Staying Involved “Because the Need Seems So Huge”: Midwives Working With Women Living in Areas of High Deprivation

The public health role of caseloading midwives in advancing health equity in childbearing women and babies living in socially deprived areas in England: The Mi-CARE Study protocol

This article outlines the protocol for a qualitative Constructivist Grounded Theory study, examining the public health role of caseloading midwives working in a continuity model of care in areas of urban social deprivation. The study is currently being conducted in a city in the south of England during the COVID-19 pandemic. Focusing specifically on the Social Determinants of Health impacting women and babies in this context and from the perspectives of women themselves, the study is developing a theoretical framework examining the actions caseloading midwives take in response to these determinants and how these actions contribute to advancing equity and equality for women and babies at increased risk of adverse perinatal outcomes. Examining and integrating the experiences of women and midwives from a Constructivist Grounded Theory perspective, the study findings will inform current NHS maternity policy and contribute to our understanding about the social processes and mechanisms underpinning the known benefits of midwifery continuity of care models in different contexts.

Providing maternity care for disadvantaged women in Aotearoa New Zealand: The impact on midwives

BACKGROUND

Health inequities and socio-economic disadvantage are causes for concern in Aotearoa New Zealand. Becoming pregnant can increase a woman's vulnerability to poverty, with the potential for an increase in multiple stressful life events. Providing midwifery care to women living in socio-economic deprivation has been found to add additional strains for midwives. Exploring the perspectives of the midwives providing care to women living with socio-economic deprivation can illuminate the complexities of maternity care.

AIM

To explore the impact on midwives when providing care for socio-economically disadvantaged women in Aotearoa New Zealand.

METHOD

Inductive thematic analysis was used to analyse an open-ended question from a survey that asked midwives to share a story around maternal disadvantage and midwifery care.

FINDINGS

A total of 214 stories were received from midwives who responded to the survey. Providing care to disadvantaged women had an impact on midwives by incurring increased personal costs (time, financial and emotional), requiring them to navigate threats and uncertainty and to feel the need to remedy structural inequities for women and their wider families. These three themes were moderated by the relationships midwives held with women and affected the way midwives worked across the different maternity settings.

CONCLUSION

Midwives carry a greater load when providing care to socio-economically deprived women. Enabling midwives to continue to provide the necessary support for women living in socio-economic deprivation is imperative and requires additional resources and funding.

A Successful Midwifery Model for a High Deprivation Community in New Zealand: A Mixed Methods Study

In August 2011, the Ministry of Health (MOH) commissioned a report to provide information, evidence, and analysis regarding an integrated lead maternity care model for a midwifery practice situated in Counties Manukau, New Zealand, a high deprivation area. The final report was entitled “A Successful Lead Maternity Care Midwifery Practice in Counties Manukau” (Priday & McAra-Couper, 2011). The project was both qualitative (qualitative descriptive) and quantitative (descriptive statistics) in its review and audit of the Midwifery Practice. The midwives from this practice have been providing continuity of midwifery care for 17 years, and the MOH was interested in how this group of midwives (“the Midwifery Practice”) was working and the implications of this style of practice. The report demonstrated that the Midwifery Practice provides continuity of care for predominantly Pacific and Maori (indigenous) women and young women, including adolescents. The socioeconomic indicators of these women place them in the high deprivation index group. Given these three factors—ethnicity, age, and deprivation decile—high perinatal mortality and other adverse outcomes could be expected. However, statistics demonstrate low perinatal mortality and morbidity, with most women booking for care before 20 weeks’ gestation and recording optimal birth outcomes. The Midwifery Practice is integrated into the community facilitating a connected and accessible service for women and families. These findings are significant in light of the repeated call from the Perinatal and Maternal Mortality Review Committee (PMMRC, 2013), urging stakeholders who provide health and social services to identify the reasons why women are failing to engage with care and to identify interventions to address barriers. This article summarizes the findings from the report.