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Thomson G, Balaam MC. Researchers' perspectives of self-agency within a context of violence and harm in maternity care. Midwifery 2024; 137:104120. [PMID: 39089175 DOI: 10.1016/j.midw.2024.104120] [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: 03/08/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/03/2024]
Abstract
PROBLEM There is an increasing awareness of the prevalence of obstetric violence within maternity care and that some women and birthing people are at greater risk of experiencing violence and harm. BACKGROUND Supporting self-agency for women and birthing people in maternity care may be a way of addressing the disparities in vulnerability to violence and harm. AIM To explore researchers' perspectives of self-agency for women from different backgrounds, what inhibits and prevents self-agency, and how self-agency can be enabled. METHODS A qualitative research design was undertaken underpinned by a reproductive justice framework. Group interviews were held with researchers working with perinatal women/birthing people with histories and experiences of violence and abuse. Reflexive thematic analysis using Bronfenbrenner's ecological systems theory was undertaken. FINDINGS 12 participants took part in two group interviews. Two themes were developed: 'defining self-agency' and 'ecological influences on self-agency'. DISCUSSION The findings identify how self-agency should not be perceived as an intrinsic attribute, but rather is underpinned by exogenous and endogenous influences. Whether and how self-agency is enacted is determined by interacting factors that operate on a micro, meso and macro level perspective. Self-agency is undermined by factors including immigration policies and sociocultural perspectives that can lead to under-resourced and judgemental care, other intersectional factors can also lead to some individuals being more vulnerable to violence and harm. CONCLUSION Implications from this work include strategies that emphasise woman-centred care, staff training and meaningful organisational change to optimise positive health and wellbeing.
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Affiliation(s)
- Gill Thomson
- MAINN research unit, School of Nursing and Midwifery, University of Central Lancashire, Preston PR2 1SG, UK.
| | - Marie-Clare Balaam
- ReaCH unit, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
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Nagesh N, Ip CHL, Leung ETY, Wong JYH, Fong DY, Lok KYW. South Asian women's views on and experiences of maternity care services in Hong Kong: A qualitative study. Women Birth 2024; 37:101806. [PMID: 39197386 DOI: 10.1016/j.wombi.2024.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Health disparities among ethnic minority and migrant women can lead to adverse maternal and neonatal outcomes. This study explores the maternity care experiences of South Asian women in Hong Kong, providing insights for woman-centred and culturally responsive care in the East Asia. OBJECTIVE To understand South Asian women's views and experiences regarding maternity care services in Hong Kong. METHODS A qualitative descriptive study was conducted with 20 English-speaking South Asian women who had used maternity care services in Hong Kong within the past 5 years. Data were analysed by thematic analysis. FINDINGS Four themes were identified: 1) Comparing maternity care services in their home country versus Hong Kong; birth location, mode of birth and care. 2) Navigating Hong Kong maternal medical care system; including private public dual care and learning information from other South Asians. 3) The discrepancy in perception of optimum care; including a preferring for assistance with daily tasks, epidural anaesthesia, doctor-led care, and priority to infants' health. 4) The impact of the COVID-19 pandemic on maternity care experiences, including the cancellation of translation services and limited visiting hours. DISCUSSION South Asian appreciate Hong Kong's public maternity services due to its perceived greater cost-effectiveness. The major incongruence between expectations and services provided being women-staff communication. CONCLUSION The quality of healthcare in Hong Kong is appreciated. Individualized care should be offered to cater to diverse needs. Improvements in staff attitude and provision of detailed information should help alleviate feelings of differential treatment.
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Affiliation(s)
- Nitya Nagesh
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Caroline Hoi Lam Ip
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Emily Tsz Yan Leung
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Janet Yuen-Ha Wong
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Daniel Yt Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
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Hudson S, Muspratt-Tucker N, Kudsk-Iversen S. On the ethics of removing Entonox® from labour ward: beyond carbon dioxide equivalents and seeking justice for patients and the planet. Anaesthesia 2024; 79:787-791. [PMID: 38606766 DOI: 10.1111/anae.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Sarah Hudson
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nadia Muspratt-Tucker
- Department of Obstetrics and Gynaecology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Søren Kudsk-Iversen
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Oxford, UK
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Collins CH, Skarparis K. The experiences of pregnancy and NHS maternity care for women who have been trafficked: A qualitative study. Midwifery 2024; 135:104040. [PMID: 38878620 DOI: 10.1016/j.midw.2024.104040] [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: 02/22/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 07/07/2024]
Abstract
PROBLEM Little is known about the maternity experiences of women who have been trafficked and further investigation is needed to better inform midwifery practice and to ensure that the voices of women are heard when developing guidance. BACKGROUND People who have been trafficked experience a range of health problems that could impact on pregnancy. AIM The aim of this study was to explore the experiences of pregnancy and NHS maternity care for women who have been trafficked, as well as increasing understanding of social and health factors that may impact on pregnancy outcomes. METHODS A qualitative interview study was conducted. Participants (professionals and service users) were recruited using purposive sampling. Data were analysed using thematic analysis. FINDINGS Seventeen interviews were conducted (5 service users and 12 professionals). Five themes were identified: 'One Size Fits All', 'Loss of Control', 'Social Complexity', 'Bridging Gaps', and 'Emotional Load'. DISCUSSION Our findings identify that women are expected to fit into a standardised model of maternity care that does not always recognise their complex individual physical, emotional or social needs, or provide them with control. Support workers play a vital role in helping women navigate and make sense of their maternity care. CONCLUSION Despite the issues identified, our research highlighted the positive impact of individualised care, particularly when women received continuity of care. A joined-up, trauma-informed approach between midwives and support workers could help improve care for women who have been trafficked.
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Affiliation(s)
- Catherine H Collins
- Northumbria University, Coach Lane Campus East, Newcastle upon Tyne, NE7 7XA, United Kingdom; Department of Nursing Midwifery and Health, Faculty of Health and Life Sciences, (At the time when research was conducted), United Kingdom.
| | - Katy Skarparis
- Northumbria University, Coach Lane Campus East, Newcastle upon Tyne, NE7 7XA, United Kingdom; Department of Nursing Midwifery and Health, Faculty of Health and Life Sciences, (At the time when research was conducted), United Kingdom
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Backer KD, Rayment-Jones H, Lever Taylor B, Bicknell-Morel T, Montgomery E, Sandall J, Easter A. Healthcare experiences of pregnant and postnatal women and healthcare professionals when facing child protection in the perinatal period: A systematic review and Critical Interpretative Synthesis. PLoS One 2024; 19:e0305738. [PMID: 38959192 PMCID: PMC11221698 DOI: 10.1371/journal.pone.0305738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers. AIM To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement. METHODS A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline. RESULTS A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play. CONCLUSIONS Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.
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Affiliation(s)
- Kaat De Backer
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
| | - Hannah Rayment-Jones
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
| | - Billie Lever Taylor
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | | | - Elsa Montgomery
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Jane Sandall
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
| | - Abigail Easter
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
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Vousden N, Bunch K, Kenyon S, Kurinczuk JJ, Knight M. Impact of maternal risk factors on ethnic disparities in maternal mortality: a national population-based cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100893. [PMID: 38585675 PMCID: PMC10998184 DOI: 10.1016/j.lanepe.2024.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024]
Abstract
Background Ethnic disparities in maternal mortality are consistently reported. This study aimed to investigate the contribution of known risk factors including age, socioeconomic status, and medical comorbidities to observed ethnic disparities in the United Kingdom (UK). Methods A cohort of all women who died during or up to six weeks after pregnancy in the UK 2009-2019 were identified through national surveillance. No single denominator population included data on all risk factors, therefore we used logistic regression modelling to compare to 1) routine population birth and demographic data (2015-19) (routine data comparator) and 2) combined control groups of four UK Obstetric Surveillance System studies (UKOSS) control comparator)). Findings There were 801 maternal deaths in the UK between 2009 and 2019 (White: 70%, Asian: 13%, Black: 12%, Chinese/Other: 3%, Mixed: 2%). Using the routine data comparator (n = 3,519,931 maternities) to adjust for demographics, including social deprivation, women of Black ethnicity remained at significantly increased risk of maternal death compared with women of white ethnicity (adjusted OR 2.43 (95% Confidence Interval 1.92-3.08)). The risk was greatest in women of Caribbean ethnicity (aOR 3.55 (2.30-5.48)). Among women of White ethnicity, risk of mortality increased as deprivation increased, but women of Black ethnicity had greater risk irrespective of deprivation. Using the UKOSS control comparator (n = 2210), after multiple adjustments including smoking, body mass index, and comorbidities, women of Black and Asian ethnicity remained at increased risk (aOR 3.13 (2.21-4.43) and 1.57 (1.16-2.12) respectively). Interpretation Known risk factors do not fully explain ethnic disparities in maternal mortality. The impact of socioeconomic deprivation appears to differ between ethnic groups. Funding This research is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-127-21202.
