The experiential knowledge of migrant women about vulnerability during pregnancy: A woman-centred mixed-methods study

Fostering empowerment through communication: The needs, expectations, and experience of maternity care among polish migrant women in Iceland

OBJECTIVE

Over recent decades, Iceland has evolved into a more diverse society, revealing disparities in perinatal outcomes for migrant women. This study explored the needs, expectations, and experiences of Polish migrant women regarding midwifery care during childbirth in Iceland.

METHODS

This longitudinal qualitative study involved semi-structured interviews conducted from December 2021 to May 2022. Eight Polish women participated in two interviews: one during their third trimester pregnancy (T1) and another within 12 weeks postpartum (T2). The interviews were analyzed using reflexive thematic analysis.

RESULTS

The longitudinal analysis generated two overarching themes: (1) Wishing for respectful individualized care and (2) The importance of receiving adequate information and sharing preferences. Additionally, one theme was constructed from T1: (1) Feeling misunderstood, isolated, and longing for support. From T2, two themes were deweloped: (1) The value of emotional and practical support from both midwives and partners during pregnancy and birth and (2) The importance of having a voice in the care process.

CONCLUSION

Insecurity about pain management and communication challenges were common. Open dialogue and strong connections with midwives were essential for positive care experiences. This study highlights gaps in language support, cultural sensitivity, and tailored information in Icelandic maternity care for Polish migrant women. Providing individualized care, marked by respect and clear communication, empowers women to make informed decisions and fosters a sense of control during childbirth. Addressing these gaps is vital for improving perinatal outcomes and ensuring equitable, comprehensive support for all women during this transformative life event.

Racialized migrant women's discrimination in maternal care: a scoping review

BACKGROUND

Despite equality and quality being the core of good healthcare, racial and ethnic inequalities continue to persist. Racialized groups, including racialized migrant women, experience various forms of discrimination-particularly during maternal care encounters, where intersectional forms of discrimination may occur. Experiences of discrimination in maternal care have been associated with poor health-seeking behavior and adverse maternal health outcomes. However, research on racialized migrant women's discrimination in maternal care is limited. This scoping review aims to give an overview of the state of current research on the discriminatory experiences of racialized migrant women when utilizing maternal healthcare and its gaps to ensure equity in global maternal healthcare.

METHODOLOGY

This scoping review mapped out all available English-language scientific empirical literature published between 2012 and 2023. All authors agreed on the inclusion criteria. Collecting, charting, and reviewing the included material were done using the 2018 Preferred Reporting Items for reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The search strategy included electronic databases, such as Pubmed, CINAHL, MEDLINE, Web of Science, and PsycInfo.

RESULTS

A total of 57 articles were included and analyzed. The majority were qualitative and conducted in European and North American countries. None of the included article's aims originally intended to focus on discrimination. However, their findings exposed the many ways racialized migrant women experienced discrimination when using maternal healthcare services-from accessibility problems, non-utilization of interpreters, and untimely and delayed care to disrespect, abuse, and differential care. Racialized migrant women's discrimination resulted in a lack of agency and being excluded from decision-making.

CONCLUSIONS

While the included articles allude to some issues related to discrimination in maternal healthcare experienced by racialized migrant women, this review delineated knowledge gaps warranting discussion. Few articles focus on and conceptualize discrimination from a racialized lens in maternal healthcare. A limited geographical scope in research and knowledge generation on discrimination and racialization exist in this field as does a lack of sufficient articles on discrimination and racism from healthcare personnel. Lastly, many of the existing studies lack an intersectional lens in exploring discrimination in maternal care against racialized migrant women.

Predicting population-level vulnerability among pregnant women using routinely collected data and the added relevance of self-reported data

Recognizing and addressing vulnerability during the first thousand days of life can prevent health inequities. It is necessary to determine the best data for predicting multidimensional vulnerability (i.e. risk factors to vulnerability across different domains and a lack of protective factors) at population level to understand national prevalence and trends. This study aimed to (1) assess the feasibility of predicting multidimensional vulnerability during pregnancy using routinely collected data, (2) explore potential improvement of these predictions by adding self-reported data on health, well-being, and lifestyle, and (3) identify the most relevant predictors. The study was conducted using Dutch nationwide routinely collected data and self-reported Public Health Monitor data. First, to predict multidimensional vulnerability using routinely collected data, we used random forest (RF) and considered the area under the curve (AUC) and F1 measure to assess RF model performance. To validate results, sensitivity analyses (XGBoost and Lasso) were done. Second, we gradually added self-reported data to predictions. Third, we explored the RF model's variable importance. The initial RF model could distinguish between those with and without multidimensional vulnerability (AUC = 0.98). The model was able to correctly predict multidimensional vulnerability in most cases, but there was also misclassification (F1 measure = 0.70). Adding self-reported data improved RF model performance (e.g. F1 measure = 0.80 after adding perceived health). The strongest predictors concerned self-reported health, socioeconomic characteristics, and healthcare expenditures and utilization. It seems possible to predict multidimensional vulnerability using routinely collected data that is readily available. However, adding self-reported data can improve predictions.

