Experiences Of Maternity Care Research Articles

O34 - Labouring Together: Clinicians’ Experiences of “Working Together To Get The Best Outcomes” in Maternity Care

Multiple investigations have determined that poor interprofessional collaboration has been detrimental to the safety and experience of maternity care, as evidenced in the publication of the recent Ockenden review in the UK. The Labouring Together study was conducted to explore women's and clinicians' perceptions and experiences of collaboration in maternity care, using a conceptual theory of collaboration to identify barriers and enablers in the context of Victoria, Australia. A sequential, mixed-methods, multi-site case study approach was used to explore collaboration and shared decision-making in maternity care in four diverse case studies of public and private hospitals. Cross-sectional surveys were conducted in each case, using validated scales to determine midwives’, obstetrician’s and GPs’ assessment of organisational context and attitudes toward collaboration, followed by in-depth interviews to explore their perceptions and experiences. Participants rated the context of each case study similarly for the provision of woman-centred care, and whilst the attitudes of most participants were positive toward collaboration, midwives were found to have a significantly more positive attitude than obstetricians ( p <.001 95% CI 2.64-7.93) and GPs ( p <.001 95% CI 5.48-12.10). The conceptual framework of Working Together to Get The Best Outcomes emerged from inductive analysis, with major subthemes of ‘Organisation of care: working for the organisation’ and ‘Partnering in care: working together with women’ . Interprofessional tensions are avoided through professional altruism and positive role-modelling of interprofessional respect and trust. However, multiple barriers to effective collaboration in maternity care were identified; and whilst participants agreed that women should have autonomy for collaborative decision-making, most identified barriers to achieving this ideal. Results of the Labouring Together study indicate that although individual attitudes toward collaboration are largely positive, fundamental barriers to collaboration in maternity care remain, and shared decision-making with women is not routine practice in Victoria, Australia.

O93 - Association of continuity of carer and women’s experiences of maternity care during the COVID-19 pandemic: A cross-sectional survey

BackgroundRecent research highlights the impact of the COVID-19 pandemic on maternity services, although none to date have asked women how they feel about the changes to care or analysed the association between continuity of carer and women’s experiences.AimThe aim of our research was to discover pregnant women’s self-reported changes to their planned care and associations between continuity of carer and how women felt about changes to their planned care.MethodsA cross-sectional online survey of pregnant women aged over 18 years in their final trimester of pregnancy in Australia was undertaken.Results1668 women completed the survey. Most women reported at least one change to pregnancy care and birthing plans. Women receiving full continuity of carer were more likely to rate the changes to care as positive (p<0.001) when compared with women who received partial or no continuity.ConclusionsPregnant women experienced many changes to their planned pregnancy and birth care during the COVID-19 pandemic. Women who received full continuity of carer experienced fewer changes to care and were more likely to feel positive about the changes than women who did not receive full continuity of carer. Our study demonstrates that women are better together through continuity of carer models.

O69 - Experiences and information needs of women who become pregnant after bariatric surgery

Obesity is known to reduce fertility and increase the risk of pregnancy related complications. Many women of childbearing age undertake bariatric surgery to lose weight for the purpose of becoming pregnant. Bariatric surgery results in physical changes that are associated with both benefits and risks for maternal and neonatal outcomes. Women’s understanding of these risks and their experiences once they become pregnant after bariatric surgery are not well documented. The aim of this study was to explore the information needs and experiences of Australian women who become pregnant following bariatric surgery. A qualitative study of 11 Australian women with experiences of pregnancy following bariatric surgery participated in a private Facebook discussion group conducted in 2021. Women were recruited via targeted advertisements on social media. The data were thematically analysed. Women reported a number of information gaps regarding the implications of having bariatric surgery for preconception, pregnancy, and postnatal periods. Family planning, pregnancy nutrition, and breastfeeding after bariatric surgery were identified as key areas of information need. Women perceived healthcare providers lacked knowledge regarding pregnancy following bariatric surgery. Women described judgemental attitudes from their clinicians, negatively impacting their maternity care experience. Healthcare care providers of women who have had bariatric procedures need to effectively communicate the risks of pregnancy too soon following bariatric surgery. Despite recommendations to delay pregnancy for 12 months post-surgery, many women will become pregnant intentionally or unintentionally earlier than advised. Undertaking shared decision making and non-judgemental approaches to effectively manage risks will be of benefit to these women. The findings suggest that specifically tailored resources and education for women and their healthcare providers can improve the care experiences of women who wish to become pregnant following bariatric surgery.

