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Obionu IM, Onyedinma CA, Mielewczyk F, Boyle E. UK maternity care experiences of ethnic minority and migrant women: Systematic review. Public Health Nurs 2023; 40:846-856. [PMID: 37548036 DOI: 10.1111/phn.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The increasing population of immigrant and migrant women in the United Kingdom has implications to the provision of healthcare and for healthcare experiences. Eliciting women's experiences and perceptions of maternity care received is an important way of monitoring and evaluating the quality of maternity services. This study was designed to explore the maternity care experiences of ethnic minority and migrant women in the United Kingdom. METHODS A literature search for relevant studies was carried across seven databases. We included nine studies carried out between 2015 and February 2022 that met the inclusion criteria. Data were analyzed using a thematic analysis approach. RESULTS Findings showed that ethnic minority women and migrant women have had mixed experiences while utilizing maternity services in the United Kingdom. However, most of the experiences were negative and included issues related to communication, discrimination, culture, access to care, physical comfort, and continuity of care. Only one of the studies reported that the respondents had a wholly positive communication experience, one found that a few women felt the staff were respectful and one reported that the midwives gave the women treatment options that would respect their cultural and religious beliefs. CONCLUSION This study has highlighted some important gaps in the maternity care experiences specific to ethnic minority and migrant women in the United Kingdom which provides useful insights to future policy and clinical practice.
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Affiliation(s)
- Ifeoma Maureen Obionu
- College of Public Health and Social Justice, Saint Louis University, St Louis, Missouri
| | - Chioma Amarachi Onyedinma
- Department of Community Medicine University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Frances Mielewczyk
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Elaine Boyle
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Asim S, Nichini E, Goggins WB, Dong D, Yeoh EK. Maternity care experience of Pakistani ethnic minority women in Hong Kong. Front Public Health 2023; 11:1009214. [PMID: 36935720 PMCID: PMC10014597 DOI: 10.3389/fpubh.2023.1009214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/07/2023] [Indexed: 03/06/2023] Open
Abstract
Background Persistent inequalities in maternity care experience and outcomes exist globally for ethnic minority (EM) and migrant women. Despite the fact that this is an important research area, no prior study has been done in Hong Kong (HK) to examine maternity care experience of EM women. Objectives To investigate maternity care experience of Pakistani EM women (both local born and immigrants) during pregnancy, birth and after birth in hospital in HK. An evaluation of their satisfaction and factors predicting satisfaction with care during the three phases of maternity care was included in the study. Methods A cross sectional survey was conducted among Pakistani EM women who had given birth in HK in last 3 years, using a structured questionnaire by a bilingual interviewer, from April to May 2020. Counts and percentages were used to describe all categorical variables. Association between predictor variables and overall satisfaction was assessed by bivariate analysis and multiple logistic regression. Results One hundred and twenty questionnaires were completed. Almost 60 percent of the women were very satisfied with the overall care. More than half of the women described the care they received as kind, respectful and well communicated. After adjusting for age and parity, HK born Pakistani women expressed relatively less satisfaction with care, especially during pregnancy and labor and birth, as compared with Pakistan born women. Women with conversational or fluent English-speaking ability also felt comparatively less satisfied particularly from intrapartum and postnatal care in hospital. Education level had a negative association with satisfaction with care during pregnancy. Conclusions Maternity care providers should take into account the diversity of EM women population in HK. Our findings suggest that effective communication and care that can meet individual needs, expectations, and values is imperative to improve experience and quality of maternity care for EM women in HK.
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Affiliation(s)
- Saba Asim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Elena Nichini
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - William Bernard Goggins
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Hong Kong, Hong Kong SAR, China
- *Correspondence: Dong Dong
| | - Eng-King Yeoh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Hong Kong, Hong Kong SAR, China
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Goodwin L, Jones A, Hunter B. Addressing social inequity through improving relational care: A social-ecological model based on the experiences of migrant women and midwives in South Wales. Health Expect 2022; 25:2124-2133. [PMID: 34337840 PMCID: PMC9615070 DOI: 10.1111/hex.13333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Migrant and ethnic inequalities in maternal and perinatal mortality persist across high-income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence-based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. METHODS An inductive modelling approach was used to develop a new evidence-based conceptual model of woman-midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social-ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman-midwife relationship. RESULTS Three key concepts influencing the woman-midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. CONCLUSIONS The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. PATIENT OR PUBLIC CONTRIBUTION At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees.
