Autistic persons in the perinatal context: A mapping review of midwifery care, experiences, needs, and evidence.

BACKGROUND: Autistic people represent a substantial and probably under-recognised population within reproductive and maternity services. Maternity care nevertheless continues to rely on neurotypical assumptions about communication, sensory tolerance, pain expression, emotional display, and help-seeking. AIM: To map the scope, distribution, and thematic content of literature on autistic people's experiences and support needs across pregnancy, childbirth, postpartum care, and infant feeding, and to identify implications for maternity service design and midwifery practice. METHODS: A mapping review was conducted using a systematic literature search. The search returned 73 relevant records. After title and abstract screening and focused relevance assessment, 25 papers were included in the final evidence map. Studies were categorized by design, perinatal stage, and thematic focus, and were synthesised narratively. RESULTS: The final map comprised 7 reviews or evidence syntheses, 9 qualitative studies, 4 survey studies, 2 cohort or comparative quantitative studies, and 3 practice-focused or contextual papers. The literature clustered most significantly around pregnancy and childbirth. Across study designs, the most consistent findings concerned sensory overload, communication barriers, poor fit between autistic needs and routine maternity care, unmet support needs, and dissatisfaction with standard care environments. Evidence on clinical outcomes and midwives' own experiences remained limited. CONCLUSION: Avoidable distress commonly arises from the interaction between autistic sensory and communication needs and inflexible maternity systems. Accessible care requires predictable and multimodal communication, consent-based touch, sensory adjustment, continuity where possible, tailored postnatal and feeding support, and co-designed pathways. Research should now evaluate implementation, sustainability, and outcomes in routine maternity services with autistic people as partners.