Perceived experience of respectful maternity care among mothers attending a selected teaching hospital of Kaski district

Introduction: Pregnancy and childbirth are momentous events in the lives of women and families and represent a time of intense vulnerability. Because parenthood is a uniquely female experience, questions of gender justice and violence are at the heart of maternity care. The study aimed to find out the perceived experience of respectful maternity care and its associated factors among postnatal mothers. Methods: A descriptive cross-sectional research design was used. The study population consisted of mothers who had a normal vaginal delivery and were admitted to the Gandaki Medical College Teaching Hospital and Research Centre’s postnatal ward from July 1 to August 1, 2021. A purposive sampling technique was used. Standard Respectful Maternity Care scale was used to collect the data. Collected data were entered, coded and edited into Statistical package for the social sciences version 16.0 and analyzed using both descriptive and inferential statistical methods. Results: Of total, 166 (83%) women did not receive respectful maternity care. Regarding the dimensions of RMC, more than half 106 (53%) of the mothers received abuse-free care. Only 40 (20%) of the mothers received friendly care. Parity with friendly care adjusted Odds ratio(AOR)=0.25, Confidence interval (CI) (0.10-0.64), education with abuse free care (AOR=3.66, CI 1.86-7.20), Parity with timely care (AOR=3.27, CI=1.45-7.38). Likewise, educational status of the respondent (AOR= 2.24,CI= 1.13-4.44), religion ( AOR=2.88, CI=1.19-6.95) and parity are the factors influencing discrimination free care( AOR= 0.36, CI=0.18-0.73). Conclusions: The majority of women did not receive dignified and respectful care throughout labor.

Labouring Together: Women's experiences of “Getting the care that I want and need” in maternity care

ObjectivePoor interprofessional collaboration and lack of decision-making with women have been identified as being detrimental to the quality, safety, and experience of maternity care. The aim of the Labouring Together study was to explore childbearing women's preferences for and experiences of collaboration and control over decision-making in maternity care. DesignA sequential, mixed-method, multi-site case study approach was used to explore the perceptions and experiences of childbearing women regarding collaboration and decision-making. Women's preferred role for decision-making compared to the actual experiences, and the influences upon their preferences and experiences of collaboration were explored using semi-structured interviews. An inductive approach was used for qualitative analysis of interviews, and cross-case analyses were conducted using replication logic. SettingPostnatal wards of 1 private and 3 public maternity services in both metropolitan and regional Victoria, Australia. ParticipantsPostnatal women, over the age of 18 years (n=182). FindingsHalf (48.3%) of the participants indicated a preference for a shared decision-making role and 35% preferred an active role. Only 16.7% participants indicated a preference for a passive role, however 24.4% of women reported experiencing a passive decision-making role during their maternity care. Statistically significant differences were also identified between preferences for and experiences of decision-making among women who chose the private obstetrician model of maternity care compared to the public maternity care system. Negative impacts upon women's autonomy over decision-making included: poor access to midwifery models of care; poor access to relational continuity of care; poor understanding of the rights of the woman; inadequate information for women about the risks and benefits of all proposed interventions; and a bureaucratic style of decision-making based upon a dominant discourse of risk avoidance that could ultimately veto the woman's choice. Key conclusionsDespite evidence of the benefits for women of having autonomy over decision-making in their own care, fundamental barriers were identified that hindered women's participation in collaboration in maternity care. Shared decision-making with childbearing women is not routine practice in maternity care in Victoria, Australia. Implications for practiceRelational continuity of care is imperative to promote the autonomy of childbearing women and an environment conducive to women's active engagement in maternity care and participation in shared decision-making.

