A global review of the inferred meaning of woman centred care within midwifery professional standards



      As an integral and guiding approach, woman centred care is well-grounded as the cornerstone of midwifery training and practice. A previous global review established that the concept, even though acknowledged as pivotal, has limited attention within the professional standards documents that underpin the discipline [
      • Crepinsek M.
      • et al.
      Towards a conceptualisation of woman centred care — A global review of professional standards.
      ]. Whilst not detracting from the overall importance of woman centred care, it is further suggested that a broader meaning is generally being implied.


      Whether other related inferences and meanings of the actual term ‘woman centred care’ are also being utilised, has not yet been established. Therefore, this review of professional documents sought to investigate the occurrence of further depictions of the concept.


      With an implied and inferred meaning of ‘woman centred care’ as the focus, a review and synthesis of narrative from a global sample of midwifery professional standards was conducted. The principles of meta-ethnography were utilised to develop a qualitative approach. Rather than the actual words ‘woman centred care’ further phrases implying or inferring the concept were sought. ‘A priori’ phrases were developed and narrative and examples were synthesised for each.


      Standards and governance documents were located from within Australia, the United Kingdom and New Zealand and a further 139 nations. Overall, the seven phrases, each considered as an inference to woman centred care, were all substantiated. As a proportion of all documents, these were collated with the outcomes being a woman’s right to choice (89%), being culturally sensitive (80.5%), a woman’s voice and right to be heard (78%), the woman as an individual (68%), universal human rights (40%), being holistic (39%) and being self-determined (17.5%).


      The outcomes of this review demonstrate that woman centred care may be a multidimensional concept. There were occurrences of all seven phrases across a broad scope of global professional midwifery documents, and each can be shown through its meaning to contribute something to an understanding of woman centred care. The creation of a universal meaning is recommended.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Crepinsek M.
        • et al.
        Towards a conceptualisation of woman centred care — A global review of professional standards.
        Women Birth. 2022;
        • Leap N.
        Woman-centred or women-centred care: does it matter?.
        Br. J. Midwifery. 2009; 17: 12-16
        • Bradfield Z.
        • et al.
        It’s what midwifery is all about”: Western Australian midwives’ experiences of being ‘with woman’ during labour and birth in the known midwife model.
        BMC Pregnancy and Childbirth. 2019; : 29
        • Homer C.
        • et al.
        The development of national competency standards for the midwife in Australia.
        Midwifery. 2007; 23: 350-360
        • Maputle M.
        • Donavon C.
        Criteria to facilitate the implementation of woman-centred care in childbirth units of Limpopo Province, South Africa (Part 2).
        Curationis. 2013; 36: 1-7
        • Giarrantano G.
        Woman-centered maternity nursing education and practice.
        J. Perinat. Educ. 2003; 12: 1
        • Fontein-Kuipers Y.
        • De Groot R.
        • Loes van Staa A.
        Woman-centered care 2.0: bringing the concept into focus.
        Eur. J. Midwifery. 2018; 2: 5
        • Fontein-Kuipers Y.
        • Boele A.
        • Stuij C.
        Midwives’ perceptions of influences on their behaviour of woman-centered care: a qualitative study.
        Front. Women’s Health. 2016; 1: 20-26
        • Brady S.
        • et al.
        Woman-centred care: an integrative review of the empirical literature.
        Int. J. Nurs. Stud. 2019; 94: 107-119
        • Maputle M.
        • Donavon C.
        Woman-centred care in childbirth: a concept analysis (Part 1).
        Curationis. 2013; 36: 1-8
        • Rigg E.
        • Dahlen H.
        Woman centred care: has the definition been morphing of late?.
        Women Birth. 2021; 34: 1-3
      1. Australian Government Department of Health Pregnancy Care Guidelines - Providing Woman-Centred Care. 2020.

      2. Australian College of Midwives Definition of a midwife. 2021.

      3. Royal College of Midwives,2011. Woman centred care-position statement. 2011; Available from: 〈〉.

        • Yanti Y.
        • et al.
        Students’ understanding of ‘Women-Centred Care Philosophy’ in midwifery care through Continuity of Care (CoC) learning model: a quasi-experimental study.
        BMC Nurs. 2015; 14: 1-7
        • Morgan L.
        Conceptualizing woman-centred care in midwifery.
        Can. J. Midwifery Res. Pract. 2015; 14: 8-15
        • Hunter L.P.
        Women give birth and pizzas are delivered: language and western childbirth paradigms.
        J. Midwifery Women’s. Health. 2006; 51: 119-124
      4. Rioux, C., et al., 2021. Gender-inclusive language in pregnancy-related research: Why and how to improve current practices. SOCArXiv Papaers, 2021(September).

        • Cahill M.
        • et al.
        Qualitative synthesis: a guide to conducting a meta-ethnography.
        Br. J. Occup. Ther. 2018; 81: 129-137
        • France E.F.
        • et al.
        A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases.
        BMC Med. Res. Methodol. 2019; : 35
      5. Australian College Midwives ACM Philosophy of Midwifery. 2017.

