Change over time in women's views and experiences of maternity care in England, 1995-2014: A comparison using survey data

Postnatal care provided by UK midwifery units and the impact of the COVID-19 pandemic: A survey using the UK Midwifery Study System (UKMidSS)

Background

Postnatal care supports healthy transitions to parenthood, mother-infant relationships, and breastfeeding establishment. Highly valued by women and families, it is often an area where parents report low satisfaction compared with other areas of maternity care. Most research about postnatal care is hospital-focused. Little is known about postnatal services provided by midwifery units, and any changes to this provision since the COVID-19 pandemic.

Aim

To describe postnatal care services provided by UK midwifery units and examine the extent to which provision was affected by the COVID-19 pandemic.

Methods

We carried out a national survey online between January-June 2022 using the United Kingdom Midwifery Study System (UKMidSS). We asked about postnatal care provision in alongside midwifery units (AMU) and freestanding midwifery units (FMU), before the COVID-19 pandemic (July-December 2019) and shortly after restrictions were eased (January-June 2022).

Findings

Overall 131 (67 %) midwifery units responded to the survey, 76 (62 %) AMUs and 55 (75 %) FMUs, from 75 % of eligible NHS organisations. In 2022, 66 % of AMUs reported that women typically stayed for 6-24 h after a straightforward birth, while 70 % of FMUs reported typical postnatal stays of <6 h. For 2019, significantly more FMUs reported providing outpatient postnatal services compared with AMUs (98 % vs 57 %, p < 0.001). From 2019 to 2022 there were significant reductions in partners staying overnight in midwifery units (65 %-42 %, p < 0.001), and in the provision of outpatient postnatal breastfeeding groups (23 %-15 %, p < 0.01) and other postnatal groups (7 %-2 %, p = 0.02).

Conclusions

The findings document the ways in which postnatal care provision differs between AMUs and FMU, with potential consequences for choice and experience for women. They are also congruent with evidence that maternity care was adversely affected by the COVID-19 pandemic, including a reduction in postnatal visiting for partners and in postnatal group support services.

Measuring women's experiences during antenatal care (ANC): scoping review of measurement tools

BACKGROUND

The new WHO model for antenatal care (ANC) focuses on improving practice, organisation and delivery of ANC within health systems, which includes both clinical care and women's experiences of care. The goal of this review is to identify tools and measures on women's experiences of ANC.

METHODS

We conducted a scoping review to identify tools and measures on women's experiences of ANC. An iterative approach was used to review all tools in a series of four steps: (1) identify papers between 2007 and 2023; (2) identify the tools from these papers; (3) map relevant measures to conceptualizations of experiences of care, notably mistreatment of women and respectful maternity care and (4) identify gaps and opportunities to improve measures.

RESULTS

Across the 36 tools identified, a total of 591 measures were identified. Of these, 292/591 (49.4%) measures were included and mapped to the typology of mistreatment of women used as a definition for women's experiences care during ANC in this review, while 299/591 (44.9%) irrelevant measures were excluded. Across the included measures, the highest concentration was across the domains of poor rapport between women and providers (49.8%) followed by failure to meet professional standards of care (23.3%). Approximately, 13.9% of measures were around overall respectful care, followed by health systems (6.3%), and any  physical or verbal abuse, stigma and/or discrimination (4.8%) .

CONCLUSION

This analysis provides an overview of the existing tools, gaps and opportunities to measure women's experiences during ANC. Expanding beyond the childbirth period, these findings can be used to inform existing and future tools for research and monitoring measuring women's experiences of ANC.

