“This Should Be the Answer!”: The Evolution of Relational Dynamic Capabilities in the Co-Production of Maternity Care Services to Vulnerable Women

Abstract

Established models of maternity care delivery in high-income countries have increasingly proved inadequate to address the highly idiosyncratic and heterogenous needs of vulnerable pregnant women, such as ethnic minorities, migrants, and asylum seekers, who still disproportionately suffer from high maternal morbidity and mortality. Intersectionality theory has been salient to represent vulnerable women’s lived, subjective experience of inequity in healthcare access; however, it has proved less effective in informing organizational and systemic change able to redress the intersectional disadvantage affecting vulnerable populations. To address these theoretical and empirical gaps, this article develops an in-depth single case study around the HAAMLA team, a specialized community midwifery group active at the Leeds Teaching Hospital NHS Trust in England (UK), which specifically evolved over time to cater to the needs of vulnerable pregnant women. We conducted semi-structured interviews with the midwives and team leadership and triangulated our data with archival material and participant feedback. Building abductively on a novel intersectional, socio-ecological theoretical framework, our findings highlight how HAAMLA midwives developed a radically different model of maternity care delivery that conceptualizes vulnerability as an intersectional, socially constructed category and that co-produces holistic, bespoke care services together with the women and with the external network of partner agencies. In doing so, the team developed and leveraged two key relational dynamic capabilities: adaptive network activation and trust-based relationship building. The article discusses contributions to theory, policy, and practice, while providing fresh insight into a strongly innovative and potentially replicable model of maternity care delivery to vulnerable groups.