Security is an essential part of the quality of life . As a need required by all humans since the beginning of mankind, security affects nearly all aspects of human life and is therefore considered an “anthropological constant” . In the transition to parenthood, expectant parents are exposed to personal, familial, and social changes [3, 4], which have important implications for the couple’s relationship, the infant-parent relationship and the infant’s development [4, 5]. The reorganisation and preparation of new living conditions and new social roles may be accompanied by subjective uncertainties, insecurities and anxieties [4, 5]. During pregnancy, a woman’s physical changes can be perceived as very positive and contribute to great pride in the abilities of one’s own body. On the other hand, these changes can be perceived as threatening because of the uncontrollable process, which can lead to a sense of insecurity and increase childbirth-related fear . For expectant fathers, pregnancy can be accompanied by great joy, and thus a high degree of paternal involvement in pregnancy processes [7, 8], or by uncertainties and anxieties regarding the paternal role during pregnancy and childbirth [9,10,11,12]. Perceived insecurities associated with pregnancy and childbirth may have serious consequences regarding the childbirth experiences of mothers and fathers, their adaption to the parental role, and their attachment to the child during the postnatal period.
Security is a familiar term to most people; however, the term security has multiple meanings, and the intended meaning is not always clear [2, 13,14,15]. The definition of security is imprecisely differentiated from similar terms, such as safety [16, 17], certainty and dependability [2, 18,19,20], making finding a common basis for discussion difficult. A feature shared by most definitions is the distinction between objective and subjective dimensions of security. Objective security is described as an absence of threats [15, 17, 19, 21] and is accompanied by risk assessments, as lower risks are associated with a higher objective security [22, 23]. However, objective security does not exist separate from the individual’s perception , and the subjective perception of security can thus deviate from the objective state of security [15, 19, 21, 24]. Therefore, this review begins with a theoretical discussion on the sense of security concept.
The sense of security concept
From the perspective of the individual, security is characterised as an elementary human need that requires fulfilment [19, 25,26,27]. Individuals strive for security to maintain the ability to act and to minimise the risk of being paralysed and unable to act . In this process, decisions are made with the aim of producing the desired future results and thus reducing future insecurities [2, 27, 28].
Sense of security is characterised by cognitive and affective components [24, 29]. On the one hand, sense of security is understood as a perception and thus represents a cognitive construction of the individual [10, 14, 17], which includes the perception of a physical state with the sense of being protected against threats [2, 19, 20, 24, 30]. On the other hand, sense of security is commonly expressed as an individual emotion in which a person feels safe [16, 17], free from anxiety [15, 19, 21], carefree [2, 19, 29], confident [19, 20, 30] and without doubt [2, 19].
Feeling secure or insecure depends on diverse internal and external factors. The factors defining sense of security are an individual’s perception of being vulnerable and at risk in addition to an assessment of one’s own coping ability [2, 28, 30]. Gender, age, past experiences, personality traits, and information may also play roles in the creation of security [28, 31, 32]. Social science studies demonstrate a partial mismatch between the objective security of a given situation and the sense of security [20, 28, 30, 31, 33]. An individual can feel secure despite the presence of objective danger because the danger is not recognised or perceived as such . On the other hand, a person may feel secure despite an objective danger due to perceived coping abilities [19, 28, 30] or self-confidence [19, 20]. However, the subjective perception of security is strongly dependent on the context; therefore, the specific factors are relative and not equally relevant in all spheres of life .
Analysis of the social science literature shows that no clear dividing line exists between feeling safe and feeling secure; both terms are often used synonymously, indicating that the concepts of security and safety are interwoven . Bar-Tal and Jacobson  argue that maintaining physical safety is a prerequisite for a subjective perception of security, which they consider to be a psychological need.
In the context of maternity care, the feeling of security is described as one of the elementary aspects of a mother’s overall birth experience [34,35,36,37,38] and, for example, plays an important role in the maintenance of breastfeeding during the postnatal period . According to Mozygemba , women strive for security during pregnancy and birth to orientate themselves during the processes of change. Further studies focusing on childbirth experiences indicate that the presence and professional support offered by midwives and hospital staff contribute to creating a sense of security for mothers [40,41,42,43,44] and fathers [43, 45,46,47,48]. Additionally, the partner’s presence at the delivery is considered beneficial for the women’s sense of security [49,50,51]. Moreover, absence of the midwife from the delivery room or not knowing how to support the woman can create a sense of insecurity for the father [43, 52].
Ideas regarding what contributes to the feeling of security can differ between the supporting midwives and the parents; while women and their partners consider the midwife’s presence important to their sense of security, the midwives do not explicitly describe their own presence as supporting the parents’ sense of security during labour .
Safety and risk concepts in the obstetric context
In most Western societies, the contemporary childbirth culture is embedded in concepts of safety and risk. In this context, the concept of safety represents a quality feature of maternity care, as it aims to reduce the risk of unnecessary harm for mothers and their babies to an acceptable minimum . The declaration of the concept of risk as “the key to safety”  results in understanding pregnancy, childbirth and the postnatal period as potential risks [55, 56], which fosters the medicalisation of pregnancy and childbirth [57,58,59]. It appears that the concepts of safety and risk complement one another and have a restrictive effect on giving birth. In this context, parents are confronted with rules and normative views of a maternity healthcare system that influence their attitudes, decisions and actions.
Studies regarding the perception of safety in the context of maternity care indicate that the safety concept is differentially perceived and interpreted. For some women, safety is associated with medical-technical care and thus also with risk minimisation [60,61,62,63]. For other women, being safe means avoiding routine interventions, giving birth in a calm and private atmosphere, having confidence in the ability to give birth or having trust in God [61, 62]. The various interpretations of safety are associated with different attitudes towards childbirth and the competence of the female body to perform birth. On the one hand, pregnancy and childbirth are understood as fundamental medical processes that require medical skills and technology [60, 61, 63, 64]; on the other hand, they are perceived as natural processes that do not require medical interventions or professional assistance [61,62,63]. In addition, the perception of safety can be influenced both negatively and positively by the care offered by midwives and other professionals [65,66,67]. The birth experience itself, including the experience of pain and the birth of a healthy child, can also retrospectively influence a woman’s view of safety . Further studies demonstrate that the various perceptions of safety have a decisive impact on women’s choice of where to give birth, such that both the hospital and the home are considered safe birthplaces for women [60,61,62,63, 66, 69, 70].
Research has revealed different meanings of safety and different needs of women. The results underline that women’s perception of safety goes beyond the medical understanding and is influenced by other cultural, emotional and psychosocial aspects.
We acknowledge the existence of a possible overlap between the concepts of safety and security. Furthermore, the concepts of safety and risk in maternity care presumably influence the sense of security.
Formulation of the problem
Theoretical and empirical literature characterise subjective perceived security as an elementary human need that requires fulfilment. During the transition to parenthood, mothers and fathers are confronted with physical and psychosocial changes that are accompanied by uncertainty and insecurity. Feelings of insecurity may have consequences for parents’ pregnancy and childbirth experiences, adaption to the parental role, and attachment to the child.
However, no study to date has critically synthesised the research literature regarding sense of security from the perspective of parents in the context of maternity care. This paper presents an integrative review of the literature addressing parents’ sense of security associated with pregnancy, childbirth and the postnatal period. For the purposes of this paper, sense of security has been defined as an emotional state in which an individual feels safe, confident and free from doubt and anxiety. A critical synthesis of current knowledge regarding parents’ security experiences in the context of maternity care is important for understanding and effectively supporting mothers and fathers with regard to their specific security needs.