Association of Sociodemographic, Obstetric, and Attitudinal Factors with Prenatal Ultrasound in Mashhad, Iran

Many antenatal sonographies are out of indication and may be asked due to mothers' requests or other factors. However, these features are not fully understood. This study aimed to assess the association of sociodemographic, obstetric, and attitudinal factors that may affect the number of ultrasound scans. In a cross-sectional study in six hospitals affiliated with Mashhad University of Medical Sciences, 360 mothers who had a delivery or were expected to be near childbirth were enrolled in the study. The mean number of sonographies was compared between different study variables by using Mann–Whitney, Kruskal–Wallis, and Pearson's Chi-squared tests. Moreover, the Spearman Rho test was used to assess the correlation between different variables and the number of sonographies. Totally, 300 cases remained in the study. The mean age of the mothers was 25.95 ± 4.77 years, and the average number of ultrasonographies was 3.50 ± 1.35. In case of sociodemographic features, the level of education (r = 0.23; p < 0.001) and several recent miscarriages (r = 0.140; p = 0.01) were correlated with number of sonographies. However, there was no association between maternal age and marriage age with several sonographies (p > 0.05). Furthermore, mothers with higher family income (p = 0.010), those with medical insurance (p = 0.010), those who had male fetuses (p = 0.020), those who were clerk or student (p = 0.003), and those who were not aware of the sonography risks (p = 0.020) had more requests for sonography. It seems that financial factors and awareness of sonography risks play an essential role in sonography requests by mothers.

Factors Affecting Delivery Health Service Satisfaction of Women and Fear of COVID- 19: Implications for Maternal and Child Health in Pakistan

Objective

High maternal and neonatal mortality rates in developing regions like Pakistan are linked to low rates of institutional deliveries. One way to improve rates of institutional deliveries is through improving institutional delivery service satisfaction in women. The aim of this research is to identify which factors influence delivery service satisfaction during the period of COVID-19 and which socio-demographic characteristics of women are associated with greater fear of catching COVID-19 during institutional deliveries.

Methods

A total of 190 women who had given birth between May to June, 2020, were sampled from two private and two public sector hospitals in Lahore, Pakistan. A standardized tool was modified for use and a combination of descriptive statistics and multivariate regression was applied.

Results

The results reveal that a majority of women, at 74.7%, are afraid of contracting COVID-19; specifically, women delivering at public hospitals, those who are illiterate or semi-literate, with more than four children, with low household income, and who are unemployed. Regression models are used to identify factors related to higher satisfaction, including the following: (i) pre-delivery care (explanatory power of R² = 0.651); (ii) during delivery care (R² = 0.716); (iii) after delivery care for women (R² = 0.525); and (iv) after delivery care for newborn (R² = 0.780). The main areas which influence satisfaction include the following: service quality of staff and administration; maintenance of hygiene and sanitation; involvement in decision-making; provision of necessary information; and advice for breastfeeding, immunization and family planning.

Conclusions for Practice

Based on our findings, we recommend improved regulation of delivery services in both public and private hospitals and increased protection for disadvantaged women groups to maintain service quality during the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10995-021-03140-4.

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital

BACKGROUND

Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences.

METHODS

A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25.

RESULTS

The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations.

CONCLUSIONS

Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

Women's agenda for the improvement of childbirth care: Evaluation of the Babies Born Better survey data set in Spain

BACKGROUND

Public patient involvement (PPI) generates knowledge about the health-illness process through the incorporation of people's experiences and priorities. The Babies Born Better (BBB) survey is a pan-European online questionnaire that can be used as a PPI tool for preliminary and consultative forms of citizens' involvement. The purpose of this research was to identify which practices support positive birth experiences and which ones women want changed.

METHODS

The BBB survey was distributed in virtual communities of practice and through social networks. The version launched in Spain was used to collect data in 2014 and 2015 from women who had given birth in the previous 5 years. A descriptive, quantitative analysis was applied to the sociodemographic data. Two open-ended questions were analyzed by qualitative content analysis using a deductive and inductive codification process.

RESULTS

A total of 2841 women participated. 41.1% of the responses concerned the category "Care received and experienced," followed by "Specific interventions and procedures" (26.6%), "Involved members of care team" (14.2%), and "Environmental conditions" (9%). Best practices were related to how care is provided and received, and the main areas for improvement referred to specific interventions and procedures.