The un-silencing of Japanese women's voices in maternity care: A hermeneutic phenomenological study of the woman–midwife relationship

ObjectiveThe purpose of this article is to understand the meaning of the woman–midwife relationship, with the overall aim to improve maternity care and women's birth experiences in Japan. To better understand the meaning of the woman–midwife relationship, this article presents women's and midwives’ experiences of having or not having a voice in maternity care. Research designHermeneutic phenomenology, as described by Max van Manen, helped to uncover the meaning of the phenomenon—the woman–midwife relationship—through participants’ lived experience. Individual interviews were conducted with 14 women and 10 midwives living in Japan. The interview data were interpreted and thematically analysed to reveal the meaning of the woman–midwife relationship. Findings‘Having a voice’ emerged as a central theme underpinning the meaning of the woman–midwife relationship; aspects of which included, 1) being unheard, 2) losing a voice, 3) having a voice, and 4) midwives speaking for women. Although having a voice should be a legitimate right for women in maternity care, some women's voices were unheard or lost in the experience with midwives. Conversely, some women gained a voice, especially when they positively and continuously developed their relationship with their midwife. How the woman and the midwife related to each other clearly affected their experience of having a voice in maternity care. Key conclusionHaving a voice, which portrays dimensions of choice, control, and autonomy, in their own maternity care is vital for women's positive birth experience. The woman–midwife relationship is critical in enabling women to have a voice and midwives to speak for women. Women and midwives need to develop their relationship. Moreover, the maternity care system needs to allow sufficient time and space, for instance, by ensuring midwife continuity of care to develop a positive woman–midwife relationship.

Perceptions and predictors of respectful maternity care in Malawi: A quantitative cross-sectional analysis

ObjectiveAccess to high-quality, respectful care is a basic human right. A lack of respectful care during childbirth is associated with poor outcomes and can negatively influence care-seeking and maternal mental health. We aimed to describe how women perceive their experience of maternity care in Malawi. MethodsWe implemented a cross-sectional survey of women (n = 660) who delivered in 25 birth facilities in four districts in Malawi in March 2020 using a validated 30-item, 90-point person-centered maternity care (PCMC) scale. We used descriptive statistics to examine women's experience of care and analyzed bivariable and multivariable mixed-effects models to evaluate predictors of PCMC. Statistical models accounted for clustering of women at the facility level and included maternal age, marital status, education, parity, mother or infant complications, timing of antenatal care (ANC), provider cadre and gender, facility type and sector, and district. ResultsMean PCMC score was 57.5 (range 21-84), with the lowest score (12.4 of 27 points) in communication and autonomy. Women reported: being prohibited from having a birth companion during labor (49.4%) or delivery (60.3%); providers did not introduce themselves (81.1%); providers did not ask consent before procedures/examinations (42.4%); women felt they could not ask questions (40.9%); and were not involved in care decisions (61.5%). Few women reported being frequently abused physically (2%) or verbally (3.5%); almost all had water/electricity available (>95%). In bivariate analyses, statistically significant positive associations were found between PCMC score and early ANC, male accompaniment to the facility, male provider, and a lack of complications; all associations remained at least potentially statistically significant in multivariable modeling. ConclusionsPhysical and verbal abuse and a lack of basic amenities were rare, while a lack of communication with patients and social support were common. Maternal characteristics (like timing of ANC and maternal or newborn complications) were predictors of RMC, while facility/system factors, like facility type and sector, were not. Continued efforts to improve respectful care will require strengthening provider communication skills and encouraging patient and companion involvement in care.

