Models of midwifery care for Indigenous women and babies: A meta-synthesis

Issue: Indigenous women in many countries experience a lack of access to culturally appropriate midwifery services. A number of models of care have been established to provide services to women. Research has examined some services, but there has not been a synthesis of qualitative studies of the models of care to help guide practice development and innovations. Aim: To undertake a review of qualitative studies of midwifery models of care for Indigenous women and babies evaluating the different types of services available and the experiences of women and midwives. Methods: A meta-synthesis was undertaken to examine all relevant qualitative studies. The literature search was limited to English-language published literature from 2000-2014. Nine qualitative studies met the inclusion criteria and literature appraisal-six from Australia and three from Canada. These articles were analysed for coding and theme development. Findings: The major themes were valuing continuity of care, managing structural issues, having negative experiences with mainstream services and recognising success. Discussion: The most positive experiences for women were found with the services that provided continuity of care, had strong community links and were controlled by Indigenous communities. Overall, the experience of the midwifery services for Indigenous women was valuable. Despite this, there were still barriers preventing the provision of intrapartum midwifery care in remote areas. Conclusion: The expansion of midwifery models of care for Indigenous women and babies could be beneficial in order to improve cultural safety, experiences and outcomes in relation to pregnancy and birth. (C) 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.