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Affiliation(s)
- Nicola Vousden
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Kathryn Bunch
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, UK
| | - Jennifer J. Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Marian Knight
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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Ellehave SM, Thomsen LLH, Frederiksen MS, Overgaard C. Initial programme theory development: The first step in a realist evaluation of a cross-sectoral intervention for expectant Danish parents living with psychosocial risks. PLoS One 2023; 18:e0295378. [PMID: 38117815 PMCID: PMC10732377 DOI: 10.1371/journal.pone.0295378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/21/2023] [Indexed: 12/22/2023] Open
Abstract
A distinct inequality in maternity care exists, and women with psychosocial risks are at a greater risk of adverse birth outcomes. In several high-income countries, a psychosocial risk assessment early in pregnancy is recommended so that expectant parents are offered an appropriate level of care which facilitates relevant, tailored interventions for those in need. In 2017, a cross-sectoral and interdisciplinary intervention for expectant parents with psychosocial risks was developed and implemented in the North Denmark Region. The development process of the intervention has not been reported and theory-based knowledge about how supportive interventions bring about change for expectant parents with psychosocial risks is scarce. Through the initial phase of a realist evaluation, we aimed to elicit key contexts and mechanisms of change regarding the intervention for expectant parents with psychosocial risks. Through an initial programme theory, this article illustrates how, for whom and in which contexts the intervention is intended to work. Data is comprised of intervention documents, 14 pilot observations and 29 realist interviews with key stakeholders. A thematic analytical approach inspired by retroductive thinking was applied to identify and analyse patterns related to the incentive of the intervention, its structure, intended outcomes, generative mechanisms and contextual matters. Generative mechanisms responsible for bringing about change in the intervention were identified as healthcare professionals' approach, continuity, trust, early intervention and social network. Cross-sectoral collaboration and healthcare professionals' competencies were assumed to be central stimulating contextual factors. The initial programme theory developed in this study will serve as the basis for further refinement via empirical testing in a later phase of the realist evaluation.
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Affiliation(s)
- Sara Mandahl Ellehave
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Louise Lund Holm Thomsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Marianne Stistrup Frederiksen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Charlotte Overgaard
- The Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Benhammou V, Marchand-Martin L, Pierrat V, Charkaluk ML, Romito P, Kaminski M, Ancel PY, Saurel-Cubizolles MJ. Maternal health-related quality of life at 1 year after a preterm birth: role of socioeconomic status at birth. J Epidemiol Community Health 2023; 78:25-32. [PMID: 37752012 DOI: 10.1136/jech-2023-220591] [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: 03/16/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Maternal problems in the postpartum period may lead to suboptimal long-term health for women and could affect mother-child attachment. Social disadvantage is a risk factor for preterm birth, which carries its own burden of health issues and stress. The main aim of this study was to investigate the role for social factors in mothers' physical and emotional health-related quality of life (HRQoL) at 1 year after a preterm birth. METHODS EPIPAGE-2 is a French nationwide, prospective, population-based cohort of preterm children born before 35 weeks' gestation (N=3614 women). At birth, detailed data on the family's social status were collected. At 1 year after birth, mothers completed a mailed questionnaire to report information on their HRQoL, assessed by the Medical Outcomes Study 12-item Short Form. We used multivariate linear regression models to assess the association between social factors and maternal HRQoL. RESULTS At 1 year after childbirth, the emotional HRQoL of mothers of preterm children was worse than their physical HRQoL, even in women without any previous signs of psychological distress at the infant's discharge from hospital. Baseline social characteristics were the most important factors influencing the physical component of HRQoL. None of the studied social factors had any clear association with the mental component of HRQoL. CONCLUSION Our study underlines the importance of social disadvantage during pregnancy as risk factors for poor physical HRQoL at 1 year after a preterm birth.
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Affiliation(s)
- Valerie Benhammou
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
| | - Laetitia Marchand-Martin
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
| | - Véronique Pierrat
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
- Department of Neonatal Medicine, CHI Créteil, Créteil, France
| | - Marie-Laure Charkaluk
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
- Department of Neonatal Medicine, Lille Catholic Institute Hospital Group, Lomme, France
| | - Patrizia Romito
- Department of Human Studies, University of Trieste, Trieste, Italy
| | - Monique Kaminski
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
| | - Pierre-Yves Ancel
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
- Center for Clinical Investigation P1419, APHP - Centre Université Paris-Cité, Paris, France
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Penman SV, Beatson RM, Walker EH, Goldfeld S, Molloy CS. Barriers to accessing and receiving antenatal care: Findings from interviews with Australian women experiencing disadvantage. J Adv Nurs 2023; 79:4672-4686. [PMID: 37366583 PMCID: PMC10952242 DOI: 10.1111/jan.15724] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
AIM To identify the barriers associated with inadequate antenatal attendance by disadvantaged women in Australia and to further explore how these barriers are experienced by this population group. DESIGN A qualitative descriptive study utilizing semi-structured interviews and thematic analysis. METHODS Interviews were conducted with 11 pregnant women who self-identified as experiencing disadvantage, purposively sampled from a local government area of Victoria, Australia, characterized by socio-economic disadvantage. Data were collected from February to July 2019. RESULTS Study participants reported a range of barriers to receiving timely and adequate antenatal care (ANC). For several women, a combination of personal (e.g., emotions, knowledge), health service provision (e.g., limited access to continuity of care provider and continuity of information, inflexible scheduling, difficulty travelling, staff attitudes), and broader social-contextual factors (e.g., financial situation, language, cultural norms) were ultimately insurmountable. Whereas some barriers were experienced as hassles or annoyances, others were unacceptable, overwhelming, or humiliating. CONCLUSION Women experiencing disadvantage in Australia value ANC but face multiple and complex barriers that undermine timely and regular access. IMPLICATIONS FOR THE PROFESSION AND/PATIENT CARE A wide range of strategies targeting barriers across multiple levels of the social-ecological environment are required if ANC attendance rates are to improve and ultimately redress existing health disparities. Various continuity of care models are well-placed to address many of the identified barriers and should be made more accessible to women, and particularly those women experiencing disadvantage. IMPACT Antenatal care appointments promote the health of women and their babies during pregnancy, but for many women, particularly those experiencing disadvantage, access is delayed or inadequate. ANC providers play a critical role in facilitating timely and adequate care. Health service practitioners and management, and health services policymakers need to understand the complexity of the barriers women encounter. These stakeholders can utilize the findings reported herein to develop more effective strategies for overcoming multiple and multi-level barriers. REPORTING METHOD The study is reported in accordance with the relevant EQUATOR guidelines: the standards for reporting qualitative research (SRQR) and consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sarah V. Penman
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
| | - Ruth M. Beatson
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Elizabeth H. Walker
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
| | - Sharon Goldfeld
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
| | - Carly S. Molloy
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
- North Western Melbourne Public Health NetworkParkvilleVictoriaAustralia
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Sharma E, Puthussery S, Tseng PC, Harden A, Li L. Development, acceptability and feasibility of a community-based intervention to increase timely initiation of antenatal care in an area of high ethnic diversity and low socio-economic status in the UK. Midwifery 2023; 126:103812. [PMID: 37690314 DOI: 10.1016/j.midw.2023.103812] [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: 03/30/2023] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Antenatal care plays an important role in preventing adverse maternal and new-born outcomes. Women from ethnic minority backgrounds and of low socio-economic status are at greater risk of initiating antenatal care later than the recommended 10 weeks. There is a paucity of research exploring the development and evaluation of community-based interventions to increase the timely initiation of antenatal care. OBJECTIVE To develop and evaluate the acceptability and feasibility of a co-produced community-based intervention to increase uptake of antenatal care in an area with high ethnic diversity and low socio-economic status. DESIGN The intervention was developed using co-production workshops and conversations with 20 local service users and 14 stakeholders, underpinned by the theory of Diffusion of Innovation. The intervention was evaluated, on the domains of acceptability, adoption, appropriateness, and feasibility. Questionnaires (n=36), interviews (n=10), and focus groups (n=13) were conducted among those who received the intervention. Observations (n=13) of intervention sessions were conducted to assess intervention fidelity. Quantitative and qualitative data were analysed using SPSS and NVivo software respectively. RESULTS Over 91% of respondents positively ranked the intervention. Qualitative findings with respect to 'acceptability' included four subthemes: how the intervention was communicated, the characteristics of the person delivering the intervention and their knowledge, and the reassurance offered by the intervention. The 'adoption' theme included three sub-themes: being informed helps women to engage with antenatal care, the intervention provides information for future use, and onwards conveyance of the intervention information. The 'appropriateness' theme included three sub-themes: existing gap in information, nature of information given as part of the intervention, and talking about pregnancy in public. The 'feasibility' theme included two sub-themes: value of delivering the intervention in areas of high footfall and relational aspect of receiving the intervention. Observations showed intervention fidelity of 100%. CONCLUSION The community-based intervention, coproduced with women and maternity care stakeholders, was positively evaluated, and offered an innovative and promising approach to engage and educate women about the timely initiation of antenatal care in an ethnically diverse and socio-economically deprived community.