CONCLUSIONS

This survey proved a useful tool to map the best and poorest practices reported. The results suggest a need for improvement in some areas of childbirth care. Women's reports on negative experiences included a wide range of routine clinical interventions, avoidable procedures, and the influence exerted by professionals on their decision-making.

Midwifery-led care in South Australia: Looking back to move forward

BACKGROUND

From the 1980s to the turn of the century, Australia saw an evolution of midwifery-led models of care, in part due to legislative reform and federal funding, but largely owing to the efforts of strong midwifery leaders and consumers who rallied for the implementation of alternative models of care. Through persistence and extensive collaboration, the first South Australian birth centres were established.

AIM

To better understand the evolution of midwifery-led care in South Australia and identify the drivers and impediments to inform the upscaling of midwifery models into the future.

METHODS

Semi-structured interviews were conducted with ten midwifery leaders and/or those instrumental in setting up birth centres and midwifery-led care in South Australia. Data was analysed using thematic analysis.

FINDINGS

Three overarching themes and several sub-themes were identified, these included: 'Midwifery suffragettes' which explored 'activism', 'adversity' and 'advocacy'; 'Building bridges' captured the importance of 'gathering midwives', a 'movement of women' and 'champions and influencers'; and 'Recognising midwifery' identified the strong 'sense of identity' needed to outface 'ignorance and opposition' and the importance of 'role reformation'.

CONCLUSION

These midwifery leaders provide insight into an era of change in the history of midwifery in South Australia and contribute valuable learnings. In order to move forward, midwives must continue to embrace the political nature of midwifery, enact authentic, transformational leadership and engage women across all levels of influence. It is critical that midwives pursue equity in professional recognition, work collaboratively to provide quality, woman-centred maternity care and expand midwifery continuity of care models.

Women's ideal and real expectations of postnatal care during their first pregnancy: An online survey in England

BACKGROUND

There are many studies of women's experiences of care during the postnatal period, however little is known about women's expectations of postnatal care.

OBJECTIVE

This study explores first-time pregnant women's expectations, both ideal and real life, of postnatal care in England.

DESIGN

a descriptive, cross-sectional online survey design was used. The questionnaire took approximately 10 minutes to complete and was developed specifically for this survey. It included an informed consent section, socio-demographic questions and closed tick-box questions on where they had received information on postnatal care, and real and ideal expectations of postnatal care in hospital/birth centre and at home.

SETTING

The survey was hosted on the National Perinatal Epidemiology Unit website and advertised through a number of third sector and commercial organisations in 2017.

PARTICIPANTS

Women who were pregnant, had not given birth before, were aged 16 years and over, and living in England were eligible to participate.

ANALYSIS

Survey data were analysed using descriptive statistics and, where appropriate, chi square test using SPSS Version 23. Data from open ended questions were analysed by two researchers separately then codes and themes were discussed until consensus was reached.

RESULTS

283 women responded to the survey of whom 200 were eligible and included in the analysis. Most had received information on postnatal care from multiple sources, with pregnancy classes and midwives being most common. Most expected to stay one day or less in hospital or birth centre after normal delivery. Real life expectations were lower than ideal expectations, and hospital/birth centre real life expectations were higher than home real life expectations for physical health advice/checks and information/help with feeding. Categories developed from the open text answers were 'Respect, compassion and individualised care at a vulnerable time', 'The ward environment', 'Feeling ready for hospital discharge' and 'Help to find support in the community'.

KEY CONCLUSIONS

Women in this survey had high ideal world expectations of their postnatal care but in real life expected more focus on checking on their health and that of their baby and on giving information about the new challenges of how to breastfeed and look after a baby. While women valued checks of their health and that of their baby, ideally they wanted easy access to reassurance that they were feeding and looking after their baby well, that they were 'doing it right', and that what was happening to them was normal.

IMPLICATIONS FOR PRACTICE

As well as the necessary checks in the immediate postpartum period, consideration also needs to be given to the best way to meet the informational and support needs of women to optimise their wellbeing and transition to parenthood. A number of resources are used by women that could be enhanced to inform expectations of postnatal care and to provide valuable information to support their postnatal care.

