competence.

INTRODUCTION Increasing numbers of maternity units are implementing routine and standardized monitoring of all women using a form of Early Warning Score System with the aim to early detect women at risk of developing critical illness or a deterioration of their condition. The implementation in Norway is relatively new. This study aimed to describe Norwegian midwives' experiences with the Obstetric Norwegian Early Warning System (ONEWS). METHODS We performed a cross-sectional study based on an electronic questionnaire, sent to heads of midwifery at all maternity units in Norway for distribution to their clinically active midwives. Thirty-one of 48 units had implemented ONEWS for over a month. About 1020 midwives received the questionnaire, 232 (23%) responded. RESULTS Of the participants, 217 (93.5%) reported receiving sufficient training and 230 (99.1%) reported using the same scoring system, including the same vital parameters measured. The criteria for use of ONEWS varied between units regarding inclusion criteria and frequency of scoring. A total of 214 (92.2%) midwives agreed that ONEWS has value in the surveillance of high-risk women, while 152 (65.5%) agreed that ONEWS contributes to medicalization of the care of low-risk women. Some 166 (71.6%) midwives reported that ONEWS was time consuming and 159 (68.5%) that the measures need to be better adapted to childbearing women. CONCLUSIONS Maternity units in Norway implementing ONEWS use an almost identical scoring system but varying criteria for whom to score and how often. Midwives considered ONEWS particularly suited for high-risk women and not for low-risk childbearing women.

This study investigated one of an important but a disregarded topic of the economy, maternal employment. The study assessed the context, features and determinants of maternal employment in urban eastern Ethiopia with a focus on two cities: Jigjiga and Dire Dawa. The study employed a mix of qualitative and quantitative techniques and tools of analysis and inference to achieve its objectives. The socioeconomic status of mothers subjected for this study shows that a majority of them have no enough income from husbands to cover the household expenses, and required them of seeking for pay jobs. On the other hand, education level and family burden holds them back from formal employments. Moreover, gender based discriminations in the labor market is also reported another challenge not to sell their labor. Pregnancy/maternity leave, difficulties to find child care services and job related reasons were also raised as major reasons for mothers not to go for paid job in the past one year. The study further assessed on the importance of social support mothers can access in times the need arises for the protection of their children. The response in this regard shows a majority of mothers were having access for child care supports from their social network (like families, friends or neighbors). The study also assessed on possible implications of households’ decisions for pay works on wellness of their family. Findings show that majority of respondent mothers were of the take that they would rather remain at home managing their family and caring their children than looking for pay jobs had the income of the income from their husbands was enough to settle family expenses. The price of motherhood was also examined ascribed to preferences of mothers’ success at work to success at home. The intent was to learn on mothers` perception on the relative importance of being successful at work against to succeed at home delivering care to children. The finding in those regards reveals that mothers objectively evaluated the case, and the price of motherhood for sake of wellbeing family and children is inferred. As the study concludes, mothers actually work for safety of their families and children while they could generate better personal gratitude if they involve in outside jobs.The study found out that the issue of maternal employment a key social issue, but lacked interventions from academic/research and policy regimes. In this regard, a host of factors should be taken into play if to properly understand the contexts, features and determinant factors of maternal employment. These include household specific, institutional and social elements. And, the study suggests future endeavors in the realm of academic, research and/or policy interventions to consider those important variables.

Background Current study was conducted with the aim of explaining domains of clinical competence in undergraduate midwifery students so that it addresses the challenges in midwifery curriculum and improving clinical assessment methods in Iranian undergraduate midwifery students. Methods Qualitative approach and conventional content analysis were used in the design of the present study. The research setting included midwifery and nursing schools and hospitals and health centers affiliated to Tehran and Guilan universities of medical sciences in Iran. The target population consisted of undergraduate midwifery students in the fourth to eighth semesters of school, midwives working in hospitals and health centers, midwifery faculty members, and obstetricians. The participants were selected through purposive maximum variation sampling, which continued until data saturation. After in-depth semi-structured interviews, the content of the interviews was analyzed according to the steps propose...