Impact of the COVID-19 pandemic on midwifery-led service provision in the United Kingdom in 2020-21: Findings of three national surveys

BackgroundThe COVID-19 pandemic required all healthcare systems to adapt quickly. There is some evidence about the impact of the pandemic on United Kingdom maternity services overall, but little is known about the impact on midwifery-led services, including midwifery units and home birth services. ObjectiveTo describe changes to midwifery-led service provision in the United Kingdom and the Channel Islands during the COVID-19 pandemic. DesignThree national surveys were circulated using the United Kingdom Midwifery Study System (UKMidSS) and the Royal College of Midwives (RCM) Heads and Directors of Midwifery Network. The UKMidSS surveys took place in wave 1 (April to June 2020) and in wave 2 (February to March 2021). The RCM survey was conducted in April 2020. FindingsThe response rate to the UKMidSS surveys was 84% in wave 1 and 70% in wave 2, while 48% of Heads and Directors of Midwifery responded to the RCM survey. Around 60% of midwifery units reported being open as usual in wave 1, with the remainder affected by closures. Fewer unit closures (15%) were reported in the wave 2 survey. Around 40% of services reported some reduction in home birth services in wave 1, compared with 15% in wave 2. The apparent impact of the pandemic varied widely across the four nations of the United Kingdom and within the English regions. ConclusionsThe pandemic led to increased centralisation of maternity care and the disruption of midwifery-led services, especially in the first wave. Further research should focus on the reasons behind closures, the regional variation and the impact on maternity care experience and outcomes.

Maternity care during COVID-19: a qualitative evidence synthesis of women’s and maternity care providers’ views and experiences

BackgroundAs COVID-19 continued to impact society and health, maternity care, as with many other healthcare sectors across the globe, experienced tumultuous changes. These changes have the potential to considerably impact on the experience of maternity care. To gain insight and understanding of the experience of maternity care during COVID-19, from the perspectives of women and maternity care providers, we undertook a qualitative evidence synthesis (QES).MethodsThe population of interest for the QES were pregnant and postpartum women, and maternity care providers, who provided qualitative data on their experiences of maternity care during COVID-19. The electronic databases of MEDLINE, CINAHL, EMBASE, PsycINFO and the Cochrane COVID study register were systematically searched from 01 Jan 2020 to 13 June 2021. The methodological quality of the included studies was appraised using a modified version of the quality assessment tool, based on 12-criteria, designed by the Evidence for Policy and Practice Information coordinating Centre (EPPI-Centre). Data were extracted by two reviewers independently and synthesised using the Thomas and Harden framework. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual).ResultsFifty records relating to 48 studies, involving 9,348 women and 2,538 maternity care providers, were included in the QES. The methodological quality of the studies varied from four studies meeting all 12 quality criteria to two studies meeting one quality criterion only. The synthesis revealed eight prominent themes. Five of these reflected women’s experiences: 1) Altered maternity care (women), 2) COVID-related restrictions, 3) Infection prevention and risk, 4) ‘the lived reality’ – navigating support systems, and 5) Interactions with maternity services. Three themes reflected maternity care providers’ experiences: 6) Altered maternity care (providers), 7) Professional and personal impact, and 8) Broader structural impact. Confidence in the findings was high or moderate.ConclusionAlthough some positive experiences were identified, overall, this QES reveals that maternity care during COVID-19 was negatively experienced by both women and maternity care providers. The pandemic and associated changes evoked an array of emotive states for both populations, many of which have the potential to impact on future health and wellbeing. Resource and care planning to mitigate medium- and longer-term adverse sequelae are required.PROSPERO registrationCRD42021232684.