How can we best use opportunities provided by routine maternity care to engage women in improving their diets and health?

Pregnancy provides motivation for women to improve their diets and increase their physical activity. Opportunistic brief interventions delivered as part of routine primary care have produced improvements in patients' health behaviour. Consequently, there have been calls for midwives to use contacts during pregnancy in this way. This study explored the experiences of pregnant women and research midwives/nurses of a brief intervention called Healthy Conversation Skills (HCS) being delivered as part of a randomised control trial, assessing the acceptability and feasibility of including this intervention in routine maternity care. Three research questions were addressed using mixed methods to produce four datasets: face-to-face interviews with participants, a focus group with the HCS-trained midwives/nurses, case reports of participants receiving HCS and audio-recordings of mid-pregnancy telephone calls to the women which produced midwife/nurse HCS competency scores. Midwives/nurses used their HCS to support women to make plans for change and set goals. Women welcomed the opportunity to address their own health and well-being as distinct from that of their baby. Midwives/nurses were competent in using the skills and saw healthy conversations as an effective means of raising issues of diet and physical activity. Recent extension of maternity appointment times provides ideal opportunities to incorporate a brief intervention to support behaviour change. Incorporating HCS training into midwifery education and continuing professional development would facilitate this. HCS is a scalable, brief intervention with the potential to improve the diets and physical activity levels of women during pregnancy, and hence the health of themselves and their babies.

Women's views of continuity of information provided during and after pregnancy: A qualitative interview study

Straightforward transfer of care from pregnancy to the postpartum period is associated with health benefits and is desired by women worldwide. Underpinning this transfer of care is the sharing of information between healthcare professionals and the provision of consistent information to women. In this qualitative study, two aspects of continuity of information were examined; first the information passed on from midwife to health visitor regarding a woman and her baby before the health visitor meets the woman postnatally and second, the consistency of information received by women from these two healthcare professionals (the main healthcare providers during and after pregnancy in England). To be eligible for the study, women had to have had a baby in England within 12 months prior to the interview. Participants also needed to be able to read and speak English and be over 18 years old. Recruitment of participants was via word of mouth and social media. Twenty-nine mothers were interviewed of whom 19 were first time mothers. The interviews took place in the summer and autumn of 2016 and were transcribed verbatim and analysed using Framework Analysis. Two overarching themes were identified: not feeling listened to and information inconsistencies. Women reported little experience of midwives and health visitors sharing information about their care, forcing women to repeat information. This made women feel not listened to and participants recommended that healthcare professionals share information; prioritising information about labour, mental health, and chronic conditions. Women had mixed experiences regarding receiving information from midwives and health visitors, with examples of both consistent and inconsistent information received. To avoid inconsistent information, joint appointments were recommended. Findings from this study clearly suggest that better communication pathways need to be developed and effectively implemented for midwives and health visitors to improve the care that they provide to women.

Mothers' satisfaction with care during facility-based childbirth: a cross-sectional survey in southern Mozambique

Background

Client satisfaction is an essential component of quality of care. Health system factors, processes of care as well as mothers’ characteristics influence the extent to which care meets the expectations of mothers and families. In our study, we specifically aimed to address the mothers’ experiences of, and satisfaction with, care during childbirth.

Methods

A population-based cross-sectional study, using structured interviews with published sequences of questions assessing satisfaction, including 4358 mothers who gave birth during the 12 months before June 2016 to estimate satisfaction with childbirth care. Regression analysis was used to determine the predictors of client satisfaction.