Background: There is a shift in focus of the curricula of undergraduate midwifery research-education-from research content to the research process, and the student from being an observer to a participant. Aim and Methods: To explore an example of how to involve midwifery students as co-investigators in research. This paper discusses the experiences of an educational research project that adopted the highest level of student autonomy in research, involving six Bachelor of Midwifery final-year students participating as co-investigators in qualitative research focusing on women's lived experiences of traumatic childbirth. The experiences are supported by the parameters of research-education and learning, and are discussed in the context of the dimensions of framing undergraduate research: Motivation, Inclusivity, Content, Originality, Setting, Collaboration, Focus and Audience Discussion: Crucial for this educational research project is the recognition of the motivation, interests, (experiential) knowledge and real-world experiences of students. It starts with listening to the questions, thoughts and ideas that students bring, recognising and respecting the content and importance of their work and what is important and meaningful to them, while facilitating a student-led learning process. Collaboration between students and students and supervisors needs to be formally facilitated and supported, as this contributes to qualitative products for curricular and extra-curricular products. An academic infrastructure is necessary to support extra-curricular activities. Conclusion: To embed research adequately and effectively in the curriculum, a pedagogical approach, institutional learning and student-centred teaching strategies and practices, including high impact practices to mainstream undergraduate research and enquiry, are crucial.

PROBLEM Within maternity care policies and practice, pregnant migrant women are regarded as a vulnerable population. BACKGROUND Women&#39;s experiential knowledge is a key element of woman-centred care but is insufficiently addressed in midwifery practice and research that involves migrant women. AIM To examine if pregnant migrant women&#39;s experiential knowledge of vulnerability corresponds with sets of criteria of vulnerability, and to explore how migrant women make sense of vulnerability during pregnancy. METHODS A sequential two-phased mixed-methods study, conducted in the Netherlands, integrating survey data of 89 pregnant migrant women and focus group data obtained from 25 migrant mothers - living in deprived areas according to the Dutch socio-economic index. RESULTS Criteria associated with vulnerability were reported by 65.2% of the participants and 62.9% of the participants reported adverse childhood experiences. On a Visual Analogue Scale, ranging from 0 (not vulnerable) to 10 (very vulnerable), participants self-reported sense of vulnerability withshowed a mean score of 4.2 (±2.56). Women&#39;s experiential knowledge of vulnerability significantly correlated with the mean sum score of clinical criteria of vulnerability (r .46;, p .002) and with the mean sum score of adverse childhood experiences (r .48, p&lt;.001). Five themes emerged from the focus group discussions: &quot;Look beyond who you think I am and see and treat me for who I really am&quot;, &quot;Ownership of truth and knowledge&quot;, &quot;Don&#39;t punish me for being honest&quot;, &quot;Projection of fear&quot; and &quot;Coping with labelling&quot;. CONCLUSION Pregnant migrant women&#39;s experiential knowledge of vulnerability is congruent with the criteria. Calling upon experiential knowledge is an attribute of the humane woman-midwife relationship.

Aim: To critically appraise and synthesise the literature regarding the role and scope of midwifery practice, specifically to inform the evidence based development of standards for practice for all midwives in Australia. Design: A structured scoping review of the literature Data sources: CINAHL Complete, MEDLINE Complete and Cochrane Libraries databases, online and grey literature databases Review methods: Comprehensive searches of databases used key words and controlled vocabulary for each database to search for publications 2006-2016. Studies were not restricted by research method. Findings: There is no substantive body of literature on midwifery competency standards or standards for practice. From 1648 papers screened, twenty-eight papers were identified to inform this review. Eight studies including systematic reviews were annotated with three research papers further assessed as having direct application to this review. To inform the development of Midwife standards for practice, the comprehensive role of the midwife across multiple settings was seen to include: woman centred and primary health care; safe supportive and collaborative practice; clinical knowledge and skills with interpersonal and cultural competence. Key conclusions: Midwifery practice is not restricted to the provision of direct clinical care and extends to any role where the midwife uses midwifery skills and knowledge. This practice includes working in clinical and non-clinical relationships with the woman and other clients as well as working in management, administration, education, research, advisory, regulatory, and policy development roles. Implications for practice: This review articulates the definition, role and scope of midwifery practice to inform the development of contemporary standards for practice for the Australian midwife.

