Autistic and non-autistic midwives' experiences of caring for autistic women and birthing-people

Autistic service-users experience elevated rates of poor mental wellbeing, healthcare inequalities, and sensory, communication, and interactional challenges during maternity care. Despite growing evidence of autistic maternity care needs, autism-specific perinatal guidelines and mandatory maternity autism training remain limited. Whilst shared neurotypes may enhance understanding, no previous research has explored autistic and non-autistic midwives' experiences of supporting autistic service-users.

This qualitative phenomenological study explored the experiences of five autistic and five non-autistic midwives caring for autistic service-users. Semi-structured interviews were analysed using integrated thematic analysis.

Both participant groups recognised autistic communication, sensory, and processing differences and acknowledged that maternity care can be stressful for autistic service-users. However, important differences emerged in how autistic and non-autistic midwives understood and responded to autistic needs. Autistic midwives described a sense of autistic resonance characterised by anticipatory understanding, intuitive recognition of support needs, proactive adjustment-making, and confidence in supporting autistic service-users. In contrast, non-autistic midwives relied more heavily on observational knowledge, visible distress, and diagnostic disclosure. Integrated analysis suggested that autistic maternity experiences are shaped through interactions between autistic ways of experiencing care, relational neurotype dynamics, and neurotypically organised maternity systems. The findings further indicate that autistic midwives may draw upon forms of experiential neurotype attunement that support recognition, interpretation, and accommodation of autistic needs in ways not consistently accessible through observational knowledge alone.

This study extends Double Empathy Theory into maternity care contexts and proposes a relational neurotype attunement model of autistic maternity care. The findings suggest that experiential neurotype knowledge represents a valuable form of professional expertise that may inform maternity practice, service design, policy development, and autism-specific training. Autistic professionals may therefore be uniquely positioned to contribute to the co-production of neurodiversity-affirming maternity services.