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Affiliation(s)
- Laura Goodwin
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - Aled Jones
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Billie Hunter
- School of Healthcare SciencesCardiff UniversityCardiffUK
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Khaw SML, Zahroh RI, O'Rourke K, Dearnley R, Homer C, Bohren MA. Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis. BMJ Glob Health 2022; 7:e009098. [PMID: 35902203 PMCID: PMC9341177 DOI: 10.1136/bmjgh-2022-009098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Community-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to bridge gaps for migrant and refugee women in maternity settings in high-income countries (HICs). The aim of this review was to explore key stakeholders' perceptions and experiences of community-based doula programmes for migrant and refugee women during labour and birth in HICs, and identify factors affecting implementation and sustainability of such programmes. METHODS We conducted a mixed-method systematic review, searching MEDLINE, CINAHL, Web of Science, Embase and grey literature databases from inception to 20th January 2022. Primary qualitative, quantitative and mixed-methods studies focusing on stakeholders' perspectives and experiences of community-based doula support during labour and birth in any HIC and any type of health facility were eligible for inclusion. We used a narrative synthesis approach to analysis and GRADE-CERQual approach to assess confidence in qualitative findings. RESULTS Twelve included studies were from four countries (USA, Sweden, England and Australia). There were 26 findings categorised under three domains: (1) community-based doulas' role in increasing capacity of existing maternity services; (2) impact on migrant and refugee women's experiences and health; and (3) factors associated with implementing and sustaining a community-based doula programme. CONCLUSION Community-based doula programmes can provide culturally-responsive care to migrant and refugee women in HICs. These findings can inform community-based doula organisations, maternity healthcare services and policymakers. Further exploration of the factors that impact programme implementation, sustainability, strategic partnership potential and possible wider-reaching benefits is needed.
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Affiliation(s)
- Sarah Min-Lee Khaw
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Rana Islamiah Zahroh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Kerryn O'Rourke
- School of Nursing and Midwifery, Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- College of Indigenous Futures, Education and the Arts, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Red Dearnley
- Birth for Humankind, North Melbourne, Victoria, Australia
| | - Caroline Homer
- Child and Adolescent Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Meghan A Bohren
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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MacLellan J, Collins S, Myatt M, Pope C, Knighton W, Rai T. Black, Asian and minority ethnic women's experiences of maternity services in the UK: A qualitative evidence synthesis. J Adv Nurs 2022; 78:2175-2190. [PMID: 35332568 PMCID: PMC9314829 DOI: 10.1111/jan.15233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/24/2022] [Accepted: 02/21/2022] [Indexed: 01/13/2023]
Abstract
AIMS Black, Asian and minority ethnic women are at higher risk of dying during pregnancy, childbirth and postnatally and of experiencing premature birth, stillbirth or neonatal death compared with their White counterparts. Discrimination against women from ethnic minorities is known to negatively impact women's ability to speak up, be heard and their experiences of care. This evidence synthesis analysed Black, Asian and minority ethnic women's experiences of UK maternity services in light of these outcomes. DESIGN We conducted a systematic review and qualitative evidence synthesis using the method of Thomas and Harden. DATA SOURCES A comprehensive search in AMED, Cinahl, Embase, Medline, PubMed and PsycINFO, alongside research reports from UK maternity charities, was undertaken from 2000 until May 2021. Eligible studies included qualitative research about antenatal, intrapartum and postnatal care, with ethnic minority women in maternity settings of the UK NHS. REVIEW METHODS Study quality was graded using the Critical Appraisal Skills Programme tool. RESULTS Twenty-four studies met the inclusion criteria. Our synthesis highlights how discriminatory practices and communication failures in UK NHS maternity services are failing ethnic minority women. CONCLUSION This synthesis finds evidence of mistreatment and poor care for ethnic minority women in the UK maternity system that may contribute to the poor outcomes reported by MBRRACE. Woman-centred midwifery care is reported as positive for all women but is often experienced as an exception by ethnic minority women in the technocratic birthing system. IMPACT Ethnic minority women report positive experiences when in receipt of woman-centred midwifery care. Woman-centred midwifery care is often the exception in the overstretched technocratic UK birthing system. Mistreatment and poor care reported by many ethnic minority women in the UK could inform the inequalities of outcomes identified in the MBRRACE report.