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Affiliation(s)
- Esther Sharma
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU.
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU.
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU.
| | - Angela Harden
- School of Health Sciences, Division of Health Services Research and Management, City, University of London, Northampton Square London EC1V 0HB.
| | - Leah Li
- Population, Policy & Practice Department, Great Ormond Street Institute of Child Health, University College London, Guildford Street, London WC1N 1EH.
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Faulks F, Shafiei T, McLachlan H, Forster D, Mogren I, Copnell B, Edvardsson K. Perinatal outcomes of socially disadvantaged women in Australia: A population-based retrospective cohort study. BJOG 2023; 130:1380-1393. [PMID: 37077044 DOI: 10.1111/1471-0528.17501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To examine the perinatal outcomes of women who experience social disadvantage using population-based perinatal data collected between 1999 and 2016. DESIGN Population-based, retrospective cohort study. SETTING Victoria, Australia. POPULATION OR SAMPLE A total of 1 188 872 singleton births were included. METHODS Cohort study using routinely collected perinatal data. Multiple logistic regression was performed to determine associations between social disadvantage and adverse maternal and neonatal outcomes with confidence limits set at 99%. Time-trend analysis for perinatal outcomes was performed in relation to area-level disadvantage measures. MAIN OUTCOME MEASURES Incidence of maternal admission to intensive care unit (ICU), postpartum haemorrhage (PPH) and caesarean section, perinatal mortality, preterm birth, low birthweight (LBW), and admission to special care nursery/neonatal intensive care unit (SCN/NICU). RESULTS Social disadvantage was associated with higher odds of adverse perinatal outcomes. Disadvantaged women were more likely to be admitted to ICU, have a PPH or experience perinatal mortality (stillbirth or neonatal death) and their neonates were more likely to be admitted to SCN/NICU, be born preterm and be LBW. A persistent social gradient existed across time for the most disadvantaged women for all outcomes except caesarean section. CONCLUSIONS Social disadvantage has a marked negative impact on perinatal outcomes. This aligns with national and international evidence regarding the impact of disadvantage. Strategies that improve access to, and reduce fragmentation in, maternity care in addition to initiatives that address the social determinants of health may contribute to improving perinatal outcomes for socially disadvantaged women.
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Affiliation(s)
- Fiona Faulks
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Helen McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Della Forster
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Ingrid Mogren
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Kristina Edvardsson
- School of Nursing and Midwifery/Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
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Hinton L, Kuberska K, Dakin F, Boydell N, Martin G, Draycott T, Winter C, McManus RJ, Chappell L, Chakrabarti S, Howland E, Willars J, Dixon-Woods M. A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy. J Health Serv Res Policy 2023; 28:222-232. [PMID: 37084393 PMCID: PMC10515462 DOI: 10.1177/13558196231165361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVE We aimed to explore the experiences and perspectives of pregnant women, antenatal healthcare professionals, and system leaders to understand the impact of the implementation of remote provision of antenatal care during the COVID-19 pandemic and beyond. METHODS We conducted a qualitative study involving semi-structured interviews with 93 participants, including 45 individuals who had been pregnant during the study period, 34 health care professionals, and 14 managers and system-level stakeholders. Analysis was based on the constant comparative method and used the theoretical framework of candidacy. RESULTS We found that remote antenatal care had far-reaching effects on access when understood through the lens of candidacy. It altered women's own identification of themselves and their babies as eligible for antenatal care. Navigating services became more challenging, often requiring considerable digital literacy and sociocultural capital. Services became less permeable, meaning that they were more difficult to use and demanding of the personal and social resources of users. Remote consultations were seen as more transactional in character and were limited by lack of face-to-face contact and safe spaces, making it more difficult for women to make their needs - both clinical and social - known, and for professionals to assess them. Operational and institutional challenges, including problems in sharing of antenatal records, were consequential. There were suggestions that a shift to remote provision of antenatal care might increase risks of inequities in access to care in relation to every feature of candidacy we characterised. CONCLUSION It is important to recognise the implications for access to antenatal care of a shift to remote delivery. It is not a simple swap: it restructures many aspects of candidacy for care in ways that pose risks of amplifying existing intersectional inequalities that lead to poorer outcomes. Addressing these challenges through policy and practice action is needed to tackle these risks.
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Affiliation(s)
- Lisa Hinton
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, UK
| | - Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, UK
| | - Francesca Dakin
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, UK
| | | | - Graham Martin
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, UK
| | - Tim Draycott
- Royal College of Obstetricians and Gynaecologists, UK
| | - Cathy Winter
- PROMPT Maternity Foundation, Southmead Hospital, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Lucy Chappell
- Women and Children’s Health, King’s College London, St Thomas’ Hospital, UK
| | | | | | - Janet Willars
- Department of Health Sciences, University of Leicester, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, UK
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Khan Z, Vowles Z, Fernandez Turienzo C, Barry Z, Brigante L, Downe S, Easter A, Harding S, McFadden A, Montgomery E, Page L, Rayment-Jones H, Renfrew M, Silverio SA, Spiby H, Villarroel-Williams N, Sandall J. Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review. Int J Equity Health 2023; 22:131. [PMID: 37434187 PMCID: PMC10334506 DOI: 10.1186/s12939-023-01948-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this population, in high-income countries (HIC). The review aimed to identify and evaluate the current evidence related to targeted health and social care service interventions in HICs which can improve health inequalities experienced by childbearing women and infants at disproportionate risk of poor outcomes and experiences. METHODS Twelve databases searched for studies across all HICs, from any methodological design. The search concluded on 8/11/22. The inclusion criteria included interventions that targeted disadvantaged populations which provided a component of clinical care that differed from standard maternity care. RESULTS Forty six index studies were included. Countries included Australia, Canada, Chile, Hong Kong, UK and USA. A narrative synthesis was undertaken, and results showed three intervention types: midwifery models of care, interdisciplinary care, and community-centred services. These intervention types have been delivered singularly but also in combination of each other demonstrating overlapping features. Overall, results show interventions had positive associations with primary (maternal, perinatal, and infant mortality) and secondary outcomes (experiences and satisfaction, antenatal care coverage, access to care, quality of care, mode of delivery, analgesia use in labour, preterm birth, low birth weight, breastfeeding, family planning, immunisations) however significance and impact vary. Midwifery models of care took an interpersonal and holistic approach as they focused on continuity of carer, home visiting, culturally and linguistically appropriate care and accessibility. Interdisciplinary care took a structural approach, to coordinate care for women requiring multi-agency health and social services. Community-centred services took a place-based approach with interventions that suited the need of its community and their norms. CONCLUSION Targeted interventions exist in HICs, but these vary according to the context and infrastructure of standard maternity care. Multi-interventional approaches could enhance a targeted approach for at risk populations, in particular combining midwifery models of care with community-centred approaches, to enhance accessibility, earlier engagement, and increased attendance. TRIAL REGISTRATION PROSPERO Registration number: CRD42020218357.
