Models and frameworks of reflective clinical supervision for midwives: a scoping review

The objective of this review was to map the extent of the literature on models and frameworks of reflective clinical supervision for midwives that embed concepts of cultural safety and trauma-informed practice, identifying key characteristics and knowledge gaps to guide future research.

Reflective clinical supervision is gaining momentum as a potential strategy to support the well-being of midwives and improve quality of care. However, it is not routinely offered by maternity services, and evidence of established practice models is scarce. Additionally, a culturally safe midwifery workforce is a global priority, as culturally unsafe care contributes to poorer outcomes for First Nations mothers and babies. However, it is not known how models of reflective clinical supervision embed cultural safety and trauma-informed principles, particularly for midwives caring for First Nations women.

This scoping review considered peer-reviewed original and gray literature that described models or frameworks of reflective clinical supervision for midwives. The context of the search was global midwifery practice; therefore, no geographical or date limitations were applied. Eligible settings included all systems in which midwives operate.

A scoping review was conducted in accordance with the JBI methodological guidance and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A search strategy was adapted for each database and information source including APA PsycINFO (EBSCOhost), CINAHL (EBSCOhost), MEDLINE (EBSCOhost), and Cochrane Library. Sources of unpublished studies and gray literature searched included ProQuest Dissertations and Theses, Google and Google Scholar, and targeted searching of relevant government and health service websites. The search did not apply date or geographical limitations. The search was conducted between October 11, 2024, and November 18, 2024. After a pilot test of the screening process, data were extracted and analyzed using basic inductive qualitative content analysis. Data are presented narratively and in tabular and figure formats.

Nineteen sources were included in the scoping review consisting of both primary research and clinical practice guidelines published between 2005 and 2024. Much of the literature originated from Australia (n=9) and the remainder from England, Ireland, New Zealand, Scotland, and Wales. Ten different models and frameworks of reflective clinical supervision used in midwifery were described, with no one-size-fits-all model of reflective clinical supervision identified. This scoping review identified 6 key characteristics of effective midwifery models of reflective clinical supervision: functions, guided reflection, safe reflective environment, session structure, trusting alliance, and supervisor characteristics. Cultural safety or trauma-informed practices for midwives were not embedded in any of the included models or frameworks.

This review found that most models of reflective clinical supervision used for midwives were implemented in both nursing and midwifery contexts, with only a few models specific to midwifery contexts. Further research is needed to explore how the principles of cultural safety and trauma-informed practice are applied in reflective clinical supervision for midwives, especially those supporting First Nations women.

OSF https://osf.io/vf73w.