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Affiliation(s)
- Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Sarah Collins
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Margaret Myatt
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | | | - Tanvi Rai
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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Malmquist A, Wikström J, Jonsson L, Nieminen K. How norms concerning maternity, femininity and cisgender increase stress among lesbians, bisexual women and transgender people with a fear of childbirth. Midwifery 2020; 93:102888. [PMID: 33260003 DOI: 10.1016/j.midw.2020.102888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore and describe norms concerning maternity, femininity and cisgender in lesbian and bisexual women and transgender people (LBT) assigned female at birth, with an expressed fear of childbirth (FOC). DESIGN Semi-structured interviews were conducted with self-identified LBT people with an expressed FOC. PARTICIPANTS 17 self-identified LBT people participated. 15 had an expressed FOC, and two were non-afraid partners. FINDINGS Participants described how their FOC was related to ideals of "the primal woman", including ideals of a natural birth. They also described stress in relation to expectations of gaining a feminine-coded body during pregnancy and of being related to as feminine women. KEY CONCLUSIONS Maternity ideals, and the ideal of the "natural" birth, can be particularly stressful on those who fear childbirth. Norms concerning femininity and cisgender can contribute to FOC among those who do not comfortably conform with feminine body ideals or feminine gender expressions. IMPLICATION FOR PRACTICE Treatments of FOC must be designed to acknowledge whether and how norms concerning maternity, femininity and cisgender affect the individual's FOC.
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Affiliation(s)
- Anna Malmquist
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83, Linköping, Sweden.
| | - Johanna Wikström
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83, Linköping, Sweden
| | - Louise Jonsson
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83, Linköping, Sweden
| | - Katri Nieminen
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
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Moore MF. Birth Observation Among African American Women Prior to Pregnancy. J Perinat Educ 2020; 29:181-187. [PMID: 33223791 PMCID: PMC7662164 DOI: 10.1891/j-pe-d-19-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A focused ethnography among African American college students who had observed a live birth prior to their own pregnancy was pursued. Women described two reasons to attend births: curiosity about birth, or a desire to support the birth mother. Women attended the births of friends, family members, or saw their mother give birth to a younger sibling. Themes included pain, operative or traumatic birth, and surprise at the length and/or stages of labor. Some language suggested lingering trauma. Future expectations included painful labor, operative birth or damage, or traumatic labor and birth. Other women felt closer to the infant, or felt more prepared for their own births after observing birth. Prior personal experiences at birth should be explored prenatally.
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Malmquist A, Nieminen K. Negotiating who gives birth and the influence of fear of childbirth: Lesbians, bisexual women and transgender people in parenting relationships. Women Birth 2020; 34:e271-e278. [PMID: 32418651 DOI: 10.1016/j.wombi.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fear of childbirth (FOC) may affect family planning in lesbian, bisexual and transgender (LBT) couples with two potential carriers of a pregnancy. FOC has previously been researched in heterosexual women, while experiences of LBT people have remained unattended. The choice of birth-giving partner in same-sex couples has gained some attention in previous research, but the potential complexities of the decision have not been studied. AIM The aim is to explore how LBT people negotiate the question of who gives birth, in couples with two potential birth parents, and where one or both partners have a pronounced FOC. METHODS Seventeen self-identified LBT people were interviewed about their expectancies and experiences of pregnancy and childbirth. Data were analysed following a six-step thematic analysis. RESULTS FOC was negotiated as one of many aspects that contributed to the decision of who would be the birth-giving partner. Several participants decided to become pregnant despite their fears, due to a desire to be the genetic parent. Others negotiated with their partner about who was least vulnerable, which led some of them to become pregnant despite FOC. Still other participants decided to refrain from pregnancy, due to FOC, and were delighted that their partner would give birth. Several participants described their partner's birth-giving as a traumatic experience for them, sometimes also when the birth did not require any obstetric interventions. The partner's experience was in some cases not addressed in postnatal care. CONCLUSIONS It is important that healthcare staff address both partners' prenatal expectancies and postnatal experiences.