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Affiliation(s)
- Zahra Khan
- Department of Women & Children’s Health, King’s College London, London, UK
| | - Zoe Vowles
- Department of Women & Children’s Health, King’s College London, London, UK
| | | | - Zenab Barry
- Patient and Public Involvement and Engagement, NIHR ARC South London, London, UK
| | | | - Soo Downe
- University of Central Lancashire, Lancashire, UK
| | - Abigail Easter
- Department of Women & Children’s Health, King’s College London, London, UK
| | - Seeromanie Harding
- Department of Population Health Sciences, King’s College London, London, UK
| | | | | | | | | | | | - Sergio A. Silverio
- Department of Women & Children’s Health, King’s College London, London, UK
| | | | | | - Jane Sandall
- Department of Women & Children’s Health, King’s College London, London, UK
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14
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Silverio SA, De Backer K, Brown JM, Easter A, Khazaezadeh N, Rajasingam D, Sandall J, Magee LA. Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis. BMC Pregnancy Childbirth 2023; 23:368. [PMID: 37210485 DOI: 10.1186/s12884-023-05641-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom - a region of high ethnic diversity with varied levels of social complexity. METHODS We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research. ANALYSIS & FINDINGS Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service. CONCLUSIONS Decision-making within maternity care was found to take three forms - where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK.
| | - Kaat De Backer
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Jeremy M Brown
- Health Research Institute, Medical School, Faculty of Health, Social Care & Medicine, Edge Hill University, St. Helen's Road, Ormskirk, L39 4QP, Lancashire, UK
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Nina Khazaezadeh
- Chief Midwifery Office, NHS England and Improvement, Wellington House, 133-155 Waterloo Road, Southwark, London, SE1 8UG, UK
| | - Daghni Rajasingam
- Maternity Services, St. Thomas' Hospital, Guy's and St. Thomas's NHS Foundation Trust, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Laura A Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK
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15
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Gram P, Thomsen LLH, Andersen CG, Overgaard C. Trusting parent-professional relationships in interprofessional interventions for expectant and new parents in vulnerable positions: A realist evaluation. J Interprof Care 2023:1-11. [PMID: 36883786 DOI: 10.1080/13561820.2023.2183185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 03/09/2023]
Abstract
Interprofessional collaboration and trusting parent-professional relationships can be key to delivering interprofessional care to meet the needs of expectant and new parents in vulnerable positions. This, however, presents challenges. This study aimed to gain deeper understanding of how and under what circumstances trusting parent-professional relationships develop and work within interprofessional team-based care for this group, from the professionals' perspectives. Realist evaluation was undertaken based on 14 semi-structured, realist interviews with midwives and health visitors and 11 observations. Multiple interrelated mechanisms were identified including patient/family-centered care, timely and relevant interprofessional involvement in care, gentle interprofessional bridging, transparency of intervention roles and purposes, and relational continuity. Good interprofessional collaboration was a primary condition for these mechanisms. Developed, trusting relationships supported parents' engagements with interprofessional care and constituted a supportive safety net that promoted parenting skills and coping abilities. We identified harmful mechanisms: distanced encounters, uncertainty of interprofessional involvement, and compromising the safe space. These mechanisms caused distrust and disengagement. Ensuring trusting parent-professional relationships within interprofessional team-based care demands each professional involved competently engages in relational work and interprofessional collaboration. Uncontrollability is thus influenced regarding interpersonal connection and potentially gives an explanation when trust-building efforts fail.
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Affiliation(s)
- Pernille Gram
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
| | - Louise Lund Holm Thomsen
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
| | - Clara Graugaard Andersen
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
| | - Charlotte Overgaard
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
- Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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16
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Hinton L, Dumelow C, Hodgkinson J, Montgomery C, Martin A, Allen C, Tucker K, Green ME, Wilson H, McManus RJ, Chappell LC, Band R. 'Nesting networks': Women's experiences of social network support in high-risk pregnancy. Midwifery 2023; 120:103622. [PMID: 36893551 DOI: 10.1016/j.midw.2023.103622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Social support, an individual's social relationships (both online and offline), may provide protection against adverse mental health outcomes, such as anxiety and depression, which are high in women who have been hospitalised with high-risk pregnancy. This study explored the social support available to women at higher risk of preeclampsia during pregnancy by examining personal social networks. DESIGN Semi-structured interviews were accompanied by social network mapping using the web-based social networking tool GENIE. SETTING England. PARTICIPANTS Twenty-one women were recruited, of whom 18 were interviewed both during pregnancy and postnatally between April 2019 and April 2020. Nineteen women completed maps pre-natally, 17 women completed maps pre-natally and post-natally. Women were taking part in the BUMP study, a randomised clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. RESULTS Women's social networks tightened during pregnancy. The inner network changed most dramatically postnatally with women reporting fewer network members. Interviews revealed networks were primarily 'real-life' rather than online social networks, with members providing emotional, informational, and practical support. Women with a high-risk pregnancy valued the relationships they developed with health professionals during pregnancy, and would like their midwife to have a more central role in their networks by providing informational and, where needed, emotional support. The social network mapping data supported the qualitative accounts of changing networks across high-risk pregnancy. CONCLUSION Women with a high-risk pregnancy seek to build "nesting networks" to support them through pregnancy into motherhood. Different types of support are sought from trusted sources. Midwives can play a key role. PRACTICE IMPLICATIONS As well as highlighting other potential needs during pregnancy and the ways in which they can be met, support from midwives has a key role. Through talking to women early in their pregnancy, signposting information and explaining ways to contact health professionals regarding informational or emotional support would fill a gap that currently is met by other aspects of their network.
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Affiliation(s)
- L Hinton
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge.
| | - C Dumelow
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - J Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - C Montgomery
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - A Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - C Allen
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
| | - K Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - H Wilson
- Department of Women and Children's Health, King's College London, London
| | - R J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - L C Chappell
- Department of Women and Children's Health, King's College London, London
| | - R Band
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
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17
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Rayment-Jones H, Dalrymple K, Harris JM, Harden A, Parslow E, Georgi T, Sandall J. Project20: maternity care mechanisms that improve access and engagement for women with social risk factors in the UK - a mixed-methods, realist evaluation. BMJ Open 2023; 13:e064291. [PMID: 36750277 PMCID: PMC9906302 DOI: 10.1136/bmjopen-2022-064291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES To evaluate how women access and engage with different models of maternity care, whether specialist models improve access and engagement for women with social risk factors, and if so, how? DESIGN Realist evaluation. SETTING Two UK maternity service providers. PARTICIPANTS Women accessing maternity services in 2019 (n=1020). METHODS Prospective observational cohort with multinomial regression analysis to compare measures of access and engagement between models and place of antenatal care. Realist informed, longitudinal interviews with women accessing specialist models of care were analysed to identify mechanisms. MAIN OUTCOME MEASURES Measures of access and engagement, healthcare-seeking experiences. RESULTS The number of social risk factors women were experiencing increased with deprivation score, with the most deprived more likely to receive a specialist model that provided continuity of care. Women attending hospital-based antenatal care were more likely to access maternity care late (risk ratio (RR) 2.51, 95% CI 1.33 to 4.70), less likely to have the recommended number of antenatal appointments (RR 0.61, 95% CI 0.38 to 0.99) and more likely to have over 15 appointments (RR 4.90, 95% CI 2.50 to 9.61) compared with community-based care. Women accessing standard care (RR 0.02, 95% CI 0.00 to 0.11) and black women (RR 0.02, 95% CI 0.00 to 0.11) were less likely to have appointments with a known healthcare professional compared with the specialist model. Qualitative data revealed mechanisms for improved access and engagement including self-referral, relational continuity with a small team of midwives, flexibility and situating services within deprived community settings. CONCLUSION Inequalities in access and engagement with maternity care appears to have been mitigated by the community-based specialist model that provided continuity of care. The findings enabled the refinement of a realist programme theory to inform those developing maternity services in line with current policy.
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Affiliation(s)
| | | | - James M Harris
- Women's Health, Chelsea And Westminster NHS Foundation Trust, London, UK
| | - Angela Harden
- Department of Health Services Research and Management, City University of London, London, UK
| | - Elidh Parslow
- Maternity and Women's Health, North Middlesex University Hospital NHS Trust, London, UK
| | - Thomas Georgi
- Department of Women and Children's Health, King's College London, London, UK
| | - Jane Sandall
- Women and Children's Health, King's College London, London, UK
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18
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Creating coherent perinatal care journeys: An ethnographic study of the role of continuity of care for Danish parents in a vulnerable position. Women Birth 2023; 36:117-126. [PMID: 35430187 DOI: 10.1016/j.wombi.2022.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/04/2022] [Accepted: 03/20/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND While continuity of care is a core element of high-quality maternity care, it is potentially even more important for pregnant women and their partners who are at risk of adverse health outcomes because of psychosocial vulnerability. However, little is known about how a coherent care journey can be ensured for women and families who may require interdisciplinary and inter-sectoral services during pregnancy and the postnatal period. AIM To explore the role of continuity of care in creating a coherent care journey for vulnerable parents during pregnancy and the postnatal period. METHODS An ethnographic study conducted in Denmark based on interviews with, and field observations, of 26 mothers and 13 fathers receiving services due to mental health problems, young age, past substance abuse and/or adverse childhood experiences. FINDINGS Three key findings emerged: 1). Developing relationships allowed parents to know and feel known by care providers, which helped them feel secure and reach out for support. 2). Handover of information allowed parents to feel secure as their need for support was recognised by care providers; some parents, however, felt exposed when information was shared 3). Receiving relevant services allowed parents to have their needs for support addressed, which requires easy referral pathways and coordination of services. CONCLUSION All forms of continuity of care should be prioritised in the organisation of maternity care services for women and families in vulnerable positions. While relational continuity is important, continuity of care must also reach across providers, sectors and services to ensure coherent care journeys.