      6. Nursing and Midwifery Board of Australia, 2008. Code of ethics for midwives in Australia . 2008.

      7. Nursing and Midwifery Board of Australia Midwifery Standards for Practice 2018..

      8. Australian College Midwives Australian College of Midwives (ACM) , 2019. Response to Woman Centred Care: Strategic Directions for Australian Maternity Services. 2019.

      9. International Confederation Midwives, 2014. International Code of Ethics for Midwives. 2014; Available from: 〈〉.

      10. International Confederation of Midwives, 2011. Global Standards for Midwifery Regulation. 2011; Available from: 〈〉.

      11. American College of Nurse - Midwives. Standards for the practice of Midwifery Division of Standards and Practice - ACNM Board of Directors 2011 [cited 2015.

      12. Indian Nursing Council, 2015. Syllabus and Regulations. 2015.

      13. MANA Core Competencies, 2003.Standards and Core Competencies for Licensed Midwives in New Mexico. 2003.

      14. Nursing and Midwifery Council, 2012. Midwives Rules and Standards. 2012; Available from: 〈〉.

      15. Camacho, A., S. Land, J. Thompson, 2014. Strengthening Midwifery in Latin America and the Caribbean. 2014.

        • Hundley V.
        • et al.
        A national survey of women’s views of their maternity care in Scotland.
        Midwifery. 2000; 16: 303-313
      16. World Health Organization, 2009. Global standards for the initial education of professional nurses and midwives. Nursing & Midwifery Human Resources for Health 2009; Available from: 〈〉.

        • Carolam M.
        • Hodnett E.
        ‘With woman’ philosophy: examining the evidence, answering the questions.
        Nurs. Inq. 2007; 14: 140-152
        • Pope R.
        • Graham L.
        • Patel S.
        Woman-centred care.
        Int. J. Nurs. Stud. 2001; 38: 227-238
      17. European Midwives Association, 2021. European Midwives Association National Guidelines 2021; Available from: 〈〉.

        • Phiri J.
        • Dietsch E.
        • Bonner A.
        Cultural safety and its importance for Australian midwifery practice.
        Collegian. 2010; 17: 105-111
        • Raines D.
        • Morgan Z.
        Culturally sensitive care during childbirth.
        Appl. Nurs. Res. 2000; 13: 167-172
      18. National Maternity Review, 2015. Better Births Improving outcomes of maternity services in England. 2015; Available from:

      19. International Confederation Midwives, 2021. Global Standards for Midwifery Education (revised 2021). 2021; Available from: 〈〉.

        • John V.
        A labour of love?’: Mothers and emotion work.
        Br. J. Midwifery. 2009; 17: 636-640
        • Thompson J.E.
        Midwives and human rights: dream or reality?.
        Midwifery. 2002; 18: 188-192
      20. O’Donohue, S. , 2021. Midwifery continuity of care: Why patients should be more vocal advocates. 2021; Available from: 〈〉.

      21. Royal College of Midwives, 2018. Embedding women's voices. 2018; Opinion Piece]. Available from: 〈〉.

        • Homer C.
        • et al.
        Community-based continuity of midwifery care versus standard hospital care: a cost analysis.
        Aust. Health Rev. 2001; : 24
      22. Canadian Association of Midwives, 2016. Midwifery Practice - Standards & Guidelines 2016.

      23. UNFPA, 2015. Comprehensive Midwifery Programme Guidance 2015.

      24. Midwives Council of Hong Kong, 2014. Handbook for Midwives. 2014.

      25. The British Institute of Human Rights, 2016. Midwifery and Human Rights: A practitioner's guide. 2016.

        • Bohren M.
        • et al.
        The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review.
        PLoS Med. 2015; 12: 1-32
        • Prochaska E.
        Human rights in maternity care.
        Midwifery. 2015; 31: 1015-1016
      26. Hall, J., 2012. The essence of the art of a midwife: Holistic, multidimensional meanings and experiences explored through creative inquiry. 2012.

        • Hunter B.
        Emotion work in midwifery: a review of current knowledge.
        J. Adv. Nurs. 2001; 34: 436-444
      27. New Zealand College of Midwives, 2016. Standards of Practice 2016.

      28. The Royal College of Midwives, 2016. The RCM standards for midwifery services in the UK. 2016; Available from: 〈〉.

      29. Nursing and Midwifery Board of Australia Midwife standards for practice 2018.

      30. Thurer, D., T. Burri, 2008. Self-Determination. Encyclopedia entries 2008; Available from: 〈〉.

      31. United Nations United Nations Charter 2018.

        • Ryan R.M.
        • Deci E.L.
        Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.
        Am. Psychol. 2002; 55: 68-78
        • Ryan R.
        • Deci E.
        Self-determination theory and the facilitation of intrinsic motivation social development and well-being.
        Am. Psychol. 2000; 55: 68-78
        • Sheehan A.
        • Schmied V.
        • Cooke M.
        Australian women's stories of their baby-feeding decisions in pregnancy.
        Midwifery. 2003; 19: 259-266
      32. Nursing and Midwifery Board of Ireland, 2015.Practice Standards for Midwives 2015.