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Affiliation(s)
- Anna Malmquist
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - Katri Nieminen
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
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Higginbottom GMA, Evans C, Morgan M, Bharj KK, Eldridge J, Hussain B, Salt K. Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes.
Objectives
Our objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies.
Review methods
An information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence.
Results
We identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated.
Limitations
Our review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women.
Conclusions
Available evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this.
Future work
Studies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource.
Study registration
This study is registered as PROSPERO CRD42015023605.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gina MA Higginbottom
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Karen Salt
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
- Centre for Research into Race and Rights, University of Nottingham, Nottingham, UK
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Henderson J, Carson C, Jayaweera H, Alderdice F, Redshaw M. Recency of migration, region of origin and women's experience of maternity care in England: Evidence from a large cross-sectional survey. Midwifery 2018; 67:87-94. [PMID: 30273924 PMCID: PMC6200018 DOI: 10.1016/j.midw.2018.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 12/01/2022]
Abstract
Background In the UK, changes to legislation in 2003 regarding the free movement of people in the European Union resulted in an increase in immigration from countries that joined the EU since 2004, the Accession countries. Objective To describe and compare the maternity experiences of recent migrant mothers to those who had been resident in the UK for longer, and to UK-born women, while taking into account their region of origin. Design Cross-sectional national survey. Setting England, 2009. Participants Random sample of postpartum women. Measurements Questionnaires asked about demographic characteristics, care during pregnancy, labour, birth and postnatally, about country of origin and, if not born in the UK, when they came to the UK. Country of origin was grouped into UK, Accession countries, and rest of the world. Recency of migration was grouped into recent arrivals (0–3 years), and earlier arrivals (4 or more years since arrival). Descriptive statistics and binary logistic regression were used to explore women's experiences of care. Stratified analyses were used to account for the strong correlation between recency of migration and region of origin. Findings Overall, 5332 women responded to the survey (a usable response rate of 54%). Seventy-nine percent of women were UK-born. Of the 21% born outside the UK, a third were born in Accession countries. All migrants reported a poorer experience of care than UK-born women. In particular, recent migrants from the Accession countries were significantly less likely to feel that they were spoken to so they could understand and treated with kindness and respect. Conclusions Given the rising population of non-UK-born women of childbearing age resident in the UK and the relatively high proportion from Accession countries, it is important that staff are able to communicate effectively, through interpreters if necessary. Implications for practice The differences in clinical practice between women's home countries and the UK should be discussed so that women's expectations of care are informed about the options available to them.
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Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Old Road, Oxford, UK.
| | - Claire Carson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Old Road, Oxford, UK.
| | - Hiranthi Jayaweera
- School of Anthropology, University of Oxford, 51/53 Banbury Road, Oxford OX2 6PE, UK.
| | - Fiona Alderdice
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Old Road, Oxford, UK.
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Old Road, Oxford, UK.
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Goodwin L, Hunter B, Jones A. The midwife-woman relationship in a South Wales community: Experiences of midwives and migrant Pakistani women in early pregnancy. Health Expect 2017; 21:347-357. [PMID: 28960699 PMCID: PMC5750740 DOI: 10.1111/hex.12629] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In 2015, 27.5% of births in England and Wales were to mothers born outside of the UK. Compared to their White British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. Existing literature highlights the importance of midwife-woman relationships in care satisfaction and pregnancy outcomes; however, little research has explored midwife-woman relationships for migrant and minority ethnic women in the UK. METHODS A focused ethnography was conducted in South Wales, UK, including semi-structured interviews with 9 migrant Pakistani participants and 11 practising midwives, fieldwork in the local migrant Pakistani community and local maternity services, observations of antenatal appointments, and reviews of relevant media. Thematic data analysis was undertaken concurrently with data collection. FINDINGS The midwife-woman relationship was important for participants' experiences of care. Numerous social and ecological factors influenced this relationship, including family relationships, culture and religion, differing health-care systems, authoritative knowledge and communication of information. Marked differences were seen between midwives and women in the perceived importance of these factors. CONCLUSIONS Findings provide new theoretical insights into the complex factors contributing to the health-care expectations of pregnant migrant Pakistani women in the UK. These findings may be used to create meaningful dialogue between women and midwives, encourage women's involvement in decisions about their health care and facilitate future midwifery education and research. Conclusions are relevant to a broad international audience, as achieving better outcomes for migrant and ethnic minority communities is of global concern.