Results

Most mothers (92.5%) reported being satisfied with care during childbirth and would recommend that a family member to deliver at the same facility. Specifically, 94.7% were satisfied with the cleanliness of the facility, 92.0% reported being satisfied with the interaction with the healthcare providers, but only 49.8% felt satisfied with the assistance to feed their baby. Mothers who had negative experiences during the process of care, such as being abandoned when needing help, disrespect, humiliation, or physical abuse, reported low levels of satisfaction when compared to those who had not had such experiences (68.5% vs 93.5%). Additionally, they reported higher levels of dissatisfaction (20.1% vs 2.1%). Regression analysis revealed that mothers who gave birth in primary level facilities tended to be more satisfied than those who gave birth in hospitals, and having a companion increased, on average, the overall satisfaction score, with 0.06 in type II health centres (CI 0.03–0.10) and with 0.05 in type I health centres (CI − 0.02 – 0.13), compared to − 0.01(CI -0.08 – 0.07) in the hospitals, irrespective of age, education and socio-economic background.

Conclusion

Childbirth at the primary level facilities contributes to the level of satisfaction. The provision of childbirth care should consider women’s preferences and needs, including having a companion of choice. We highlight the challenge in balancing safety of care versus satisfaction with care and in developing policies on the optimum configuration of childbirth care. Interventions to improve the interaction with providers and the provision of respectful care are recommended.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2449-6) contains supplementary material, which is available to authorized users.

Expectations and experiences of hospital postnatal care in the UK: a systematic review of quantitative and qualitative studies

OBJECTIVES

To report on women's and families' expectations and experiences of hospital postnatal care, and also to reflect on women's satisfaction with hospital postnatal care and to relate their expectations to their actual care experiences.

DESIGN

Systematic review.

SETTING

UK.

PARTICIPANTS

Postnatal women.

PRIMARY AND SECONDARY OUTCOMES

Women's and families' expectations, experiences and satisfaction with hospital postnatal care.

METHODS

Embase, MEDLINE, PsycINFO, Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health (CINAHL Plus), Science Citation Index, and Social Sciences Citation Index were searched to identify relevant studies published since 1970. We incorporated findings from qualitative, quantitative and mixed-methods studies. Eligible studies were independently screened and quality-assessed using a modified version of the National Institutes of Health Quality Assessment Tool for quantitative studies and the Critical Appraisal Skills Programme for qualitative studies. Data were extracted on participants' characteristics, study period, setting, study objective and study specified outcomes, in addition to the summary of results.

RESULTS

Data were included from 53 studies, of which 28 were quantitative, 19 were qualitative and 6 were mixed-methods studies. The methodological quality of the included studies was mixed, and only three were completely free from bias. Women were generally satisfied with their hospital postnatal care but were critical of staff interaction, the ward environment and infant feeding support. Ethnic minority women were more critical of hospital postnatal care than white women. Although duration of postnatal stay has declined over time, women were generally happy with this aspect of their care. There was limited evidence regarding women's expectations of postnatal care, families' experience and social disadvantage.

CONCLUSION

Women were generally positive about their experiences of hospital postnatal care, but improvements could still be made. Individualised, flexible models of postnatal care should be evaluated and implemented.

PROSPERO REGISTRATION NUMBER

CRD42017057913.

Women's experiences of maternity care in England: preliminary development of a standard measure

BACKGROUND

As maternity services evolve and the population of women served also changes, there is a continuing need to effectively document the views of women with recent experience of care. A woman's maternity experience can have a positive or negative effect upon her emotional well-being and health, in the immediate and the long-term, which can also impact the infant and the wider family system. Measuring women's perceptions of maternity services is an important way of monitoring the quality of care provision, as well as providing key indicators to organisations of the services that they are providing. It follows that, without information identifying possible areas in need of improvement, it is not clear what changes should be made to improve the experiences of women during their journey through maternity services from pregnancy to the early weeks at home with a new baby . The objective is to describe the development process and psychometric properties of a measure of women's experience of maternity care covering the three distinctly different phases of maternity - pregnancy, labour and birth, and the early postnatal period.

METHODS

Data from a national survey of women who had recently given birth (n = 504) were used. Exploratory and confirmatory factor analytic methods were employed. The measure was assessed for underlying latent factor structure, as well as for reliability, internal consistency, and validity (predictive, convergent and discriminant).