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During the period 2006-2008 more than 50% of midwifery students at the college under study failed the midwifery training programme. The academic performance of students can be attributed to various factors, ranging from personal uniqueness and institutional aspects to the course content itself. Accordingly, this study aims to explore the perceptions and experiences of student midwives with reference to their training programme. vi lektor, is ook waargeneem. Studente voel dat dele van die kurrikuluminhoud vir dokters bedoel is. Hulle is van mening dat meer klastyd nodig is om teorie te onderrig, aangesien die kurrikulum oorvol is. Hoewel die leiding op kliniese gebied, deur die kliniese opvoeders, positief ervaar is, is die student-opvoeder verhouding as ʼn uitdaging beskou. Die studente het gevoel dat hul toetse en eksamenantwoordstelle te streng nagesien was.

Recent European studies suggest that fathers' leave-taking may contribute to parental relationship stability. Paternity leave-taking may signal a commitment by fathers toward a greater investment in family life, which may reduce the burden on mothers and strengthen parental relationships. This study uses longitudinal data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) to analyze the association between paternity leave-taking and relationship stability in the United States. Results indicate that paternity leave-taking, and taking relatively short leaves (i.e., two weeks or less) in particular, is associated with greater relationship stability. These findings increase our understanding of the potential benefits of paternity leave, and can inform policy decisions that aim to increase family stability.

Objective: This study examines the associations between paternity leave and parents' reports of relationship satisfaction and relationship conflict, and whether the associations vary by parent gender and mothers' work statuses. Background: Paternity leave research in the U.S. has focused on implications for father involvement, but paternity leave may also help to strengthen parental relationships by promoting a more equitable division of domestic labor. Given gender gaps in childcare, the association between paternity leave and parental relationship outcomes may also vary by gender and mothers' work statuses. Method: The sample consists of 4,700 couples (i.e., parent dyads) from the Early Childhood Longitudinal Study, Birth Cohort. Multilevel models are used to assess the associations between paternity leave and both relationship satisfaction and conflict, and whether these associations vary by gender and mothers' work statuses. Results: Paternity leave-taking is positively associated with parents' reports of relationship satisfaction, but length of paternity leave is only positively associated with mothers' reports of relationship satisfaction. Also, among mothers who worked prior to the child's birth, paternity leave-taking and length of leave are negatively associated with their reports of relationship conflict. In contrast, among mothers who did not work in paid labor pre-birth, paternity leave is positively associated with mothers' reports of relationship conflict. Conclusion: Paternity leave may have implications for parental relationships (and especially mothers' perceptions of their relationships with fathers).

Aim: to evaluate the ISeeYou project that aims to equip first year Bachelor midwifery students to support them in their learning of providing woman-centred care. Methods: the project has an ethnographic design. First year midwifery students buddied up to one woman throughout her continuum of the childbirth process and accompanied her during her antenatal and postnatal care encounters. Participant-observation was utilised by the students to support their learning. The Client Centred Care Questionnaire (CCCQ) was administered to collect data about women's care experiences. The project was evaluated using the SWOT model. Main findings: 54 first year students completed the project and observed and evaluated on average eight prenatal visits and two postnatal visits. Students gained insight into women's lived experiences during the childbirth process and of received care throughout this period. Students reported that this was meaningful and supported and enhanced their comprehension of women-centred care. Logistic issues (lectures, travel, time) and being conscious of their role as an 'outsider' sometimes constrained, but never hindered, the students in meeting the requirements of the project. Overall, the project provided students with opportunities to expand competencies and to broaden their outlook on midwifery care. Conclusion: the project offers students unique and in-depth experiences supporting and augmenting their professional competencies and their personal, professional and academic development.

INTRODUCTION Woman-centered care has become a midwifery concept with implied meaning. In this paper we aim to provide a clear conceptual foundation of woman-centered care for midwifery science and practice. METHODS An advanced concept analysis was undertaken. At the outset, a systematic search of the literature was conducted in PubMed, OVID and EBSCO. This was followed by an assessment of maturity of the retrieved data. Principle-based evaluation was done to reveal epistemological, pragmatic, linguistic and logic principles, that attribute to the concept. Summative conclusions of each respective component and a detailed analysis of conceptual components (antecedents, attributes, outcomes, boundaries) resulted in a definition of woman-centered care. RESULTS Eight studies were selected for analyses. In midwifery, woman-centered care has both a philosophical and a pragmatic meaning. There is strong emphasis on the woman-midwife relationship during the childbearing period. The concept demonstrates a dual and equal focus on physical parameters of pregnancy and birth, and on humanistic dimensions in an interpersonal context. The concept is epistemological, dynamic and multidimensional. The results reveal the concept's boundaries and fluctuations regarding equity and control. The role of the unborn child is not incorporated in the concept. CONCLUSION An in-depth understanding and a broad conceptual foundation of womancentered care has evolved. Now, the concept is ready for research and educational purposes as well as for practical utility.