Does maternity care in Australia align with the national maternity Strategy? Findings from a national survey of women's experiences

BACKGROUND

Women Centred Care: Strategic directions for Australian maternity services (the Strategy), released in November 2019, provides national guidance on effective maternity care provision. The Strategy is structured around four core values (safety, respect, choice, and access) underpinning twelve woman-centred care principles.

AIM

To explore whether the experiences of women who accessed Australian maternity services were aligned with the Strategy's values and principles.

METHODS

Women who had completed an entire maternity care episode in Australia between January 2020 and June 2023 were invited to participate in an online survey. Women's experiences according to the Strategy's values and principles and their association with model of care, age, place of residence, educational attainment, and household income are reported.

FINDINGS

The survey was completed by 1750 women. A proportion of women perceived the Strategy's values were not reflected in the care they experienced. At its lowest, only 50.3 % of women received an aspect of care that mostly or always aligned with the values, and 85.9 % at its highest. Women in private models of care were more likely to experience care according to the Strategy. Women in standard and high-risk public hospital care, rural/remote dwelling women, and younger women were less likely to experience care accordingly. Care was universally perceived to be worse in the postnatal period.

CONCLUSION

Despite articulating how Australian maternity care should be provided, the intent of the Strategy has not been fully realised. Inequities exist in women's access to and experiences of care across the entire maternity episode.

The extent of implementation and perceptions of maternity and social care professionals about two interprofessional programs for care for pregnant women: a mixed methods study

BACKGROUND

In 2018, the Dutch government initiated the Solid Start program to provide each child with the best start in life. Key program elements are a biopsychosocial perspective on pregnancy and children's development and stimulating local collaborations between social and health domains, with a specific focus on (future) families in vulnerable situations. Two programs for interprofessional collaboration between maternity and social care professionals to optimize care for pregnant women in vulnerable situations were developed and implemented, in Groningen in 2017 and in South Limburg in 2021. This paper describes the extent of implementation of these programs and the perceptions of involved professionals about determinants that influence program implementation.

METHODS

We conducted a mixed-methods study in 2021 and 2022 in two Dutch regions, Groningen and South Limburg. Questionnaires were sent to primary care midwives, hospital-based midwives, obstetricians (i.e. maternity care professionals), (coordinating) youth health care nurses and social workers (i.e. social care professionals), involved in the execution of the programs. Semi-structured interviews were held with involved professionals to enrich the quantitative data. Quantitative and qualitative data were collected and analyzed using Fleuren's implementation model.

RESULTS

The findings of the questionnaire (n = 60) and interviews (n = 28) indicate that professionals in both regions are generally positive about the implemented programs. However, there was limited knowledge and use of the program in Groningen. Promoting factors for implementation were mentioned on the determinants for the innovation and the user. Maternity care professionals prefer a general, conversational way to identify vulnerabilities that connects to midwives' daily practice. Low-threshold, personal contact with clear agreements for referral and consultation between professionals contributes to implementation. Professionals agree that properly identifying vulnerabilities and referring women to appropriate care is an important task and contributes to better care. On the determinants of the organization, professionals indicate some preconditions for successful implementation, such as clearly described roles and responsibilities, interprofessional training, time and financial resources.

CONCLUSIONS

Areas for improvement for the implementation of interprofessional collaboration between maternity care and social care focus mainly on determinants of the organization, which should be addressed both regionally and nationally. In addition, sustainable implementation requires continuous awareness of influencing factors and a process of evaluation, adaptation and support of the target group.

Cross-cultural nursing care for immigrant women during pregnancy and childbirth: experiences and vulnerabilities

OBJECTIVE

To understand the experiences and vulnerabilities for cross-cultural nursing care for immigrant women during pregnancy and delivery.