RESULTS

The models developed confirmed the use of three separate, but related scales about experience of maternity care during pregnancy, labour and birth and the postnatal period. Data reduction was effective, resulting in a measure with 36 items (12 per scale).

CONCLUSION

The need for a psychometrically robust and qualitatively comprehensive measure of women's experience of maternity care has been addressed in the development and validation of this prototype measure. The whole measure can be used at one time point, or the three separate subscales used as individual measures of experience during particular phases of the maternity journey with identified factor structures in their own right.

Is maternity care in Scotland equitable? Results of a national maternity care survey

OBJECTIVE

High-quality maternity care is key to long-term improvements in population health. However, even within developed welfare systems, some mothers and babies experience poorer care and outcomes. This study aimed to explore whether women's experiences of maternity care in Scotland differs by their physical or sociodemographic characteristics.

DESIGN

Secondary analysis of the 2015 Scottish Maternity Care Experience Survey. The questionnaire was based on the Care Quality Commission English maternity survey.

SETTING

National Health Service maternity care in Scotland.

PARTICIPANTS

The survey was distributed to 5025 women who gave birth in Scotland during February and March 2015 with 2036 respondents (41%).

MAIN OUTCOME MEASURES

The questionnaire explored aspects of care processes and interpersonal care experienced from the first antenatal contact (booking) to 6 weeks following the birth. The analysis investigated whether experiences were related to age, parity, deprivation, rurality, self-reported general health or presence of a health condition that limited daily activities. Analysis used mixed effect multilevel models incorporating logistic regression.

RESULTS

There were associations between parity, age and deprivation with gestation at booking indicating that younger women, women from more deprived areas and multiparous women booked later. Women reporting generally poorer health were more likely to describe poorer care experiences in almost every domain including continuity, pain relief in labour, communication with staff, support and advice, involvement in decision making, confidence and trust and overall rating of care.

CONCLUSIONS

We found few differences in maternity care experience for women based on their physical or socioeconomic characteristics. Our findings indicate that maternity care in Scotland is generally equitable. However, the link between poorer general health after childbirth and poorer experience of maternity care is an important finding requiring further study.

A qualitative exploration of women's experiences of antenatal and intrapartum care: The need for a woman-centred approach in the Peruvian Amazon

OBJECTIVE

To explore women's experiences and perceptions of antenatal and intrapartum care in the Peruvian Amazon, including their perceived motivators, enablers and barriers to accessing care.

DESIGN

Interpretive descriptive qualitative study using semi-structured face-to-face interviews.

SETTING

Primary healthcare centre, Iquitos, Peru.

PARTICIPANTS

Women (n = 20) attending the healthcare centre who had given birth in the past 6 months.

MEASURES

Interviews were conducted using a female interpreter, transcribed clean verbatim and thematically analysed.

FINDINGS

Four core themes relating to antenatal care were interpreted. (1) Perceived knowledge of antenatal care and its importance: women generally understood the importance of care, mainly for their baby's health rather than their own. (2) Appointments and information received: women wanted more appointments to facilitate greater depth of information relating to their pregnancy. (3) Interaction with healthcare practitioners: women felt they received inadequate attention, care lacked continuity and they were often uncomfortable with male practitioners. (4) Perceived motivators, barriers and enablers to accessing antenatal care: Knowledge of the importance of care acted as the main motivator. Few direct barriers were identified, other than employment. Free care and ease of access enabled attendance. Two core themes were interpreted relating to intrapartum care. (1) Expectations and preferences for labour and delivery: the need for a safe environment for childbirth was acknowledged. (2) Actual experiences of labour and delivery: for most women labour and delivery experiences were not as they had expected. Women objected less to male professionals during labour than antenatal care.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Women reported negative experiences of both antenatal and intrapartum care. There is clearly a need for a more woman-centred approach to care and service provision. Ideally, this would involve employing more staff, acknowledging the implications on resources, improving attitudes towards women, facilitating continuity of care, and allowing patient choice to give women greater involvement.

Sociodemographic differences in women's experience of early labour care: a mixed methods study

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.