Abstract
BackgroundHigh quality maternity care is increasingly understood to represent a continuum of care. As well as ensuring a positive experience for mothers and families, integrated maternity care is responsive to mental health needs of mothers. The aim of this paper is to summarize differences in women’s experiences of maternity care between women with and without a self-reported mental health condition.MethodsSecondary analyses of a randomized, stratified sample patient experience survey of 4787 women who gave birth in a New South Wales public hospital in 2017. We focused on 64 measures of experiences of antenatal care, hospital care during and following birth and follow up at home. Experiences covered eight dimensions: overall impressions, emotional support, respect for preferences, information, involvement, physical comfort and continuity. Multivariable logistic regression was used to compare experiences of women with and without a self-reported longstanding mental health condition.ResultsCompared to women without a condition, women with a longstanding mental health condition (n = 353) reported significantly less positive experiences by eight percentage points on average, with significant differences on 41 out of 64 measures after adjusting for age, education, language, parity, type of birth and region. Disparities were pronounced for key measures of emotional support (discussion of worries and fears, trust in providers), physical comfort (assistance, pain management) and overall impressions of care. Most women with mental health conditions (75% or more) reported positive experiences for measures related to guidelines for maternity care for women with mental illness (discussion of emotional health, healthy behaviours, weight gain). Their experiences were not significantly different from those of women with no reported conditions.ConclusionsWomen with a mental health condition had significantly less positive experiences of maternity care across all stages of care compared to women with no condition. However, for some measures, including those related to guidelines for maternity care for women with mental illness, there were highly positive ratings and no significant differences between groups. This suggests disparities in experiences of care for women with mental health conditions are not inevitable. More can be done to improve experiences of maternity care for women with mental health conditions.
Highlights
High quality maternity care is increasingly understood to represent a continuum of care spanning antenatal, labour and birth and postnatal phases that ensures a positive experience for mothers and families, and responds to their mental health needs
63% of women rated their antenatal care as ‘very good’ – this ranged from lows of 53% among women aged 18 to 24, and 55% among women with a mental health condition, to 74% of women from small hospitals
Where other studies on disparities in experiences have focused on young mothers, from diverse or low-income backgrounds [11], this current study demonstrates that mothers with mental health conditions need more support in terms of overall maternal care and care for mental health needs
Summary
High quality maternity care is increasingly understood to represent a continuum of care spanning antenatal, labour and birth and postnatal phases that ensures a positive experience for mothers and families, and responds to their mental health needs. Pregnancy and childbirth is a life changing period for women and their families, with many uncertainties and changes that may bring up new or existing mental health-related needs It is estimated more than one in 10 mothers experience depressive episodes in the first months following birth [1] with other studies suggesting as many as a quarter of women have depression or other mental disorders in early pregnancy [2]. NSW’s First 2000 Days Framework sets out guidelines to help improve opportunities for health intervention between pregnancy and the child’s fifth birthday It acknowledges the unmet emotional needs of women negatively impact both mothers’ and babies’ outcomes [7]
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