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Affiliation(s)
- Laura Goodwin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Billie Hunter
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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12
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Abstract
OBJECTIVES To explore women's experiences of early labour care focusing on sociodemographic differences, and to examine the effect of antenatal education, using mixed methods. SETTING England, 2014. PARTICIPANTS Women who completed postal questionnaires about their experience of maternity care, including questions about antenatal education, early labour and sociodemographic factors, included space for free-text comments. OUTCOME MEASURES Worries about labour, contact with midwives in early labour and subsequent care. METHODS This study was based on secondary analysis of a national maternity survey carried out in England in 2014. Quantitative data were analysed using descriptive statistics and binary logistic regression; qualitative data were analysed using a thematic content analytic approach. RESULTS Completed questionnaires were received from 4578 women (47% response rate). There were significant differences by sociodemographic factors, particularly ethnicity, in women's worries about early labour. Compared with white women, women from black or minority ethnic groups had an adjusted OR of 1.93 (95% CI 1.56 to 2.39) of feeling worried about not knowing when labour would start. Among women who contacted a midwife at the start of labour, 84% perceived their advice as appropriate, more in older and multiparous women. Overall, 64% of women were asked to come to the hospital at this time, more in multiparous women (adjusted OR 1.63, 95% CI 1.35 to 1.96). Those who did not have access to antenatal education experienced greater worry about early labour. Five themes emerged from the qualitative analysis: 'Differentiating between early and active labour', 'Staff attitudes', 'Not being allowed…', 'Previous labours' and 'Perceived consequences for women'. CONCLUSION These findings reinforce the importance of providing reassurance to women in early labour, taking care that women do not feel neglected or dismissed. In particular, primiparous and ethnic minority women reported greater worry about early labour and require additional reassurance.
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Affiliation(s)
- Jane Henderson
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Midwifery continuity of carer in an area of high socio-economic disadvantage in London: A retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997–2009). Midwifery 2017; 48:1-10. [DOI: 10.1016/j.midw.2017.02.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/11/2017] [Accepted: 02/24/2017] [Indexed: 01/14/2023]
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Aziato L, Ohemeng HA, Omenyo CN. Experiences and perceptions of Ghanaian midwives on labour pain and religious beliefs and practices influencing their care of women in labour. Reprod Health 2016; 13:136. [PMID: 27842544 PMCID: PMC5109714 DOI: 10.1186/s12978-016-0252-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background Beliefs surrounding pain during childbirth has biblical foundations that contribute to labour pain being viewed as a natural phenomenon. Contemporary health care promotes evidence-based labour pain management but the faith of the midwife may influence her midwifery practice regarding labour pain management. Therefore this study sought to gain in-depth insight into the experiences and perceptions of midwives regarding labour pain and the religious beliefs and practices influencing their care of women in labour in Ghana. Methods The design of the study was an interpretive phenomenology using individual in-depth interviews. The study participants were 27 Ghanaian female midwives of various religious backgrounds. Interviews were conducted in English, audio-taped and transcribed verbatim. Colaizzi’s qualitative analysis procedures were employed concurrently with data collection. Results Three major themes were generated: religious beliefs about labour pain, religious practices in labour and religious artefacts used in labour. The midwives’ faith and their experiences during their midwifery practice were inter-connected. The midwives believed labour pain was natural and religious practices are important to prevent complications. Religious artefacts used in labour included anointing oil and water, necklaces, rubber bands, bracelets, stickers and beads. Conclusion It is important that midwives provide an enabling environment for women in labour to practice their faith and they should employ context-appropriate strategies to effectively manage labour pain that takes into account the religious beliefs and practices of women.