Learning from women: Improving experiences of respectful maternity care during unplanned caesarean birth for women with diverse ethnicity and racial backgrounds

ProblemWomen from diverse ethnicity and racial backgrounds have few opportunities to share birth experiences to inform improvements in care. BackgroundRespectful maternity care is recognised as a global women’s health priority. Integrating that framework into diverse care systems and models may help bridge care gaps for women who had unexpected birth experiences, including unplanned caesarean birth. AimTo describe the experiences of women who had unplanned caesarean births and use knowledge gained to inform best practice recommendations that embody respectful maternity care. MethodsQualitative data were analysed from focus groups involving a convenience sample of 11 English speaking women, from diverse ethnic and racial backgrounds, with prior unplanned caesarean experience. Respectful maternity care was used as the lens for interpreting women’s narratives using Thorne’s interpretive description. The study site was an outpatient prenatal clinic within an urban academic, tertiary-care medical centre in the United States. FindingsTwo predominant, contrasting themes emerged: “not feeling well cared for” and “feeling well supported”. Positive experiences included sources of support and strength from the midwifery practice, group prenatal care, and a doula program. Eight domains of respectful maternity care were applied to findings, highlighting current positive institutional practices and proposing areas for future quality improvement. ConclusionKey practices promoting respectful maternity care include adequate communication and information sharing between pregnancy care providers and women, and a more robust informed consent process. Further emphasis on respectful maternity care is needed to support women to make shared decisions that best fit their circumstances and preferences.

An exploratory study of client and provider experience and perceptions of facility-based childbirth care in Quich\xe9, Guatemala

IntroductionRespectful maternity care (RMC) is fundamental to women’s and families’ experience of care and their decision about where to give birth. Studies from multiple countries describe the mistreatment of women during facility-based childbirth, though only a small number of studies from Guatemala have been published. Less information is available on women’s negative and positive experiences of childbirth care and health workers’ perceptions and experiences of providing maternity care.MethodsAs part of a program implemented in the Western Highlands of Guatemala to improve quality of reproductive maternal newborn and child health care, a mixed methods assessment was conducted in three hospitals and surrounding areas to understand women’s and health workers’ experience and perceptions of maternity care. The quantitative component included a survey of 31 maternity health workers and 140 women who had recently given birth in these hospitals. The qualitative component included in-depth interviews (IDIs) and focus group discussions (FGDs) with women and maternity health workers and managers.ResultsWomen reported a mix of positive and negative experiences of childbirth care related to interpersonal and health system factors. 81% of surveyed women reported that health workers had treated them with respect while 21.4% of women reported verbal abuse. Fifty-five percent and 12% of women, respectively, reported not having access to a private toilet and bath or shower. During IDIs and FGDs, many women described higher rates of verbal abuse directed at women who do not speak Spanish. A regression analysis of survey results indicated that speaking Ixil or K’iche at home was associated with a higher likelihood of women being treated negatively during childbirth in a facility. Health worker survey results corroborated negative aspects of care described by women and also reported mistreatment of health workers by clients and families (70.9%) and colleagues (48.2%).ConclusionsThis study adds to the literature on women’s experience of institutional childbirth and factors that influence this experience by triangulating experience and perceptions of both women and health workers. This assessment highlights opportunities to address mistreatment of both women and health workers and to build on positive care attributes to strengthen RMC for all women.

To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria

BackgroundTo institutionalise respectful maternity care, frequent data on the experience of childbirth care is needed by health facility staff and managers. Telephone interviews have been proposed as a low-cost alternative...

Women's experiences with maternity care in public health facilities of Assam, India.

India is committed to Sustainable Development Goal 3 of reducing the national maternal mortality ratio to <70/100,000 live births by 2030. This article describes women's experiences of maternity care in public health facilities in three districts of the north-eastern Indian state of Assam. Fourteen focus-group discussions were carried out among 149 married women aged 18-45 years belonging to different ethnic communities. Data were analyzed using a grounded theory approach and organized using a framework of dimensions of maternal satisfaction. The findings suggest that access and distance were important considerations determining maternal care quality, especially in the two remote districts. Women reported inadequate infrastructure, lack of cleanliness, and poor access to medicines. Lack of prompt care was identified as an important issue, and women complained about being left unattended during labor and facing obstetric violence in the labor room. Our findings point toward the need to strengthen referral transport systems and establish maternity waiting homes in remote areas. It is important to also sensitize health providers about obstetric violence and the right of women to receive prompt and respectful maternity care.