INTRODUCTION Woman-centered care has become a midwifery concept with implied meaning. In this paper we aim to provide a clear conceptual foundation of woman-centered care for midwifery science and practice. METHODS An advanced concept analysis was undertaken. At the outset, a systematic search of the literature was conducted in PubMed, OVID and EBSCO. This was followed by an assessment of maturity of the retrieved data. Principle-based evaluation was done to reveal epistemological, pragmatic, linguistic and logic principles, that attribute to the concept. Summative conclusions of each respective component and a detailed analysis of conceptual components (antecedents, attributes, outcomes, boundaries) resulted in a definition of woman-centered care. RESULTS Eight studies were selected for analyses. In midwifery, woman-centered care has both a philosophical and a pragmatic meaning. There is strong emphasis on the woman-midwife relationship during the childbearing period. The concept demonstrates a dual and equal focus on physical parameters of pregnancy and birth, and on humanistic dimensions in an interpersonal context. The concept is epistemological, dynamic and multidimensional. The results reveal the concept's boundaries and fluctuations regarding equity and control. The role of the unborn child is not incorporated in the concept. CONCLUSION An in-depth understanding and a broad conceptual foundation of womancentered care has evolved. Now, the concept is ready for research and educational purposes as well as for practical utility.

Highlights  A caseload placement was a quality capstone experience for the midwifery student  The midwife-woman-student relationship resulted in holistic learning and improved confidence  Students valued being able to apply a woman centred social model of care  Whilst challenging, students gained an understanding of sustainable caseload practice  The study reinforced the value of the caseload model for women, midwives and students

INTRODUCTION The purpose of antenatal care is to ensure that a woman has a safe pregnancy and that does not mean absence of any disease during this period. Antenatal care allows screening of preeclampsia, fetal abnormalities and other prevention strategies to be incorporated. The purpose of this study was to assess the reason for attending antenatal care clinics and knowledge of antenatal care content package in women. METHODS A cross-sectional study was conducted on 395 pregnant women attending antenatal care clinic at the Ruth K. M. Pfau Civil hospital, Karachi, Pakistan from 1 July 2019 to 31 December 2019. Each eligible woman was asked about the reason for attendance and her knowledge about WHO standardized antenatal care package. RESULTS The commonest reason for utilizing antenatal care in booked attendees was place of birth concern (25.9%) and in not booked was referral from private centers (33.6%) which was statistically significant (p=0.006). Both booked and not booked women (67.9% vs 59.1%, p=0.409) stated avoidance of complication during pregnancy and labor as the commonest reason for attendance. Women with higher parity were more likely to identify weight measurement (p=0.001), iron and folic acid supplementation (p=0.001), and urine detailed report (p=0.002), as content of the standard package. CONCLUSIONS Our study shows that women did not utilize antenatal care clinics for improving their health or the health of their fetus. The knowledge of the antenatal care package was limited to weight measurement and supplements. Moreover, attendance and visits at an antenatal care facility do not equate to good service provision.

Background: The skills of midwives in childbirth care competence are still inadequate. This problem is influenced by limitation experience of midwifery students of childbirth care in the field of practice area. That condition related to the proportion of midwifery students and case of childbirth woman was an imbalance. Midwifery students must prepare this competence in an education with childbirth care experience from practice in the laboratory and in the field of practice. Reflective learning is an appropriate learning method that uses experience as the basis of learning to improve childbirth care competence of midwifery students. Objective: This study is to analyze the effect of reflective learning implementation in childbirth care practice to improve students' competence. Method: This research uses quasi-experimental design with non-equivalent control group design. The respondents were midwifery students in the fourth semester who had experienced the theory of childbirth care. There were totally 64 samples, 34 samples for treatment group and 30 samples for control group. Data were analyzed by using unpaired t test, Mann Whitney U and linear regression. Results: The respondents were homogeny in motivation and grade point of average (GPA). The improvement of childbirth care competency is influenced by treatment of 19.064 with R 2 = 57.7%. Conclusion: The implementation of reflective learning in childbirth care practice affected the improvement of students' competence.