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19
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Vincent CM, Spineli LΜ, Barlow P, Gross MM. Unplanned visits and midwife-led antenatal care. Eur J Midwifery 2022; 6:72. [PMID: 36591332 PMCID: PMC9773263 DOI: 10.18332/ejm/157160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Midwives provide antenatal care to women to ensure the health of both mother and baby, according to women's needs. This study aims to investigate demographic and social, clinical and obstetrical factors that may be associated with unplanned visits to the emergency by nulliparous and multiparous women who received midwifery care during the antenatal period. METHODS This was a retrospective cohort study with data collection from medical records of the CHU Saint-Pierre hospital. A total of 971 women gave birth between 1 January and 31 December 2017 and received midwifery-led care during their pregnancy. Descriptive statistics and multivariable logistic regression models with 95% confidence intervals (95% CI) were performed separately for nulliparous and multiparous women. RESULTS For nulliparae (n=246), the odds of visiting emergency services during pregnancy were 1.45 times (95% CI: 1.08-2.27) higher in women with more previous pregnancies than women with less previous pregnancies, 3.57 times (95% CI: 1.43-11.11) more likely in women without than with high-level hypertension, and 1.09 times (95% CI: 1.01-1.25) more likely in women with less previous midwifery-led visits than women with more previous midwifery-led visits. For multiparae (n=444), the odds of visiting emergency services during pregnancy were 2.12 times (95% CI: 1.06-6.07) higher in women presenting risk factors at first consultation than women without such factors. CONCLUSIONS For nulliparous and multiparous women, some characteristics seem to be associated with unplanned visits. Spontaneous visits may be driven by a need for care perceived by women and/or their partner but not specifically by urgent or unfavorable medical conditions.
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Affiliation(s)
- Céleste M. Vincent
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Loukia Μ. Spineli
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Patricia Barlow
- Department of Obstetrics, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
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20
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Silverio SA, Memtsa M, Barrett G, Goodhart V, Stephenson J, Jurković D, Hall JA. Emotional experiences of women who access early pregnancy assessment units: a qualitative investigation. J Psychosom Obstet Gynaecol 2022; 43:574-584. [PMID: 36094423 DOI: 10.1080/0167482x.2022.2119958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Purpose: Early pregnancy complications are common and often result in pregnancy loss, which can be emotionally challenging for women. Research on the emotional experiences of those attending Early Pregnancy Assessment Units [EPAUs] is scarce. This analysis explored the emotions which women spontaneously reported when being interviewed about their experiences of using EPAU services.Materials and methods: Semi-structured telephone interviews were conducted with a purposive sample of 38 women. Using Thematic Framework Analysis, we identified six unique emotional typologies which mapped onto women's clinical journeys.Results: Women with ongoing pregnancies were characterized as having: "Anxious Presentation" or "Sustained Anxiety due to Diagnostic Uncertainty", dependent on whether their initial scan result was inconclusive. Women with pregnancy loss had one of four emotional typologies, varying by diagnostic timing and required interventions: "Anxious-Upset"; "Anxious-Upset after Diagnostic Uncertainty"; "Anxious-Upset with Procedural Uncertainty"; "Anxious with Sustained Uncertainty".Conclusions: We provide insights into the distinct emotions associated with different clinical pathways through EPAU services. Our findings could be used to facilitate wider recognition of women's emotional journeys through early pregnancy complications and stimulate research into how best to support women and their partners, in these difficult times.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK.,Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Maria Memtsa
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Women's Health Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Venetia Goodhart
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Women's Health Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Davor Jurković
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Gynaecology Diagnostic and Outpatient Treatment Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jennifer A Hall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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21
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Rayment-Jones H, Harris J, Harden A, Turienzo CF, Sandall J. Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation. Women Birth 2022; 36:e314-e327. [PMID: 36443217 DOI: 10.1016/j.wombi.2022.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. AIM To evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. METHODS Realist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. FINDINGS Experiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women's anxiety, enabled the development of a supportive network and improved women's ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. CONCLUSION The identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole.
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22
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Evans C, Evans K, Booth A, Timmons S, Jones N, Nazmeen B, Sunney C, Clowes M, Clancy G, Spiby H. Realist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol. BMJ Open 2022; 12:e062106. [PMID: 36127105 PMCID: PMC9490633 DOI: 10.1136/bmjopen-2022-062106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION One of the most commonly reported COVID-19-related changes to all maternity services has been an increase in the use of digital clinical consultations such as telephone or video calling; however, the ways in which they can be optimally used along maternity care pathways remain unclear. It is imperative that digital service innovations do not further exacerbate (and, ideally, should tackle) existing inequalities in service access and clinical outcomes. Using a realist approach, this project aims to synthesise the evidence around implementation of digital clinical consultations, seeking to illuminate how they can work to support safe, personalised and appropriate maternity care and to clarify when they might be most appropriately used, for whom, when, and in what contexts? METHODS AND ANALYSIS The review will be conducted in four iterative phases, with embedded stakeholder involvement: (1) refining the review focus and generating initial programme theories, (2) exploring and developing the programme theories in light of evidence, (3) testing/refining the programme theories and (4) constructing actionable recommendations. The review will draw on four sources of evidence: (1) published literature (searching nine bibliographic databases), (2) unpublished (grey) literature, including research, audit, evaluation and policy documents (derived from Google Scholar, website searches and e-thesis databases), (3) expertise contributed by service user and health professional stakeholder groups (n=20-35) and (4) key informant interviews (n=12). Included papers will consist of any study design, in English and from 2010 onwards. The review will follow the Realist and Meta-narrative Evidence Synthesis Evolving Standards quality procedures and reporting guidance. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of Nottingham, Faculty of Medicine and Health Sciences Ethics Committee (FMHS 426-1221). Informed consent will be obtained for all key informant interviews. Findings will be disseminated in a range of formats relevant to different audiences. PROSPERO REGISTRATION NUMBER CRD42021288702.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Kerry Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Andrew Booth
- ScHARR, The University of Sheffield, Sheffield, UK
| | | | - Nia Jones
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Benash Nazmeen
- School of Allied Health Professionals and Midwifery, University of Bradford, Bradford, UK
| | | | - Mark Clowes
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Georgia Clancy
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
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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] [MESH Headings] [Grants] [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 SciencesUniversity of Oxford, Radcliffe Observatory QuarterOxfordUK
| | - Sarah Collins
- Nuffield Department of Women's & Reproductive HealthUniversity of Oxford, Level 3, Women's Centre, John Radcliffe HospitalOxfordUK
| | - Margaret Myatt
- University Hospitals Sussex NHS Foundation TrustWorthingUK
| | - Catherine Pope
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford, Radcliffe Observatory QuarterOxfordUK
| | | | - Tanvi Rai
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford, Radcliffe Observatory QuarterOxfordUK
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Jones GL, Mitchell CA, Hirst JE, Anumba DOC. Understanding the relationship between social determinants of health and maternal mortality: Scientific Impact Paper No. 67. BJOG 2022; 129:1211-1228. [PMID: 35139580 DOI: 10.1111/1471-0528.17044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Within this document we use the terms pregnant woman and women's health. However, it is important to acknowledge that it is not only people who identify as women for whom it is necessary to access care. Obstetric and gynaecology services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.