The end of a challenging year

British Journal of MidwiferyVol. 29, No. 12 EditorialThe end of a challenging yearSuzannah AllkinsSuzannah AllkinsEditorSearch for more papers by this authorSuzannah AllkinsPublished Online:2 Dec 2021https://doi.org/10.12968/bjom.2021.29.12.665AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Baby Lifeline. Mind the gap. 2021. https://bit.ly/3DSyBHW (accessed 24 November 2021) Google ScholarBBC News. Austria to go into full lockdown as Covid surges. 2021. https://bbc.in/32xhsWG (accessed 25 November 2021) Google ScholarGov.uk. Government to introduce COVID-19 vaccination as a condition of deployment for all frontline health and social care workers. 2021. https://bit.ly/3xi15bQ (accessed 24 November 2021) Google ScholarJardine J, Walker K, Gurol-Urganci I et al.. Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study. The Lancet. 2021;398(10314):1905–1912. https://doi.org/10.1016/S0140-6736(21)01595-6 Crossref, Google ScholarMartin H, Hameed A. The effect of COVID-19 on intrapartum care: a case review from early in the pandemic. Br J Midwifery. 2021;29(9):532–535. https://doi.org/10.12968/bjom.2021.29.9.532 Link, Google ScholarRoyal College of Midwives. RCM outlines next steps for pay campaign. 2021. https://bit.ly/3HNLJAx (accessed 24 November 2021) Google ScholarSmith V, Panda S, O'Malley D, Vallejo N, Barry P. COVID-19 and clinical outcomes of pregnancy: a comparative study. Br J Midwifery. 2021;29(11):642–647. https://doi.org/10.12968/bjom.2021.29.11.642 Link, Google ScholarStacey T, Darwin Z, Keely A, Smith A, Farmer D, Heighway K. Experiences of maternity care during the COVID-19 pandemic in the North of England. Br J Midwifery. 2021;29(9):516–523. https://doi.org/10.12968/bjom.2021.29.9.516 Link, Google Scholar FiguresReferencesRelatedDetails 2 December 2021Volume 29Issue 12ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 2 December 2021 Published in print 2 December 2021 Information© MA Healthcare LimitedPDF download

Quantifying the differences in birth outcomes and out-of-pocket costs between Australian Defence Force servicewomen and civilian women: A data linkage study

ObjectivesServicewomen in Defence Forces the world over are constrained in their health service use by defence healthcare policy. These policies govern a woman’s ability to choose who she receives maternity care from and where. The aim of this study was to compare Australian Defence Force (ADF) servicewomen and children’s birth outcomes, health service use, and out-of-pocket costs to those of civilian women and children. MethodsRetrospective cohort study using linked administrative data for women giving birth between 1 July 2012 and 30 June 2018 in Queensland, Australia (n = 365,138 births). Women serving in the ADF at the time of birth were identified as having their care funded by the Department of Defence (n = 395 births). Propensity score matching was used to identify a mixed public/private civilian sample of women to allow for comparison with servicewomen, controlling for baseline characteristics. Sensitivity analysis was also conducted using a sample of civilian women accessing only private maternity care. FindingsNearly all servicewomen gave birth in the private setting (97.22%). They had significantly greater odds of having a caesarean section (OR 1.71, 95%CI 1.29−2.30) and epidural (OR 1.56, 95%CI 1.11−2.20), and significantly lower odds of having a non-instrumental vaginal birth (OR 0.57, 95%CI 0.43−0.75) compared to women in the matched public/private civilian sample. Compared to civilian children, children born to servicewomen had significantly higher out-of-pocket costs at birth ($275.93 ± 355.82), in the first ($214.98 ± 403.45) and second ($127.75 ± 391.13) years of life, and overall up to two years of age ($618.66 ± 779.67) despite similar health service use. ConclusionsADF servicewomen have higher rates of obstetric intervention at birth and also pay significantly higher out-of-pocket costs for their children’s health service utilisation up to 2-years of age. Given the high rates of obstetric intervention, greater exploration of servicewomen’s maternity care experiences and preferences is warranted, as this may necessitate further reform to ADF maternity healthcare policy.

