What matters to women: a systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women

BACKGROUND: Global uptake of antenatal care (ANC) varies widely and is influenced by the value women place on the service they receive. Identifying outcomes that matter to pregnant women could inform service design and improve uptake and effectiveness. OBJECTIVES: To undertake a systematic scoping review of what women want, need and value in pregnancy. SEARCH STRATEGY: Eight databases were searched (1994-2015) with no language restriction. Relevant journal contents were tracked via Zetoc. DATA COLLECTION AND ANALYSIS: An initial analytic framework was constructed with findings from 21 papers, using data-mining techniques, and then developed using meta-ethnographic approaches. The final framework was tested with 17 more papers. MAIN RESULTS: All continents except Australia were represented. A total of 1264 women were included. The final meta-theme was: Women want and need a positive pregnancy experience, including four subthemes: maintaining physical and sociocultural normality; maintaining a healthy pregnancy for mother and baby (including preventing and treating risks, illness and death); effective transition to positive labour and birth; and achieving positive motherhood (including maternal self-esteem, competence, autonomy). Findings informed a framework for future ANC provision, comprising three equally important domains: clinical practices (interventions and tests); relevant and timely information; and pyschosocial and emotional support; each provided by practitioners with good clinical and interpersonal skills within a high quality health system. CONCLUSIONS: A positive pregnancy experience matters across all cultural and sociodemographic contexts. ANC guidelines and services should be designed to deliver it, and those providing ANC services should be aware of it at each encounter with pregnant women. TWEETABLE ABSTRACT: Women around the world want ANC staff and services to help them achieve a positive pregnancy experience

Care needs of pregnant women with a private health insurance: a comprehensive social phenomenology approach Necesidades de cuidado de mujeres embarazadas que poseen seguro de salud: una aproximación comprensiva de la fenomenología social Necessidades de cuidado das mulheres grávidas que possuem convênio saúde: abordagem compreensiva da fenomenologia social

This study aimed to understand the meanings women who possess health plans hold regarding pregnancy and get to know their care needs in this phase of the vital cycle. It was based on the qualitative research of phenomenological inspiration. The discourses analysis was based on the sociologist and fenomenologist Alfred Schutz's thought. Having health plans and being attended in private institutions were defined as inclusion criteria. The following categories emerged from the discourses: having new responsibilities; experiencing a special situation; experiencing insecurity, anxiety and expectations; feeling limited; trusting the health professional. It was found, through the analysis of categories, that the experience of the pregnant women who participated in the study is similar to those who do not possess health plans. However, in the category "trusting the health professional" it was possible to perceive the importance of possessing health plan, which allows the intersubjectivity between the woman and the health professional.<br>Este estudio tiene como objetivo comprender los significados que las mujeres que poseen seguro de salud atribuyen al embarazo y conocer sus necesidades de cuidado en esta fase del ciclo vital. El estudio fue fundamentado en la investigación cualitativa de inspiración fenomenológica. El pensamiento del sociólogo y fenomenólogo Alfred Schutz condujo el análisis de los discursos. Como criterio de inclusión, se definió que los individuos deberían ser atendidos en instituciones privadas y poseer seguro de salud. De las declaraciones surgieram las categorías: teniendo nuevas responsabilidades; vivenciando una situación especial; vivenciando inseguridad, ansiedad y expectativas; sintiéndose limitadas; confiando en el profesional de salud. Por medio del análisis de las categorías, fue constatado que la vivencia de las mujeres embarazadas que participaron de este estudio se mostró de forma similar a la de las mujeres que no poseen seguro de salud. Sin embargo, en la categoría "confiando en el profesional de salud", fue posible percibir la importancia de poseer plano de salud, hecho que posibilita la intersubjetividad entre la mujer y el profesional de salud.<br>Este estudo objetivou compreender os significados que as mulheres que possuem convênio saúde têm da gravidez e conhecer quais as necessidades de cuidado das mulheres nessa fase do ciclo vital. Fundamentou-se na pesquisa qualitativa de inspiração fenomenológica. O pensamento do sociólogo e fenomenólogo Alfred Schutz conduziu a análise das falas. Como critério de inclusão, definiu-se que os sujeitos deveriam ser atendidos em instituições privadas e possuir convênio saúde. Dos depoimentos emergiram as categorias: tendo novas responsabilidades; vivenciando uma situação especial; vivenciando insegurança, ansiedade e expectativas; sentindo-se limitada; confiando no profissional de saúde. Por meio da análise das categorias, constatou-se que a vivência das mulheres grávidas que participaram deste estudo mostrou-se de forma similar à daquelas mulheres grávidas que não possuem convênio saúde. No entanto, na categoria "confiando no profissional de saúde" foi possível perceber a importância de possuir convênio saúde, fato que possibilita a intersubjetividade entre a mulher e o profissional de saúde