INTRODUCTION In the Netherlands birth centres have recently become an alternative option as places where women with uncomplicated pregnancies can give birth. This article focusses on the job satisfaction of three groups of maternity care providers (community midwives, clinical care providers and maternity care assistants) working in or with a birth centre compared to those working only in a hospital or at home. METHODS In 2015, an existing questionnaire was adapted and distributed to maternity care providers and 4073 responses were received. Using factor analyses, two composite measures were constructed, a Composite Job Satisfaction scale and an Assessment-of-Working-in-or-with-a-Birth-Centre scale. Differences between groups were tested with Student's t-test and MANOVA with post hoc test and linear regression analyses. RESULTS The overall score on the Composite Job Satisfaction scale did not differ between community midwives or clinical care providers working in or with a birth centre and those working in a different setting. For maternity care assistants there was a small but significantly higher score for those not working in a birth centre. Maternity care assistants' overall job satisfaction score was higher than that of both other groups. In a linear regression analysis working or not working in or with a birth centre was related to the overall job satisfaction score, but repeated for the three professional groups separately, this relation was only found for maternity care assistants. CONCLUSIONS Job satisfaction is generally high, but, except for maternity care assistants, not related to the setting (working or not working in or with a birth centre).

INTRODUCTION Continuity models are rare in Sweden. The aim was to compare the intrapartum care experiences between women who had or not a known midwife attending their birth. METHODS A cohort study was conducted in a rural area with long distance to a labor ward in Sweden. From August 2017 to June 2019, a continuity model with a known midwife was offered between 7 a.m. and 11 p.m. daily. Questions about intrapartum care were assessed in two aspects; the perceived reality and the subjective importance. RESULTS A total of 226 women recruited in early pregnancy were followed up two months after giving birth. Women who had a known midwife providing labor care reported higher overall satisfaction and were more likely to value the subjective importance and the perceived reality significantly higher than women who received intrapartum care without a known midwife assisting. When analyzing the medical aspects of intrapartum care, the most important factors for not being satisfied were defic...

INTRODUCTION Midwifery-led continuity of care models are beneficial to women and babies, but might be challenging for midwives. Several studies have, however, shown that midwives report higher job satisfaction and less burnout when working with caseload. Another challenge is to staff such models in rural areas. The aim of this study was to describe midwives’ experiences of working in a caseload model in a rural region of Australia. METHODS A qualitative descriptive approach using interviews and thematic analysis was undertaken with eleven midwives. RESULTS The overarching theme, ‘A modified caseload model of care in rural Australia creates opportunities for increased job satisfaction despite the challenges involved with being on call’, comprised: two themes, ‘Increased job satisfaction’ and ‘Challenges’; one core theme, ‘Being on call’; and several subthemes. Working with caseload creates job satisfaction and increases vitality and positive feelings about being a midwife. The main d...

Woman-centred care is a philosophy authentic to the midwifery profession, scaffolding and preceding the capacity and utility of woman-centred care in daily practice. Through providing guidance on the philosophical capacities-the virtues-the practical capacity and utility of woman-centred care becomes more clear and more tangible. This paper discusses the virtues of woman‐centred care in midwifery practice. Eighteen virtues, described by Comte‐Sponville, serve as a philosophical lens to explore and understand how each specific virtue integrates into the woman‐centred care concept or vice versa, herewith becoming woman‐centred care virtuous acts. The virtues are politeness, fidelity, prudence, temperance, courage, justice, generosity, compassion, mercy, gratitude, humility, simplicity, tolerance, purity, gentleness, good faith, humour and love. Exploring these virtues provides a manageable view of the complexity of woman‐centred care. In this paper, first each virtue is discussed in relation to the body of knowledge of woman‐centred care in midwifery. Thereafter, a sketch of pragmatism is provided through translating the virtues into practical recommendations for the professional socialization and transformation of becoming, being and doing woman‐centred care.