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Affiliation(s)
| | | | - Jane E Hirst
- Royal College of Obstetricians and Gynaecologists, London, UK
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Pilav S, De Backer K, Easter A, Silverio SA, Sundaresh S, Roberts S, Howard LM. A qualitative study of minority ethnic women's experiences of access to and engagement with perinatal mental health care. BMC Pregnancy Childbirth 2022; 22:421. [PMID: 35585579 PMCID: PMC9116695 DOI: 10.1186/s12884-022-04698-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background Approximately one in five women will experience mental health difficulties in the perinatal period. However, for a large group of women, symptoms of adverse perinatal mental health remain undetected and untreated. This is even more so for women of ethnic minority background, who face a variety of barriers which prevents them from accessing appropriate perinatal mental health care. Aims To explore minority ethnic women’s experiences of access to and engagement with perinatal mental health care. Methods Semi-structured interviews were conducted with 18 women who had been diagnosed with perinatal mental health difficulties and who were supported in the community by a specialist perinatal mental health service in South London, United Kingdom. Women who self-identified as being from a minority ethnic group were purposefully selected. Data were transcribed verbatim, uploaded into NVivo for management and analysis, which was conducted using reflective thematic analysis. Results Three distinct overarching themes were identified, each with two or three subthemes: ‘Expectations and Experiences of Womanhood as an Ethnic Minority’ (Shame and Guilt in Motherhood; Women as Caregivers; Perceived to Be Strong and Often Dismissed), ‘Family and Community Influences’ (Blind Faith in the Medical Profession; Family and Community Beliefs about Mental Health and Care; Intergenerational Trauma and Family Dynamics) and ‘Cultural Understanding, Empowerment, and Validation’ (The Importance of Understanding Cultural Differences; The Power of Validation, Reassurance, and Support). Conclusion Women of ethnic minority background identified barriers to accessing and engaging with perinatal mental health support on an individual, familial, community and societal level. Perinatal mental health services should be aware ethnic minority women might present with mental health difficulties in different ways and embrace principles of cultural humility and co-production to fully meet these women’s perinatal mental health needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04698-9.
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Affiliation(s)
- Sabrina Pilav
- Oxleas NHS Foundation Trust, Bexley, Bromley and Greenwich Perinatal Mental Health Service, Queen Mary's Hospital, I Block, Frognal Avenue, Sidcup, DA14 6LT, London, UK
| | - Kaat De Backer
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St., Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St., Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. .,Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St., Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sushma Sundaresh
- Oxleas NHS Foundation Trust, Bexley, Bromley and Greenwich Perinatal Mental Health Service, Queen Mary's Hospital, I Block, Frognal Avenue, Sidcup, DA14 6LT, London, UK
| | - Sara Roberts
- Oxleas NHS Foundation Trust, Bexley, Bromley and Greenwich Perinatal Mental Health Service, Queen Mary's Hospital, I Block, Frognal Avenue, Sidcup, DA14 6LT, London, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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Clayton CE, Hemingway A, Hughes M, Rawnson S. 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. Eur J Midwifery 2022; 6:17. [PMID: 35434538 PMCID: PMC8973215 DOI: 10.18332/ejm/146012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Charlotte E. Clayton
- Department of Medical Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Ann Hemingway
- Department of Medical Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Mel Hughes
- Department of Social Sciences and Social Work, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Stella Rawnson
- Department of Midwifery and Health Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
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Rayment-Jones H, Harris J, Harden A, Silverio SA, Turienzo CF, Sandall J. Project20: interpreter services for pregnant women with social risk factors in England: what works, for whom, in what circumstances, and how? Int J Equity Health 2021; 20:233. [PMID: 34689772 PMCID: PMC8543874 DOI: 10.1186/s12939-021-01570-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Black and minority ethnic women and those with social risk factors such as deprivation, refugee and asylum seeker status, homelessness, mental health issues and domestic violence are at a disproportionate risk of poor birth outcomes. Language barriers further exacerbate this risk, with women struggling to access, engage with maternity services and communicate concerns to healthcare professionals. To address the language barrier, many UK maternity services offer telephone interpreter services. This study explores whether or not women with social risk factors find these interpreter services acceptable, accessible and safe, and to suggest solutions to address challenges. METHODS Realist methodology was used to refine previously constructed programme theories about how women with language barriers access and experience interpreter services during their maternity care. Twenty-one longitudinal interviews were undertaken during pregnancy and the postnatal period with eight non-English speaking women and their family members. Interviews were analysed using thematic framework analysis to confirm, refute or refine the programme theories and identify specific contexts, mechanisms and outcomes relating to interpreter services. RESULTS Women with language barriers described difficulties accessing maternity services, a lack of choice of interpreter, suspicion around the level of confidentiality interpreter services provide, and questioned how well professional interpreters were able to interpret what they were trying to relay to the healthcare professional during appointments. This resulted in many women preferring to use a known and trusted family member or friend to interpret for them where possible. Their insights provide detailed insight into how poor-quality interpreter services impact on their ability to disclose risk factors and communicate concerns effectively with their healthcare providers. A refined programme theory puts forward mechanisms to improve their experiences and safety such as regulated, high-quality interpreter services throughout their maternity care, in which women have choice, trust and confidence. CONCLUSIONS The findings of this study contribute to concerns highlighted in previous literature around interpreter services in the wider healthcare arena, particularly around the lack of regulation and access to high-quality interpretation. This is thought to have a significant effect on pregnant women who are living socially complex lives as they are not able to communicate their concerns and access support. This not only impacts on their safety and pregnancy outcomes, but also their wider holistic needs. The refined program theory developed in this study offers insights into the mechanisms of equitable access to appropriate interpreter services for pregnant women with language barriers.
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Affiliation(s)
- Hannah Rayment-Jones
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, 10th Floor, North Wing St. Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - James Harris
- Chelsea and Westminster NHS Foundation Trust, Clinical Research Facility, St Stephen’s Centre, 252 Fulham Road, London, SW109NA UK
| | - Angela Harden
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Sergio A. Silverio
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, 10th Floor, North Wing St. Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, 10th Floor, North Wing St. Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Jane Sandall
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, 10th Floor, North Wing St. Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
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Laureij LT, van der Hulst M, Lagendijk J, Been JV, Ernst-Smelt HE, Franx A, Lugtenberg M. Insight into the process of postpartum care utilisation and in-home support among vulnerable women in the Netherlands: an in-depth qualitative exploration. BMJ Open 2021; 11:e046696. [PMID: 34489272 PMCID: PMC8422309 DOI: 10.1136/bmjopen-2020-046696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To gain insight into the process of postpartum care utilisation and in-home support among vulnerable women. DESIGN, METHOD, PARTICIPANTS AND SETTING A qualitative interview study was conducted among 23 pregnant and postpartum vulnerable women in the Netherlands, following a grounded theory approach. Women were determined as vulnerable by their healthcare providers. Theoretical sampling of participants was applied and was alternated by data analysis to include information-rich cases until saturation was achieved. RESULTS A conceptual framework of postpartum care utilisation was generated consisting of three phases: pregnancy, early postpartum period and late postpartum period. Within these phases, information provision, parenting self-efficacy and social network were identified as overarching themes. Perceived inadequate information on content of postpartum care posed a major barrier to forming realistic expectations during pregnancy and hindered its utilisation. Low self-efficacy facilitated postpartum care utilisation. All women experienced increased self-efficacy during and after postpartum care. Support from a social network influenced expectations regarding the added value of postpartum care during pregnancy, and lowered actual utilisation during the postpartum period. The costs of postpartum care and the role of the maternity care assistant acted as general barriers or facilitators influencing the three overarching themes and therefore postpartum care utilisation indirectly. CONCLUSIONS Our findings suggest that postpartum care utilisation among vulnerable women may be improved by considering the particular phase and relevant themes applying to individual women, and adapt care accordingly. We recommend to provide comprehensive, understandable information and to emphasise the gains of postpartum care in improving self-efficacy for vulnerable women. Moreover, involving a woman's social network in postpartum care may add value to this care for this population.
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Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Marije van der Hulst
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
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Fernandez Turienzo C, Rayment-Jones H, Roe Y, Silverio SA, Coxon K, Shennan AH, Sandall J. A realist review to explore how midwifery continuity of care may influence preterm birth in pregnant women. Birth 2021; 48:375-388. [PMID: 33749001 DOI: 10.1111/birt.12547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Midwifery continuity of care models are the only health system intervention associated with both a reduction in preterm birth (PTB) and an improvement in perinatal survival; however, questions remain about the mechanisms by which such positive outcomes are achieved. We aimed to uncover theories of change by which we can postulate how and why continuity of midwifery care models might affect PTB. METHODS We followed Pawson's guidance for conducting a realist review and performed a comprehensive search to identify existing literature exploring the impact of continuity models on PTB in all pregnant women. A realist methodology was used to uncover the context (C), mechanisms (M), and outcomes (O) and to develop a group of CMO configurations to illuminate middle-range theories. RESULTS Eleven papers were included from a wide variety of settings in the United Kingdom, Australia, and the United States. The majority of study participants had low socioeconomic status or social risk factors and received diverse models of midwifery continuity of care. Three themes-woman-midwife partnership, maternity pathways and processes, and system resources-encompassed ten CMO configurations. Building relationships, trust, confidence, and advocacy resulted in women feeling safer, less stressed, and more secure and respected, and encouraged them to access and engage in antenatal care with more opportunities for early prevention and diagnosis of complications, which facilitated effective management when compliance to guidelines was ensured. Organizational infrastructure, innovative partnerships, and robust community systems are crucial to overcome barriers, address women's complex needs, ensure quality of care, and reduce PTB risk. CONCLUSIONS Pregnant women living in different contexts in the United Kingdom, Australia, and the United States at low and mixed risk of complications and with low socioeconomic status or social risk factors experienced continuity models in similar ways, and similar underlying mechanisms may have influenced PTB outcomes. Further research is required to understand how continuity models may influence behavioral change, physiological stress levels, ethnic disparities in PTB and care coordination, and navigation of health services.
