• Jacqueline Pangas, Olayide Ogunsiji, Rakime Elmir, Shanti Raman, Pranee Liamputtong, Elaine Burns, Hannah G Dahlen, and Virginia Schmied.
• School of Nursing and Midwifery, Western Sydney University, NSW, Australia.
• Int J Nurs Stud. 2019 Feb 1; 90: 31-45.

ObjectivesThe aim of this meta-ethnographic review was to examine refugee women's experiences negotiating motherhood and maternity services in a new country with a view to identifying the specific needs of refugee women accessing maternity care in high income countries.DesignA meta-ethnographic synthesis of qualitative research.Data SourcesFive databases were searched for papers published in English between January 2000 and January 2017.Review MethodsThe synthesis process was guided by the seven steps of meta-ethnography. The quality of included studies was assessed using the COREQ tool.ResultsOne overarching theme and three major themes emerged from the synthesis. The overarching theme "Living between two cultures" conveyed women's experience of feeling "in between" cultures and described refugee women's experience of striving to maintain a strong cultural identity from their country of origin while simultaneously adapting to their new context and country. This theme permeated the following three major themes: 1) "Constructing maternal identity across cultures" which discusses the cultural conflict experienced by refugees accessing maternity services in their host country; 2) "Understanding in practice" which describes reciprocal issues in communication between women and health professionals; and 3) "Negotiating care" which illustrates a mix of coping mechanisms which refugee women utilise to navigate health services in the context of high income countries.ConclusionLiminality is a ubiquitous experience for refugee women seeking maternity care in high income countries. It impacts feelings of belonging and connection to services and society. It is often a challenging experience for many women and a time in which they reformulate their identity as a citizen and a mother. This review found that the experience of liminality could be perpetuated by social factors, and inequality of healthcare provision, where communication and cultural barriers prevented women accessing care that was equal, accessible, and meaningful. Findings revealed both positive and negative experiences with maternity care. Continuity, culturally appropriate care, and healthcare relationships played an important role in the positive experiences of women. The review also revealed the damaging effects of disparities in care experienced by refugee women.Copyright © 2018. Published by Elsevier Ltd.

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