Background: Midwifery across the world is facing changes and uncertainties. By recognizing plausible future options, a contemporary and strategic scope of midwifery practice and education can be established. The city of Antwerp, Belgium, was the indicative case for this study. Key drivers were identified to serve as input for scenarios.

Method: Structuration theory and intuitive logics scenario planning methods were used to structure contextual midwifery scenarios.

Results: Six certain and six uncertain variables were identified. A two-dimensional framework showed these factors: (a) maternity care services and organization and (b) the society of childbearing women and their families. Three scenarios described the plausible future of midwifery: (a) midwife-led care monitoring maternal health needs, (b) midwife-led holistic care, and (c) midwife/general practitioner–led integrated maternity care.

Conclusion: All of the scenarios show the direction of change with a strategic focus, the importance of midwifery authenticity, and digital adaptability in maternity services. Also, the coronavirus disease 2019 (COVID-19) pandemic cannot be ignored in future midwifery.

Values are person’s existential standards that define personal, professional, group, and social behavior and affect individual attitudes and moral.[3-7] Professional midwifery values are the accepted norms by a midwife and/or a group or organization of midwives that are associated with the responsibilities and trust that society assigns to the midwifery profession.[3,8-10] Professional values shape the midwife’s identity, principles and beliefs, decisions, consideration of consequences, and clinical judgment.[11] Midwives values derive from history, education, and traditions.[6,7] These values are embedded within the professional code of ethics,[12-15] which aims to create a professional culture that supports best practice and attempts to draw boundaries around what is deemed acceptable conduct. For example, the Dutch organization of midwives refers to values such as human dignity, autonomy, the trusting relationship between midwives and women and maintained professional knowledge.[...

INTRODUCTION Increasing numbers of maternity units are implementing routine and standardized monitoring of all women using a form of Early Warning Score System with the aim to early detect women at risk of developing critical illness or a deterioration of their condition. The implementation in Norway is relatively new. This study aimed to describe Norwegian midwives’ experiences with the Obstetric Norwegian Early Warning System (ONEWS). METHODS We performed a cross-sectional study based on an electronic questionnaire, sent to heads of midwifery at all maternity units in Norway for distribution to their clinically active midwives. Thirty-one of 48 units had implemented ONEWS for over a month. About 1020 midwives received the questionnaire, 232 (23%) responded. RESULTS Of the participants, 217 (93.5%) reported receiving sufficient training and 230 (99.1%) reported using the same scoring system, including the same vital parameters measured. The criteria for use of ONEWS varied between ...

Background: Video recording studies have been found to be complex, however very few studies describe the actual introduction and enrolment of the study, the resulting dataset and its interpretation. In this paper we describe the introduction and the use of video recordings of health care provider (HCP)-client interactions in primary care midwifery for research purposes. We also report on the process of data management, data coding and the resulting data set. Methods: We describe our experience in undertaking a study using video recording to assess the interaction of the midwife and her client in the first prenatal consultation, in a real life clinical practice setting in the Netherlands. Midwives from six practices across the Netherlands were recruited to videotape 15-20 intakes. The introduction, complexity of the study and intrusiveness of the study were discussed within the research group. The number of valid recordings and missing recordings were measured; reasons not to participate, non-response analyses, and the inter-rater reliability of the coded videotapes were assessed. Video recordings were supplemented by questionnaires for midwives and clients. The Roter Interaction Analysis System (RIAS) was used for coding as well as an obstetric topics scale. Results: At the introduction of the study, more initial hesitation in cooperation was found among the midwives than among their clients. The intrusive nature of

Background The increasing and specific use of home care services by frail, older people asks for the evaluation of the client-centeredness of these services. To our knowledge, no instrument that measures client-centeredness of home care from this group's unique perspective exists. We therefore tested the factor structure, reliability, content validity and acceptability of the Client-centered Care Questionnaire (CCCQ), an existing instrument developed for general home care users, in a population of frail, older people in the Netherlands. Methods We used data from a 2-year clinical trial. Study population: frail, older people who received home care. Data were collected at baseline (n = 600) and 24-month measurements (n = 389); retest data (n = 67) were collected 7-14 days after the 24-month measurements. Analyses: We performed confirmatory factor analysis, investigated reliability and validity parameters and assessed acceptability. Results The factor analysis yielded a bifactor model with essential unidimensionality. Internal consistency was high (omega total .88). We found a test-retest reliability of total test scores of .81; the standard error of measurement was 2.61 (total score range 15-75) and the limits of agreement were-7.03 and 7.86. We rejected three out of four hypotheses for construct validity. Conclusions The CCCQ is sufficiently unidimensional to permit the use of total test scores. We found acceptable reliability values, but considered our results on construct validity inconclusive. Respondents found the CCCQ questions challenging to answer, which is indicative of a high degree of respondent burden. Future instruments that measure client-centeredness of home care from the frail, older client's perspective should therefore be tailored to the specific circumstances of this population.

