Exploring healthcare providers’ experiences and perceptions of caring for women with mobility disabilities during antenatal, intrapartum and postpartum periods: A qualitative systematic review and thematic synthesis

Abstract

Background: Women with mobility disabilities encounter significant barriers to accessing justifiable and inclusive maternity care during the perinatal period. These challenges stem from a combination of structural inaccessibility, organisational constraints, attitudinal bias, and gaps in healthcare providers (HCPs) preparedness. While research has examined both women’s and providers’ perspectives, limited synthesis focuses on HCPs’ experiences, despite their perceptions and clinical decisions playing a central role in shaping the quality and accessibility of maternity care. Objectives: This systematic review aimed to systematically explore and synthesise qualitative evidence exploring HCPs’ experiences and perceptions of delivering maternity care to women with mobility disabilities across the antenatal, intrapartum, and postnatal periods. Specifically, it sought to examine HCP’s perceptions of their professional roles and preparedness, identify barriers and facilitators influencing care delivery, and explain the support and resources required to enhance the quality and accessibility of disability-inclusive maternity care, with implications for policy, practice, education, and future research. Search strategy: A comprehensive search was conducted across various electronic databases in accordance with Queen’s University Belfast (QUB) library guidance, supplemented by Covidence software and manual citation searching. The search adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and applied predefined inclusion and exclusion criteria. To ensure relevance to contemporary maternity practice, professional roles, and evolving disability-inclusive care frameworks, only studies published within the last 10 years were considered. These studies provided in-depth insights into HCPs’ experience and perspectives across diverse geographical regions, including the United States, Austria, Eswatini, Iran, Canada, and Cambodia. Results: Of the 50 records initially identified through Covidence software, eight qualitative studies fulfilled the eligibility criteria. Data was synthesised using Thomas and Harden three stages of thematic analysis and synthesis. Six interrelated themes were identified: (1) physical and structural barriers to accessing care (2) systemic and organisational constraints (3) professional commitment amongst challenges (4) Gap in knowledge, training, and preparedness (5) emotional and ethical tensions in caregiving and (6) attitudinal bias and implicit discrimination. Although HCPs frequently exhibited adaptability and resilience, the delivery of care was significantly impeded by infrastructural inaccessibility, a lack of training specific to disability, fragmented referral systems, and continuing societal discriminations. The quality appraisal of the studies indicated generally high methodological rigor; however, several limitations were identified, including small sample sizes and restricted geographical scope within the included contexts. Conclusion: This qualitative systematic review highlights the urgent necessity for system-level reforms to integrate disability inclusion into maternity care policy, practice, and education. Essential measures include standardised guidelines, adaptive equipment, inclusive infrastructure, and disability-awareness training to overcome existing structural and attitudinal barriers. Future research should focus on underrepresented regions, employ variety of approaches, and assess the impact of inclusive interventions on both maternal and provider outcomes. Addressing these gaps is crucial for advancing reproductive justice and ensuring equitable maternity care for women with mobility disabilities worldwide.