The midwife-woman relationship in a South Wales community: Experiences of midwives and migrant Pakistani women in early pregnancy.

Laura Goodwin,Aled Jones,Billie Hunter

doi:10.1111/hex.12629

Laura Goodwin, Aled Jones + Show 1 more

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https://doi.org/10.1111/hex.12629

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Journal: Health Expectations	Publication Date: Sep 29, 2017
Citations: 26	License type: CC BY 4.0

Affiliation: University of Birmingham, Cardiff University

Abstract

BackgroundIn 2015, 27.5% of births in England and Wales were to mothers born outside of the UK. Compared to their White British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. Existing literature highlights the importance of midwife–woman relationships in care satisfaction and pregnancy outcomes; however, little research has explored midwife–woman relationships for migrant and minority ethnic women in the UK.MethodsA focused ethnography was conducted in South Wales, UK, including semi‐structured interviews with 9 migrant Pakistani participants and 11 practising midwives, fieldwork in the local migrant Pakistani community and local maternity services, observations of antenatal appointments, and reviews of relevant media. Thematic data analysis was undertaken concurrently with data collection.FindingsThe midwife–woman relationship was important for participants' experiences of care. Numerous social and ecological factors influenced this relationship, including family relationships, culture and religion, differing health‐care systems, authoritative knowledge and communication of information. Marked differences were seen between midwives and women in the perceived importance of these factors.ConclusionsFindings provide new theoretical insights into the complex factors contributing to the health‐care expectations of pregnant migrant Pakistani women in the UK. These findings may be used to create meaningful dialogue between women and midwives, encourage women's involvement in decisions about their health care and facilitate future midwifery education and research. Conclusions are relevant to a broad international audience, as achieving better outcomes for migrant and ethnic minority communities is of global concern.

Highlights

In 2015, 27.5% of births in England and Wales were to mothers born outside of the UK
Higher maternal mortality rates are observed for minority ethnic and migrant women.[12]
The risk of maternal mortality seems to be increasing for some migrant women in the UK: between 2011 and 2014, the relative risk of maternal mortality for Pakistan-born women living in the UK increased from 1.53 to 2.24.12,13 Data consistently suggest that minority ethnic and migrant women are at an increased risk of perinatal mortality

Summary

Introduction

In 2015, 27.5% of births in England and Wales were to mothers born outside of the UK Compared to their White British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. Conclusions: Findings provide new theoretical insights into the complex factors contributing to the health-care expectations of pregnant migrant Pakistani women in the UK. These findings may be used to create meaningful dialogue between women and midwives, encourage women’s involvement in decisions about their health care and facilitate future midwifery education and research. In 2013, mothers of Black ethnic origin were twice as likely to have a stillbirth than mothers of White ethnic origin,[14] and women of Asian or Asian British ethnic origin had up to 64% higher stillbirth rates than their White counterparts.[15]

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