METHOD

Exploratory, qualitative research, in the light of the Theory of Diversity and Universality of Cultural Care, in Foz do Iguaçu, Brazil, through interviews with eight postpartum woman and 18 nurses, between February and September 2022. The interpretation of meanings was adopted for analysis.

RESULTS

The categories of analysis emerged: Experiences, vulnerabilities and acculturation of immigrant women during pregnancy and delivery; Cross-cultural care and vulnerabilities experienced by immigrants in Brazilian health services. Vulnerabilities were identified in Cultural and Social Structure Dimensions expressed in access to work, low socioeconomic conditions, lack of family and social support and specific services for this population. The potentialities experienced included good care provided by health services, quality of the multidisciplinary team and appreciation of professional knowledge, however, the understanding of expectations and cultural aspects needs to be deepened.

FINAL CONSIDERATIONS

Understand that immigrant women experience situations of vulnerability in pregnancy and childbirth, in the Brazilian context, mainly related to social and programmatic dimensions. However, potentialities were also experienced, evidenced by positive aspects in cross-cultural nursing care in Brazil.

The future of midwife-led continuity of care: Call for a dialogue

Background/Purpose

Midwife-led continuity of care (MLCC) is an evidence-based care model positively influencing the health and wellbeing of women and their families. Despite the evidence, a sustainable future of the model is uncertain. The aim of this paper is to give an example of a theoretical exercise that enhances the understanding of the trends and developments impacting MLCC's future state.

Methods

The industrial complex theory scaffolded the theoretical approach. The intuitive logics scenario development methodology was used to structure the key variables that influence the utility of MLCC. Dimensionally structured scenarios representing the probable, possible and probable MLCC futures were written.

Results

Thirteen key variables that greatly impact the future MLCC, with varying degrees of certainty were identified. A theoretical framework representing two underlying meta dimensions of MLCC was constructed: identity system of midwife-led continuity of care (fixed vs fluid) and embodied orientation to the world (reasoning vs meaning making). Within the framework, four different storylines of possible, plausible prospective futures emerged: Sense & sensibility, The birth of mothers, Too many sisters and One-stop-shop.

Conclusion

The paper is an example of how to approach the future of MLCC, the method serving as a tool to establish a theoretical truth of how its future state may unfold, the scenarios facilitating a dialogue among stakeholders and informing the public.

Woman-centered care and associated factors among midwives working in urban health centers and public and private hospitals in Tabriz, Iran: a cross-sectional study

BACKGROUND

Woman-centered care (WCC) is the cornerstone of the midwifery profession. However, no study has been conducted on WCC provided by Iranian midwives and its associated factors. Thus, this study aimed to determine WCC and factors associated with midwives' WCC for midwives working in urban health centers and public and private hospitals in Tabriz, Iran.

METHODS

This cross-sectional study was the first part (i.e., the quantitative phase) of a sequential explanatory mixed-method study conducted on 575 midwives working in urban health centers and public and private hospitals in Tabriz-Iran from November 2022 to January 2023. The required data was collected by distributing a socio-demographic and job characteristics questionnaire and woman-centered care scale-midwife self-report (WCCS-MSR). To determine the factors associated with WCC, an independent t-test or one-way analysis of variance (ANOVA) was used in bivariate analysis, and a general linear model (GLM) was employed in multivariate analysis to control possible confounding variables.

RESULTS

The statistical population consisted of 575 midwives, with a response rate of 88.2%. According to the GLM, the total mean WCCS-MSR score of single [β (95% CI) 23.02 (7.94 to 38.10)] and married [β (95% CI) 21.28 (6.83 to 35.72)] midwives was significantly higher than that of divorced midwives after adjusting their demographic and job characteristics. Also, the total mean WCCS-MSR score of midwives with sufficient income was significantly higher than those with insufficient income [β (95% CI) 8.94 (0.12 to 17.77). In addition, the total mean WCCS-MSR score of midwives with < 5 years of work experience [β (95% CI) - 7.87 (- 14.79 to - 0.94)], and midwives with official-experimental employment status [β (95% CI) - 17.99 (- 30.95 to - 5.02)], was significantly lower than those with more than 5 years of work experience and contractual employment status.

CONCLUSIONS

The findings indicate that marital status, level of income, years of practice, and employment status were significantly related to WCC provided by midwives. Focusing only on the midwifery community is insufficient to ensure the improved quality of WCC. However, arrangements should be made at three levels, including policy-makers, managers, and health care provider (midwives).