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Affiliation(s)
| | - Hannah Rayment-Jones
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Yvette Roe
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, Qld, Australia
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Kirstie Coxon
- Department of Midwifery, Kingston University and St. George's, University of London, London, UK
| | - Andrew H Shennan
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
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Midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies: A qualitative study. Women Birth 2021; 35:152-159. [PMID: 34074625 DOI: 10.1016/j.wombi.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PROBLEM Childbearing women from ethnic minority groups in the United Kingdom (UK) have significantly poorer perinatal outcomes overall. BACKGROUND Childbearing women from ethnic minority groups report having poorer experiences and outcomes in perinatal care, and health professionals report having difficulty in providing effective care to them. Yet barriers in relation to providing such care remain underreported. AIM The aim of this study was to elicit midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies and how to overcome these barriers. METHODS A qualitative study was undertaken in a single obstetric led unit in London, UK. A thematic analysis was undertaken to identify themes from the data. FINDINGS A total of 20 midwives participated. They self-identified as White British (n=7), Black African (n=7), Black Caribbean (n=3) and Asian (n=3). Most (n=12) had more than 10 years' experience practising as a registered midwife (range 2 - 35 years). Four themes were identified: 1) Communication, 2) Continuity of carer, 3) Policy and 4) Social determinants. Racism and unconscious bias underpin many of the findings presented. DISCUSSION Co-created community hubs may improve access to more effective care for childbearing women from ethnic minority groups. A focus on robust anti-racism interventions, continuity of carer, staff wellbeing and education along with the provision of orientation and bespoke translation services are also suggested for the reduction of poorer outcomes and experiences. CONCLUSION Along with policies designed to promote equality and irradicate racism, there is a need for co-created community hubs and continuity of carer in perinatal services. Further research is also required to develop and evaluate culturally safe, and evidence-based interventions designed to address the current disparities apparent.
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Rayment-Jones H, Dalrymple K, Harris J, Harden A, Parslow E, Georgi T, Sandall J. Project20: Does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study. PLoS One 2021; 16:e0250947. [PMID: 33945565 PMCID: PMC8096106 DOI: 10.1371/journal.pone.0250947] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/17/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Social factors associated with poor childbirth outcomes and experiences of maternity care include minority ethnicity, poverty, young motherhood, homelessness, difficulty speaking or understanding English, migrant or refugee status, domestic violence, mental illness and substance abuse. It is not known what specific aspects of maternity care work to improve the maternal and neonatal outcomes for these under-served, complex populations. METHODS This study aimed to compare maternal and neonatal clinical birth outcomes for women with social risk factors accessing different models of maternity care. Quantitative data on pregnancy and birth outcome measures for 1000 women accessing standard care, group practice and specialist models of care at two large, inner-city maternity services were prospectively collected and analysed using multinominal regression. The level of continuity of care and place of antenatal care were used as independent variables to explore these potentially influential aspects of care. Outcomes adjusted for women's social and medical risk factors and the service attended. RESULTS Women who received standard maternity care were significantly less likely to use water for pain relief in labour (RR 0.11, CI 0.02-0.62) and have skin to skin contact with their baby shortly after birth (RR 0.34, CI 0.14-0.80) compared to the specialist model of care. Antenatal care based in the hospital setting was associated with a significant increase in preterm birth (RR 2.38, CI 1.32-4.27) and low birth weight (RR 2.31, CI 1.24-4.32), and a decrease in induction of labour (RR 0.65, CI 0.45-0.95) compared to community-based antenatal care, this was despite women's medical risk factors. A subgroup analysis found that preterm birth was increased further for women with the highest level of social risk accessing hospital-based antenatal care (RR 3.11, CI1.49-6.50), demonstrating the protective nature of community-based antenatal care. CONCLUSIONS This research highlights how community-based antenatal care, with a focus on continuity of carer reduced health inequalities and improved maternal and neonatal clinical outcomes for women with social risk factors. The findings support the current policy drive to increase continuity of midwife-led care, whilst adding that community-based care may further improve outcomes for women at increased risk of health inequalities. The relationship between community-based models of care and neonatal outcomes require further testing in future research. The identification of specific mechanisms such as help-seeking and reduced anxiety, to explain these findings are explored in a wider evaluation.
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Affiliation(s)
- Hannah Rayment-Jones
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Kathryn Dalrymple
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - James Harris
- Clinical Research Facility, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Angela Harden
- School of Health Sciences, City University of London, London, United Kingdom
| | - Elidh Parslow
- St Mary’s Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Thomas Georgi
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Jane Sandall
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
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Deliktas Demirci A, Kabukcuoglu K, Haugan G, Aune I. Turkish midwives' experiences and opinions in promoting normal births: A grounded theory study. Midwifery 2021; 99:103006. [PMID: 33910158 DOI: 10.1016/j.midw.2021.103006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Worldwide, the biomedical model of maternity care has been dominant, with the overuse of interventions. AIM This study aimed to gain a deeper understanding of the experiences and opinions of Turkish midwives regarding the promotion of normal births. METHODS In-depth interviews were conducted with 12 midwives; data were analysed using grounded theory. The data were analysed according to the constant comparative method. FINDINGS The study generated a core category (We want to promote normal births, but have no power to do it), which means all participants wanted to promote normal births. However, they have been disempowered by the medicalised systems of care. There were also three main categories (different ideologies in the labour ward, the midwives have no power, unempowered women). The participants reported that different ideologies in the labour ward were a challenge to promoting normal births. Their working conditions and education level were not enough to support normal birth. The pregnant women were described as unempowered due to a lack of antenatal education and having a fear of childbirth. CONCLUSION AND IMPLICATIONS FOR PRACTICE Normal birth could be promoted by enhancing the power and responsibilities of midwives. The women need antenatal education to have a normal birth. The normal birth may promote the enhanced readiness of women and midwives.
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Affiliation(s)
- Ayse Deliktas Demirci
- Akdeniz University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Antalya, Turkey.
| | - Kamile Kabukcuoglu
- Akdeniz University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Antalya, Turkey
| | - Gorill Haugan
- Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Trondheim, Norway; Nord University, Faculty of Nursing and Health Science
| | - Ingvild Aune
- Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, Midwifery Education, Trondheim, Norway
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Frederiksen MS, Schmied V, Overgaard C. Supportive encounters during pregnancy and the postnatal period: An ethnographic study of care experiences of parents in a vulnerable position. J Clin Nurs 2021; 30:2386-2398. [PMID: 33870548 DOI: 10.1111/jocn.15778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Marianne Stistrup Frederiksen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Dixon S, Duddy C, Harrison G, Papoutsi C, Ziebland S, Griffiths F. Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations. BMJ Open 2021; 11:e039809. [PMID: 33753429 PMCID: PMC7986780 DOI: 10.1136/bmjopen-2020-039809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/11/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Little is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients. SETTING Primary care in England. DATA SOURCES Realist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients. PRIMARY OUTCOME MEASURE This realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated. RESULTS 124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations. CONCLUSIONS There is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities' health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation. PROSPERO REGISTRATION NUMBER CRD42018091996.
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Affiliation(s)
- Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Frances Griffiths
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
- Warwick Medical School, University of Warwick, Coventry, UK
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Brandstetter S, Rothfuß D, Seelbach-Göbel B, Melter M, Kabesch M, Apfelbacher C. Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study. BMJ Open 2020; 10:e037745. [PMID: 33109648 PMCID: PMC7592309 DOI: 10.1136/bmjopen-2020-037745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate mothers' knowledge and utilisation of antenatal and perinatal support services as well as predictors of knowledge and service utilisation. DESIGN Cross-sectional study. SETTING Prospective birth cohort in Regensburg, Eastern Bavaria, Germany. PARTICIPANTS 2455 mothers after delivery. OUTCOME MEASURES Participants' knowledge of distinct antenatal and perinatal support services (poor vs good, defined by median split). Participants' use of antenatal services provided by midwife (yes, no) and of any other antenatal support services (yes, no). RESULTS The vast majority of mothers knew at least some support services. Two-thirds of women (68.4%) reported to have used the services provided by midwives. 23.6% of women reported to have used at least one of the other antenatal services. Good knowledge of services was associated with higher education (OR 1.37, 95% CI 1.13 to 1.67), no migration background (OR 2.26, 95% CI 1.76 to 2.90), better health literacy (OR 1.04, 95% CI 1.03 to 1.06), while being primiparous (OR 0.72, 95% CI 0.60 to 0.86) and being unmarried/living with a partner (OR 0.71, 95% CI 0.57 to 0.89) reduced the chance. Predictors of service utilisation differed with regard to the services considered. CONCLUSIONS Overall, mothers had a good level of knowledge of antenatal and perinatal support services. However, we found that some groups of women were less well informed. This inequality in social predictors of knowledge of services was also partly reflected in differences in service utilisation during pregnancy.