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Affiliation(s)
- Lydia Aziato
- Department of Adult Health, School of Nursing, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana. .,Department of Adult Health, School of Nursing, University of Ghana, Legon, Accra, Ghana.
| | - Hannah Antwi Ohemeng
- Department of Adult Health, School of Nursing, University of Ghana, Legon, Accra, Ghana
| | - Cephas N Omenyo
- College of Education, University of Ghana, Legon, Accra, Ghana
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Respect to Women’s Autonomy in Childbirth: A Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.29344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Henderson J, Redshaw M. Worries About Labor and Birth: A Population-Based Study of Outcomes for Young Primiparous Women. Birth 2016; 43:151-8. [PMID: 26806273 DOI: 10.1111/birt.12219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pregnancy at a young age is a continuing public health concern strongly associated with socioeconomic deprivation, social isolation, and stigma. The objectives were to see whether, compared with women aged 21 or more, women aged 20 years or younger worried more about labor and birth, and had poorer maternal outcomes. Another objective was to investigate the extent to which worries about labor and birth mediated the associations between young age and outcomes. METHODS A secondary analysis of data was conducted relating to 2,598 primiparous women's experience of maternity care in England in 2010. The survey collected data on care in the antenatal, intrapartum, and postnatal periods, and sociodemographic factors. A validated checklist measured worries about labor and birth. RESULTS Compared with women aged 21 or more, women aged 20 years or younger worried more about labor and birth. The pain and duration of labor worried all women and those aged 20 years or younger were particularly worried about the uncertainty of labor onset, cesarean section birth, and about embarrassment. In logistic regression, after adjusting for potential confounders, young age was a significant independent risk factor for worries about pain and distress in labor, and self-reported depression at 1 and 3 months. However, young age was also significantly associated with having a normal vaginal delivery. CONCLUSIONS It may be appropriate to focus support on women experiencing multiple disadvantage, rather than young age alone.
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Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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17
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Garcia R, Ali N, Papadopoulos C, Randhawa G. Specific antenatal interventions for Black, Asian and Minority Ethnic (BAME) pregnant women at high risk of poor birth outcomes in the United Kingdom: a scoping review. BMC Pregnancy Childbirth 2015; 15:226. [PMID: 26403078 PMCID: PMC4581493 DOI: 10.1186/s12884-015-0657-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/08/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Disparity exists in maternal and infant birth outcomes of Black and Minority Ethnic (BAME) women giving birth in the United Kingdom (UK) compared to the majority. There is therefore a need to reconsider existing maternity service provision to ensure culturally competent services. The purpose of this scoping review was to ascertain what specific maternity interventions have been implemented in the UK for BAME women (2004-2014) so that increased awareness of the need and scope of specific maternity interventions for BAME women can be identified. METHODS A scoping review was conducted in order to determine the evidence base. It was determined that no prior systematic reviews had been conducted and it was apparent that literature in this field was sparse. Scoping review is an ideal method when literature is likely to be heterogeneous and the research field relatively unexplored. A keyword strategy was used implementing population (P), intervention (I), comparison (C) and outcomes (O). RESULTS An initial 2188 papers were identified. Following screening and review, only 5 heterogeneous papers remained suitable and were included. The included interventions employed sample sizes of N = 160-1441, examined a range of different outcome measures and were delivered across different parts of the UK with high numbers of BAME residents. CONCLUSIONS There is a lack of rigorous research interventions and practice interventions which are currently documented, of specific maternity interventions which are aimed to address culturally competent maternity services and the sharing of best practice addressing the increased risks of BAME women delivering in the UK.