Monitored but not sufficiently guided – A qualitative descriptive interview study of maternity care experiences and needs in women with chronic medical conditions

ObjectiveTo explore maternity care experiences and needs of women with various types of chronic medical conditions receiving specialised maternity care. Design A qualitative descriptive study. SettingA highly specialised hospital providing maternity care to women with high-risk pregnancies in Copenhagen, Denmark. Participants Fourteen purposefully selected women referred to specialist maternity care at a large tertiary hospital due to one or more chronic medical conditions. MethodsIndividual in-depth interviews (n = 14) were performed between January 2018 and June 2019. Analysed using thematic analysis. ResultsOne overarching theme was identified: Monitored but not sufficiently guided. Three main themes unfolding this overarching theme were: Chronic condition as determining pregnancy care, Childbearing woman as messenger and interpreter, and Feelings of abandonment after giving birth. Key conclusionsAcross various types of chronic medical conditions, women expressed a need for increased continuity in specialised maternity care. Healthcare professionals should help women with chronic medical conditions navigate the healthcare system and interpret complex information. Implications for practicePregnancy should be recognised as a significant life event, even though the childbearing woman is living with a chronic medical condition, and professionals should emphasise the aspects of pregnancy that develop uncomplicated. Information about the anticipated development of chronic medical conditions postpartum and concerns regarding breastfeeding could preferably be addressed during pregnancy. Continuity of care was particularly important to the women and could relieve some of the worrying women experienced during pregnancy.

Prenatal mental and physical health, behaviours, and maternity care experiences during the COVID-19

Abstract Background During pregnancy, women's mental and physical health, health behaviours, and experiences of maternity care can have significant implications for obstetric, maternal and child outcomes. These factors can be impacted by adverse life-events, such as the COVID-19 pandemic. Aim This study examined pregnant women's mental and physical health, health behaviours, and experiences of maternity care during the COVID-19 pandemic. Methods An international online survey was conducted in June and July 2020. Pregnant women self-reported levels of general stress, pregnancy-specific stress and COVID-19 related stress. Women also self-reported their mental and physical health, general health behaviours and COVID-19 related health behaviours. Maternity care experiences were reported using closed and open-ended questions. Descriptive statistics and thematic analyses were used for quantitative and qualitative data respectively. Results 573 pregnant women from 15 countries participated. Women reported high levels of pregnancy-specific and COVID-19-related stress, and low levels of mental and physical health, during the pandemic. Women reported distress related to restrictions implemented in their maternity care that limited in-person interactions with healthcare professionals and partner attendance at antenatal appointments. Lack of information on COVID-19 and pregnancy also led to uncertainty for women about pregnancy and birth. Encouragingly, pregnant women reported high levels of adherence to public health advice and healthy prenatal behaviours. Conclusions The COVID-19 pandemic is having significant adverse effects on the mental and physical health of pregnant women. Population level interventions targeting pregnancy- and pandemic-specific stress are needed to better support the mental and physical health of women during the on-going pandemic and minimise adverse outcomes for women and children. Key messages The COVID-19 pandemic is significantly adversely impact the mental and physical health of pregnant women, indicating need for population level interventions for prenatal mental and physical health. Restrictions in maternity care and uncertainty about COVID-19 impacts are key determinant of adverse prenatal physical and mental health outcomes.