Background: Video recording studies have been found to be complex, however very few studies describe the actual introduction and enrolment of the study, the resulting dataset and its interpretation. In this paper we describe the introduction and the use of video recordings of health care provider (HCP)-client interactions in primary care midwifery for research purposes. We also report on the process of data management, data coding and the resulting data set. Methods: We describe our experience in undertaking a study using video recording to assess the interaction of the midwife and her client in the first prenatal consultation, in a real life clinical practice setting in the Netherlands. Midwives from six practices across the Netherlands were recruited to videotape 15-20 intakes. The introduction, complexity of the study and intrusiveness of the study were discussed within the research group. The number of valid recordings and missing recordings were measured; reasons not to participate, non-response analyses, and the inter-rater reliability of the coded videotapes were assessed. Video recordings were supplemented by questionnaires for midwives and clients. The Roter Interaction Analysis System (RIAS) was used for coding as well as an obstetric topics scale. Results: At the introduction of the study, more initial hesitation in cooperation was found among the midwives than among their clients. The intrusive nature of

INTRODUCTION The purpose of antenatal care is to ensure that a woman has a safe pregnancy and that does not mean absence of any disease during this period. Antenatal care allows screening of preeclampsia, fetal abnormalities and other prevention strategies to be incorporated. The purpose of this study was to assess the reason for attending antenatal care clinics and knowledge of antenatal care content package in women. METHODS A cross-sectional study was conducted on 395 pregnant women attending antenatal care clinic at the Ruth K. M. Pfau Civil hospital, Karachi, Pakistan from 1 July 2019 to 31 December 2019. Each eligible woman was asked about the reason for attendance and her knowledge about WHO standardized antenatal care package. RESULTS The commonest reason for utilizing antenatal care in booked attendees was place of birth concern (25.9%) and in not booked was referral from private centers (33.6%) which was statistically significant (p=0.006). Both booked and not booked women (67.9% vs 59.1%, p=0.409) stated avoidance of complication during pregnancy and labor as the commonest reason for attendance. Women with higher parity were more likely to identify weight measurement (p=0.001), iron and folic acid supplementation (p=0.001), and urine detailed report (p=0.002), as content of the standard package. CONCLUSIONS Our study shows that women did not utilize antenatal care clinics for improving their health or the health of their fetus. The knowledge of the antenatal care package was limited to weight measurement and supplements. Moreover, attendance and visits at an antenatal care facility do not equate to good service provision.

INTRODUCTION The aim of this scoping review is to explore the concept of 'vulnerability' affecting pregnant women and to identify an appropriate definition of this term. METHODS Five stages were adopted for conducting the scoping review. A literature search was undertaken between 1 October 2017 and 5 January 2018, using three databases. Relevant publications were appraised, and semantic content analysis was performed to identify emergent themes and four determinants of the vulnerability concept. This involved combining items that seem to address the same issue. RESULTS Eleven publications were considered, and eight definitions of vulnerability were identified, and from these four themes emerged: poor health outcome or status; exposure to risk; complex social needs; and lack of resources. Further analysis of evidence found examples of groups of people considered to be vulnerable; they were reported into six matrices, mainly with social and psychological difficulties. From these, eleven themes arose. Following a semantic and content analysis of all themes, thirteen final themes were identified. They represent the characteristics associated with women considered to be vulnerable and are called indices of vulnerability. Semantic and content analysis allowed addressing the thirteen indices of vulnerability into four categories called determinants of the vulnerability concept: deficiency, need, risk exposure, and barriers. CONCLUSIONS The vulnerability could be defined as a lack of health, related to the presence of at least one of the four determinants. Midwives are the key to identify vulnerable women, offering appropriate care.