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Affiliation(s)
- Rebecca Garcia
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
| | - Nasreen Ali
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
| | - Chris Papadopoulos
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
| | - Gurch Randhawa
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
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Yelland J, Riggs E, Small R, Brown S. Maternity services are not meeting the needs of immigrant women of non-English speaking background: Results of two consecutive Australian population based studies. Midwifery 2015; 31:664-70. [DOI: 10.1016/j.midw.2015.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 02/17/2015] [Accepted: 03/02/2015] [Indexed: 11/17/2022]
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Halperin O, Sarid O, Cwikel J. The influence of childbirth experiences on women׳s postpartum traumatic stress symptoms: A comparison between Israeli Jewish and Arab women. Midwifery 2015; 31:625-32. [DOI: 10.1016/j.midw.2015.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/31/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022]
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Redshaw M, Alderdice F. Listening and talking to women: informing the research agenda and the research process. J Reprod Infant Psychol 2015. [DOI: 10.1080/02646838.2015.1017946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nieuwenhuijze MJ, Korstjens I, de Jonge A, de Vries R, Lagro-Janssen A. On speaking terms: a Delphi study on shared decision-making in maternity care. BMC Pregnancy Childbirth 2014; 14:223. [PMID: 25008286 PMCID: PMC4104734 DOI: 10.1186/1471-2393-14-223] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/27/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women. METHODS An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive consensus was defined as 70% or more of the experts scoring ≥6 (70% panel agreement). RESULTS Consensus was reached on 45 quality criteria statements and 4 competency statements. SDM in maternity care is a dynamic process that starts in antenatal care and ends after birth. Experts agreed that the regular visits during pregnancy offer opportunities to build a relationship, anticipate situations and revisit complex decisions. Professionals need to prepare women antenatally for unexpected, urgent decisions in birth and revisit these decisions postnatally. Open and respectful communication between women and care professionals is essential; information needs to be accurate, evidence-based and understandable to women. Experts were divided about the contribution of professional advice in shared decision-making and about the partner's role. CONCLUSIONS SDM in maternity care is a dynamic process that takes into consideration women's individual needs and the context of the pregnancy or birth. The identified ingredients for good quality SDM will help practitioners to apply SDM in practice and educators to prepare (future) professionals for SDM, contributing to women's positive birth experience and satisfaction with care.
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Affiliation(s)
- Marianne J Nieuwenhuijze
- Research Centre for Midwifery Science, Faculty Midwifery Education & Studies, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Irene Korstjens
- Research Centre for Midwifery Science, Faculty Midwifery Education & Studies, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Ank de Jonge
- Midwifery Science/EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Raymond de Vries
- Research Centre for Midwifery Science, Faculty Midwifery Education & Studies, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
- CAPHRI, University Maastricht, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Antoine Lagro-Janssen
- Department of General Practice, Women Studies Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, the Netherlands
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Hastings-Tolsma M. Antenatal perineal massage decreases risk of perineal trauma during birth. Evid Based Nurs 2014; 17:77. [PMID: 24170818 DOI: 10.1136/eb-2013-101451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Marie Hastings-Tolsma
- Division of Women, Children & Family Health, University of Colorado Denver, College of Nursing, Aurora, Colorado, USA
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Henderson J, Gao H, Redshaw M. Experiencing maternity care: the care received and perceptions of women from different ethnic groups. BMC Pregnancy Childbirth 2013; 13:196. [PMID: 24148317 PMCID: PMC3854085 DOI: 10.1186/1471-2393-13-196] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/07/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women. METHODS Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women's experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity. RESULTS A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff. CONCLUSION Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern.
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Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
| | - Haiyan Gao
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
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Redshaw M, Malouf R, Gao H, Gray R. Women with disability: the experience of maternity care during pregnancy, labour and birth and the postnatal period. BMC Pregnancy Childbirth 2013; 13:174. [PMID: 24034425 PMCID: PMC3848505 DOI: 10.1186/1471-2393-13-174] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/10/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It has been estimated that 9.4% of women giving birth in the United Kingdom have one or more limiting longstanding illness which may cause disability, affecting pregnancy, birth and early parenting. No large scale studies on a nationally representative population have been carried out on the maternity experiences of disabled women to our knowledge. METHOD Secondary analysis of data from a survey of women in 2010 by English National Health Service Trusts on behalf of the Care Quality Commission was undertaken. 144 trusts in England took part in the postal survey.Women self-identified with disability and were excluded if less than 16 years of age or if their baby had died. The 12 page structured questionnaire with sections on antenatal, labour and birth and postnatal care covered access, information, communication and choice. Descriptive and adjusted analyses compared disabled and non-disabled groups. Comparisons were made separately for five disability subgroups: physical disability, sensory impairment, mental health conditions, learning disability and women with more than one type of disability. RESULTS Disabled women comprised 6.14% (1,482) of the total sample (24,155) and appeared to use maternity services more than non-disabled women. Most were positive about their care and reported sufficient access and involvement, but were less likely to breastfeed. The experience of women with different types of disability varied: physically disabled women used antenatal and postnatal services more, but had less choice about labour and birth; the experience of those with a sensory impairment differed little from the non-disabled women, but they were more likely to have met staff before labour; women with mental health disabilities also used services more, but were more critical of communication and support; women with a learning disability and those with multiple disabilities were least likely to report a positive experience of maternity care. CONCLUSION This national study describes disabled women's experiences of pregnancy, child birth and postnatal care in comparison with non-disabled women. While in many areas there were no differences, there was evidence of specific groups appropriately receiving more care. Areas for improvement included infant feeding and better communication in the context of individualised care.
