The midwifery capabilities theory: How midwives enact woman-centered care to address systemic inequity.

Background: Healthcare for childbearing women with complex needs demands a multi-disciplinary approach requiring transitions between care providers, paradigms, and models of care. These transitions may create disconnects between women and the maternity care "system." Poorly managed care transitions can lead to women becoming hostage to the power struggles between healthcare organizations and the professionals working within them, further increasing the risk of poor outcomes. This paper presents the findings of a study that aimed to better understand how midwives provide woman-centered care for women with complex needs in the real world of maternity services.

Methods: A constructivist grounded theory approach, using Clarke's situational analysis to extend critical and feminist perspectives in data analysis. Qualitative data were obtained from two sources: publicly available data, and individual interviews with providers of care (midwives) and recipients of care (women with complex pregnancies).

Results: Woman-centered care is defined as care in which the woman is seen, heard, and known. "The midwifery capabilities theory" describes the process whereby midwives create opportunities to develop women's capabilities. Capabilities are enabled through the midwifery relationship creating space, moments in time, and equalizing power and positionality.

Conclusions: Aligning with contemporary theories surrounding the provision of midwifery care, the midwifery capabilities theory recognizes the individual health and social status of women and the rights to self-determination. This centers care around each individual's needs, which, in addition to improving health and well-being outcomes, contributes to improved self-confidence, enhancing engagement through authentic professional relationships.