PURPOSE:
Individualised maternity care planning is a cornerstone of respectful care. However, some midwives encounter systemic, cultural, and institutional barriers, particularly when client choices deviate from standard guidelines and norms. In contrast, others report being able to provide this care, either enabled by the systems in which they work or despite them. This presentation will discuss ‘what works, where and for whom’ to enable midwives in different settings to support individualised care planning.

DISCUSSION:
Providing maternity care is a complex process. In most jurisdictions, to manage care for large numbers of clients, maternity services are standardised and routine. When evidence is used, it is often quantitative and population-based, privileging data from large randomised trials or systematic reviews. These methods can override the views and experiences of individuals, as well as cultural differences and diversity, in favour of population-level outcomes. However, newer methods allow for a more nuanced approach. Realist methods are designed to explore complexity. They aim to uncover how and why an intervention works (or doesn’t), for whom, and in what circumstances. By examining context–mechanism–outcome configurations (CMOCs), realist approaches are well suited to maternity care, where outcomes are shaped not only by clinical interventions but by relationships, values, power dynamics, and broader system structures.

EVIDENCE WHERE RELEVANT:
A realist review was undertaken as part of a doctoral project to identify ‘what works, where and for whom’ in enabling midwives to support individualised care planning. An initial programme theory, shaped by stakeholder input, suggests midwives are more likely to do so in systems that support midwifery philosophy, value client autonomy, acknowledge cultural differences, and uphold human rights.

KEY MESSAGE:
CMO configurations help identify how midwives can be supported to provide individualised care. Delegates can use these insights to reflect on their own practice settings. Poster session 2 (Group A)