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Affiliation(s)
- Maggie Redshaw
- Policy Research Unit for maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
| | - Reem Malouf
- Policy Research Unit for maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
| | - Haiyan Gao
- Policy Research Unit for maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
| | - Ron Gray
- Policy Research Unit for maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
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Michels A, Kruske S, Thompson R. Women’s postnatal psychological functioning: the role of satisfaction with intrapartum care and the birth experience. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2013.791921] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Henderson J, Redshaw M. Who is well after childbirth? Factors related to positive outcome. Birth 2013; 40:1-9. [PMID: 24635418 DOI: 10.1111/birt.12022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poor outcomes after childbirth are associated with physical ill health and with an absence of a positive sense of well-being. Postnatally poor physical health is thought to be influenced by the care received, the nature of the birth, and associated complications. The aim of this study was to estimate the effects of a range of clinical and other factors on positive outcome and well-being 3 months after childbirth. METHODS This study used data on more than 5,000 women from a 2010 National Maternity Survey about their experiences of maternity care, and health and well-being 3 months after childbirth. Positive outcome was defined as women reporting no problems and feeling "very well" at the time of the survey. RESULTS In the univariate analysis, several variables were significantly associated with positive outcome, including sociodemographic, antenatal, intrapartum, and postnatal factors. In the final logistic regression model, young mothers, those without physical disability and those with no or few antenatal or early postnatal problems, were most likely to have positive outcomes. Other significant factors included a positive initial reaction to the pregnancy, not reporting antenatal depression, fewer worries about the labor and birth, and access to information about choices for care. CONCLUSIONS This study shows how positive outcomes for women after childbirth may be influenced by health, social, and care factors. It is important for caregivers to bear these factors in mind so that extra support may be made available to those women who are likely to be susceptible to poor outcome.
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Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
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Jomeen J, Redshaw M. Ethnic minority women's experience of maternity services in England. ETHNICITY & HEALTH 2012; 18:280-296. [PMID: 23039872 DOI: 10.1080/13557858.2012.730608] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Provision for ethnic minority groups has been acknowledged as integral to good maternity care in England and ethnicity has been highlighted as an indicator of both poorer clinical outcomes and poorer experiences. Improving outcomes and services is dependent on understanding women's interaction with both service delivery and provision. The aim of this study was to explore Black and minority ethnic (BME) women's experiences of contemporary maternity care in England. DESIGN A UK-wide survey which investigated core aspects of maternity care sought the views of BME women about their experiences. A random sample of women were selected by the Office for National Statistics from birth registration in England and invited to complete a questionnaire three months after the birth. In a secondary analysis, text responses to open-ended questions about their maternity care were analysed using thematic analysis. RESULTS Sixty per cent of the 368 women who self-identified as BME responded with open text. Themes that emerged related to 'feeling cared for,' with subthemes of 'expectations of care' and 'policies, rules and organisational pressures'; 'staff attitudes and communication' with sub-themes of 'please believe me,' 'hospital as a safe place,' 'choices denied' and 'being sensitive and supportive would help,' and 'ethnicity and culture' with sub-themes of 'stereotyping' and 'improving the quality of care.' CONCLUSION The findings highlight issues affecting the quality of maternity care that BME women in England receive. Many issues are not unique to BME women; however, the findings reflect some seemingly enduring issues and coherence with other wider international findings, particularly in relation to post-natal care and staff attitudes. Actually being cared for and supported across their child-bearing experience are needs that women themselves identified as critical for care providers to recognise and respond to. The failures of care provision described should inform the development of services.
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Affiliation(s)
- Julie Jomeen
- Faculty of Health and Social Care, University of Hull, Hull, UK
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