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Affiliation(s)
- Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - David Rothfuß
- Coordinating Center for Early Interventions, City of Regensburg, Regensburg, Germany
| | - Birgit Seelbach-Göbel
- Clinic of Obstetrics and Gynecology St Hedwig, University of Regensburg, Regensburg, Germany
| | - Michael Melter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Wiggins M, Sawtell M, Wiseman O, McCourt C, Eldridge S, Hunter R, Bordea E, Mustard C, Hanafiah A, Hatherall B, Holmes V, Mehay A, Robinson H, Salisbury C, Sweeney L, Mondeh K, Harden A. Group antenatal care (Pregnancy Circles) for diverse and disadvantaged women: study protocol for a randomised controlled trial with integral process and economic evaluations. BMC Health Serv Res 2020; 20:919. [PMID: 33028319 PMCID: PMC7541287 DOI: 10.1186/s12913-020-05751-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background Group antenatal care has been successfully implemented around the world with suggestions of improved outcomes, including for disadvantaged groups, but it has not been formally tested in the UK in the context of the NHS. To address this the REACH Pregnancy Circles intervention was developed and a randomised controlled trial (RCT), based on a pilot study, is in progress. Methods The RCT is a pragmatic, two-arm, individually randomised, parallel group RCT designed to test clinical and cost-effectiveness of REACH Pregnancy Circles compared with standard care. Recruitment will be through NHS services. The sample size is 1732 (866 randomised to the intervention and 866 to standard care). The primary outcome measure is a ‘healthy baby’ composite measured at 1 month postnatal using routine maternity data. Secondary outcome measures will be assessed using participant questionnaires completed at recruitment (baseline), 35 weeks gestation (follow-up 1) and 3 months postnatal (follow-up 2). An integrated process evaluation, to include exploration of fidelity, will be conducted using mixed methods. Analyses will be on an intention to treat as allocated basis. The primary analysis will compare the number of babies born “healthy” in the control and intervention arms and provide an odds ratio. A cost-effectiveness analysis will compare the incremental cost per Quality Adjusted Life Years and per additional ‘healthy and positive birth’ of the intervention with standard care. Qualitative data will be analysed thematically. Discussion This multi-site randomised trial in England is planned to be the largest trial of group antenatal care in the world to date; as well as the first rigorous test within the NHS of this maternity service change. It has a recruitment focus on ethnically, culturally and linguistically diverse and disadvantaged participants, including non-English speakers. Trial registration Trial registration; ISRCTN, ISRCTN91977441. Registered 11 February 2019 - retrospectively registered. The current protocol is Version 4; 28/01/2020.
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Affiliation(s)
- Meg Wiggins
- Social Research Institute, University College London, 27 Woburn Square, London, WC1H 0AA, UK
| | - Mary Sawtell
- Social Research Institute, University College London, 27 Woburn Square, London, WC1H 0AA, UK.
| | - Octavia Wiseman
- School of Health Sciences, City, University of London, London, UK
| | | | - Sandra Eldridge
- Queen Mary University of London, Pragmatic Clinical Trials Unit, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Ekaterina Bordea
- University College London, Institute of Clinical Trials & Methodology, London, UK
| | - Connor Mustard
- Queen Mary University of London, Pragmatic Clinical Trials Unit, London, UK
| | - Ainul Hanafiah
- Institute for Health and Human Development, University of East London, London, UK
| | - Bethan Hatherall
- Institute for Health and Human Development, University of East London, London, UK
| | - Vivian Holmes
- Institute for Health and Human Development, University of East London, London, UK
| | - Anita Mehay
- Institute for Health and Human Development, University of East London, London, UK
| | | | - Cathryn Salisbury
- Institute for Health and Human Development, University of East London, London, UK
| | - Lorna Sweeney
- Institute for Health and Human Development, University of East London, London, UK
| | | | - Angela Harden
- Institute for Health and Human Development, University of East London, London, UK
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Rayment-Jones H, Silverio SA, Harris J, Harden A, Sandall J. Project 20: Midwives' insight into continuity of care models for women with social risk factors: what works, for whom, in what circumstances, and how. Midwifery 2020; 84:102654. [PMID: 32066030 PMCID: PMC7233135 DOI: 10.1016/j.midw.2020.102654] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Continuity of care models are known to improve clinical outcomes for women and their babies, but it is not understood how. A realist synthesis of how women with social risk factors experience UK maternity care reported mechanisms thought to improve clinical outcomes and experiences. As part of a broader programme of work to test those theories and fill gaps in the literature base we conducted focus groups with midwives working within continuity of care models of care for women with social factors that put them at a higher chance of having poor birth outcomes. These risk factors can include poverty and social isolation, asylum or refugee status, domestic abuse, mental illness, learning difficulties, and substance abuse problems. OBJECTIVE To explore the insights of midwives working in continuity models of care for women with social risk factors in order to understand the resources they provide, and how the model of care can improve women's outcomes. DESIGN Realist methodology was used to gain a deeper understanding of how women react to specific resources that the models of care offer and how these resources are thought to lead to particular outcomes for women. Twelve midwives participated, six from a continuity of care model implemented in a community setting serving an area of deprivation in London, and six from a continuity of care model for women with social risk factors, based within a large teaching hospital in London. FINDINGS Three main themes were identified: 'Perceptions of the model of care, 'Tailoring the service to meet women's needs', 'Going above and beyond'. Each theme is broken down into three subthemes to reveal specific resources or mechanisms which midwives felt might have an impact on women's outcomes, and how women with different social risk factors respond to these mechanisms. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Overall the midwives in both models of care felt the service was beneficial to women and had a positive impact on their outcomes. It was thought the trusting relationships they had built with women enabled midwives to guide women through a fragmented, unfamiliar system and respond to their individual physical, emotional, and social needs, whilst ensuring follow-up of appointments and test results. Midwives felt that for these women the impact of a trusting relationship affected how much information women disclosed, allowing for enhanced, needs led, holistic care. Interesting mechanisms were identified when discussing women who had social care involvement with midwives revealing techniques they used to advocate for women and help them to regain trust in the system and demonstrate their parenting abilities. Differences in how each team provided care and its impact on women's outcomes were considered with the midwives in the community-based model reporting how their location enabled them to help women integrate into their local community and make use of specialist services. The study demonstrates the complexity of these models of care, with midwives using innovative and compassionate ways of working to meet the multifaceted needs of this population.
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Affiliation(s)
- Hannah Rayment-Jones
- Department of Women and Children's Health Faculty of Life Sciences & Medicine, King's College London, 10th Floor, North Wing St. Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK.
| | - Sergio A Silverio
- Department of Women and Children's Health Faculty of Life Sciences & Medicine, King's College London, 10th Floor, North Wing St. Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK.
| | - James Harris
- Centre for Nursing, Midwifery and Allied Health Professional Research, First Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Angela Harden
- Institute for Health and Human Development, University of East London, UH250, Stratford Campus, London, E15 4LZ, UK.
| | - Jane Sandall
- Department of Women and Children's Health Faculty of Life Sciences & Medicine, King's College London, 10th Floor, North Wing St. Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK.
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Rayment‐Jones H, Harris J, Harden A, Khan Z, Sandall J. How do women with social risk factors experience United Kingdom maternity care? A realist synthesis. Birth 2019; 46:461-474. [PMID: 31385354 PMCID: PMC6771833 DOI: 10.1111/birt.12446] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Echoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care. METHODS Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0). RESULTS Three themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships. CONCLUSIONS The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes.
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Affiliation(s)
- Hannah Rayment‐Jones
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and MedicineNorth Wing St. Thomas' Hospital, King's College LondonLondonUK
| | - James Harris
- Elizabeth Garrett Anderson Wing, University College HospitalLondonUK
| | - Angela Harden
- Institute for Health and Human Development, University of East LondonLondonUK
| | - Zahra Khan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and MedicineNorth Wing St. Thomas' Hospital, King's College LondonLondonUK
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