Supportive encounters during pregnancy and the postnatal period: An ethnographic study of care experiences of parents in a vulnerable position

BACKGROUND

Pregnant women and partners with psychological and/or social challenges are exposed to adverse health outcomes. It is therefore recommended that they receive targeted maternity care services. The relationship between parents and professionals is key to help parents engage with services and experience them as supportive. However, more knowledge is needed on parents' care experiences during encounters with professionals to further understand when and how these are experienced as supportive.

OBJECTIVES

This study aimed at identifying the key elements of supportive care practices by exploring how parents in vulnerable positions experience their relationship and encounters with the professionals involved in their pregnancy and postnatal care.

DESIGN

Ethnographic fieldwork was conducted in a Danish municipality, including 50 semi-structured interviews with parents and 51 field visits during parent-professional encounters, including informal interviews and participant observation. Using a purposive recruitment strategy, 26 women and 13 men were recruited, who varied in age, socioeconomic background and vulnerability factors. COREQ reporting guidelines were used.

RESULTS

The analysis identified five themes: (a) Having a voice: Feeling listened to, (b) Being met with empathy: Feeling understood, (c) Worthy of attention: Feeling taken seriously, (d) On equal terms: Feeling like a normal family and (e) Moving in the right direction: Feeling reassured.

CONCLUSION

Positive care experiences facilitate engagement with services and professionals as this contribute to parents feeling included, respected and safe. Conversely, negative care experiences leave parents feeling excluded, judged and anxious, potentially reinforcing and adding to existing feelings of anxiety and stigma. This requires that professionals have good communication skills and are able to approach parents in an open and non-judgmental way.

RELEVANCE TO CLINICAL PRACTICE

Understanding the significance of supportive care practices is paramount for health visitors, midwives and other professionals involved in providing for parents in vulnerable positions during pregnancy and the postnatal period.

"Ashamed, Silent and Stuck in a System"-Applying a Structural Violence Lens to Midwives' Stories on Social Disadvantage in Pregnancy

Historical and enduring maternal health inequities and injustices continue to grow in Aotearoa New Zealand, despite attempts to address the problem. Pregnancy increases vulnerability to poverty through a variety of mechanisms. This project qualitatively analysed an open survey response from midwives about their experiences of providing maternity care to women living with social disadvantage. We used a structural violence lens to examine the effects of social disadvantage on pregnant women. The analysis of midwives’ narratives exposed three mechanisms by which women were exposed to structural violence, these included structural disempowerment, inequitable risk and the neoliberal system. Women were structurally disempowered through reduced access to agency, lack of opportunities and inadequate meeting of basic human needs. Disadvantage exacerbated risks inequitably by increasing barriers to care, exacerbating the impact of adverse life circumstances and causing chronic stress. Lastly, the neoliberal system emphasised individual responsibility that perpetuated inequities. Despite the stated aim of equitable access to health care for all in policy documents, the current system and social structure continues to perpetuate systemic disadvantage.