The interpersonal experiences of autistic women and birthing people in the perinatal period: a systematic review...

Autistic women and birthing people encounter challenges beyond those typically experienced in the perinatal period. In non-perinatal healthcare settings, autistic people do not feel well-understood and supported by healthcare professionals. Little is known about how autistic people experience maternity and perinatal healthcare services. This systematic review synthesises studies exploring autistic women and birthing people's interpersonal experiences when engaging with perinatal healthcare services, using the Autistic SPACE Framework to guide interpretation.

Searches of MEDLINE, CINAHL, Embase, PsycINFO, Scopus and Web of Science were supplemented with hand searching. Studies were included if they included qualitative data from peer-reviewed publications relating to autistic women and birthing people's experiences of perinatal healthcare. Studies were assessed using the Critical Appraisal Skills Programme (CASP) qualitative checklist. Data were extracted and synthesised using thematic synthesis; confidence in findings was assessed using the GRADE CER-Qual framework.

Ten high-quality studies, with 301 participants, were included. Eight over-arching themes were identified with high confidence, mapping onto the SPACE framework: (1) Feeling over-stimulated; (2) The need to build rapport with healthcare professionals; (3) The need for clear factual information; (4) Feeling judged; (5) Poor understanding of autism; (6) Not asking for help does not mean not needing help, (7) The need for autism-tailored communication and (8) Feeling uncared for.

Autistic women and birthing people's needs are not well-understood and supported in perinatal and maternity services, which negatively effects access to, and experience of, care. More autism-nuanced training, including education on sensory and communication differences, is needed.