Because a number of the causal determinants of adverse infan

Because a number of the causal determinants of adverse infant outcomes associated with low SEP are potentially avoidable, strategies that promise even modest improvements warrant serious consideration. In a Cochrane Review (2015) examining randomized trials that compared midwifery-led continuity of care models to other care models for childbearing women, researchers found that midwifery care reduced the likelihood of preterm birth by 24% (Relative Risk 0.76, 95% CI: 0.64, 0.91) and fetal loss before 24 weeks gestation by 19% (RR 0.81, 95% CI: 0.67, 0.98) (Sandall, Soltani, Gates, Shennan, & Devane, 2015). If these findings are equally applicable for women of low SEP, whose infants are at the greatest risk of adverse outcomes, midwifery-led care may be an ideal model for vulnerable women. Typically, physician-led care equates with the biomedical model of care. In this model the aim of prenatal care is to reduce risk of maternal fetal/infant morbidity and mortality through screening, diagnosis and treatment of complications as they arise (van Teijlingen, 2005). The biomedical model assumes a standardized approach to pregnancy and childbirth, with deviations from the norm often countered through medical intervention (Gregg, 1995). Though patient-centered care is encouraged within the biomedical model, the model is shaped by pathology and the underlying medical paradigm (Barry & Edgman-Levitan, 2012). In contrast, midwifery practice specifically focuses on the mother׳s social, psychological, and cultural well-being, as well as the normal biological processes of pregnancy, birth and transition to parenthood (ten Hoope-Bender et al., 2014). A core order Prostaglandin E2 of the model, as defined in The Lancet Midwifery Series, includes capacity building to strengthen women׳s ability “to care for themselves and their families” (ten Hoope-Bender et al., 2014, p. 1227). Empowering patients as partners in health care requires mutual trust, and regard for the “woman׳s need for time, information, encouragement, validation and a supportive presence” (Kennedy, 2000, p. 10). Because of long appointment times and the model׳s relational emphasis, midwives are well positioned to understand and respond to contextual factors influencing patients’ behavior (Davis, 2010), such as personal autonomy, material and social resources, and individual abilities (Downe, Finlayson, Walsh, & Lavender, 2009). For low income women, practitioner–patient trust has been linked with clinician continuity, another hallmark of midwifery care (Phillippi & Avery, 2014), and has been associated with adherence to clinical advice (Sheppard, Zambrana, & O׳Malley, 2004). In addition, personalized continuity of care, in which a woman feels that her prenatal caregiver knows and remembers her and her health history from one visit to the next, has been shown to result in a three-fold increase in “very good” patient care ratings (Davey, Brown, & Bruinsma, 2005), which is especially important for women of low SEP who have reported lower levels of satisfaction in care compared to women of higher SEP (Haviland, Morales, Dial, & Pincus, 2005). All of these elements of care: time, trusting relationship, and individualized care, along with emotional support, and the de-medicalization of pregnancy, have been identified as key attributes of quality prenatal care by women and care providers of all types (Sword et al., 2012). In addition, spongy bone is important to note that despite their names, either model, the biomedical model or midwifery model, can and has been adopted and delivered by various types of maternity providers. The attributes of midwifery care described here are not exclusive to the midwifery profession; it is a clinician׳s philosophy of care that determines his or her model of practice. To date there has been no review of the literature examining birth outcomes of midwifery-led care compared to physician-led care for women of low SEP. The purpose of this scoping review is to identify all available information on this topic from the last 25 years, in order to present a summary of the “extent, range and nature” of the research, determine key gaps in the literature, and provide guidance for future studies (Arksey & O׳Malley, 2005, p. 6). This review will investigate if, in countries belonging to the Organization of Economic Co-operation and Development (OECD) (Organization of Economic Co-operation and Development (OECD), 2014), midwives’ patients of low socioeconomic position were at greater or lesser risk of adverse infant birth outcomes compared to physicians’ patients.