Table 4.

Additional programme theories for testing in realist evaluation of specialist models of care for women with social risk factors).

Programme Theories

If midwives are able to work flexibly, then they are able to meet women's individual needs and increase safety through spending time care planning and coordinating support that may not be available on demand (for example during an allocated appointment time in the standard maternity care model).

If midwives advocate social care to women through explaining their role and how they can provide practical support, then women's perception of surveillance may lessen leading to engagement, and child protection outcomes and maternal infant-bonding improve.

If the midwife-mother relationship is ‘two way’, that is the midwife also has trust in the woman then the many known benefits of the trusting relationship will be enhanced.

If models of care are based in the hospital setting or have large catchment areas, then midwives are less likely to have the knowledge and familiarity of niche support services that may benefit the women they care for.

If midwives are placed in the community setting, then they will be better able to place the individual needs of women before institutional norms because they feel a sense of obligation and responsibility towards the woman rather than the system.

If women do not have the time to form a trusting relationship with a midwife, then they are unlikely to disclose sensitive information and seek support for issues that may have long-term detrimental consequences for themselves and their families.

If women who remain resistant to help throughout their pregnancy despite continuity of care are known/handed over to primary care and early years services, then they will have a support network in place and will be more likely to be able to regain trust in the system over time.