Social media and experiences of maternity care during the Covid-19 pandemic

BackgroundSocial media offer expecting and new mothers a space to discuss birth-related fears, hopes and experiences. This is particularly the case during the Covid-19 pandemic, which has altered delivery of maternity care. Measures to reduce transmission risk in birth facilities and changes in birth plans are likely to have had an impact on new mothers' experiences of birth and birth care. From a feminist epidemiology perspective, seeking to incorporate more the views of the “researched”, we explored themes discussed by (expecting) mothers on social media, hoping that those real-life concerns would find echo in the design of future research instruments for data collection.MethodsUsing content analysis, we identified key themes in 200+ comments posted on a social media public page as a reaction to the dissemination of a research survey on maternity care during the Covid-19 pandemic in Germany.ResultsIn the comments, the most mentioned topics were own mask wearing, having a companion of choice during birth, visiting hours, and the possibility to welcome visitors (e.g. siblings of the newborn, other relatives and friends). Those topics also generated the most reactions, revealing compassion from other women and mixed feeling about health measures (from acceptance to anger). Concerns about quality or appropriateness of care were almost absent from the data.ConclusionsSocial media content analysis shows clearly that women giving birth during the pandemic are most concerned with a specific set of disrupting and potentially upsetting measures. These spontaneous testimonies differ content-wise from what research surveys tend to ask women about (e.g. care standards). Those discrepancies are to some extent inevitable, but integrating more bottom-up generated topics from social media into research instruments could help move forward toward better care.Key messages On social media, women were most concerned with own mask wearing, presence of a birth companion and visits from the newborn’s siblings.Social media analysis brings valuable insights into what matters the most to women who give birth during the pandemic and could inform future research developments.

Ethnic minority women’s interactions with antenatal care providers in Europe

Abstract Background Ethnic minority women are at greater risk of maternal morbidity and mortality. Antenatal care reduces risks of adverse maternal and neonatal outcomes and supports a positive transition to motherhood. Important components of quality antenatal care are interactions between women and care providers which are supportive and empowering. Methods We conducted a systematic review to identify and synthesise qualitative evidence on ethnic minority women's experiences of accessing antenatal care in European countries. Following a comprehensive search of 8 databases and two-step screening process, we included 27 studies from various European countries. Study findings were coded and synthesised using a ‘best-fit' framework approach. Findings Overall women expressed satisfaction with their antenatal care, frequently framed in relation to experiences of maternity care in countries of origin. Women highly valued interactions with antenatal care providers which were supportive and trust-inducing, and when there was continuity of carer to facilitate this. However, studies frequently showed a dichotomy between reported satisfaction with antenatal care and experiences of interactions with care providers which could be discriminatory, stigmatising and disempowering. Some women blamed themselves for negative interactions. Language barriers were frequently identified by women as a factor which hindered their communication with antenatal care providers and the subsequent quality of care received, when suitable interpreters were not available. Negative interactions with antenatal care providers could result in a withdrawal from ongoing antenatal care for some women. Conclusions This review highlights the importance of quality interactions between ethnic minority women and antenatal care providers. Policy implications: Antenatal care should be provided in such a way as to facilitate trust, support and effective communication between women and care providers. Key messages Positive interactions with care providers form an important element of quality antenatal care for ethnic minority women in Europe. Trust, support and the provision of suitable interpreters, where needed, contribute to positive interactions with antenatal care providers for ethnic minority women in Europe.

Examining person-centered maternity care in a peri-urban setting in Embakasi, Nairobi, Kenya.

Peri-urban settings have high maternal mortality and the quality of care received in different types of health facilities is varied. Yet few studies have explored the construct of person-centered maternity care (PCMC) within peri-urban settings. Understanding women's experience of maternity care in peri-urban settings will allow health facility managers and policy makers to improve services in these settings. This study examines factors associated with PCMC in a peri-urban setting in Kenya. We analyzed data from a cross-sectional study with 307 women aged 18-49 years who had delivered a baby within the preceding six weeks. Women were recruited from public (n = 118), private (n = 76), and faith based (n = 113) health facilities. We measured PCMC using the 30-item validated PCMC scale which evaluates women's experiences of dignified and respectful care, supportive care, and communication and autonomy. Factors associated with PCMC were evaluated using multilevel models, with women nested within facilities. The average PCMC score was 58.2 (SD = 13.66) out of 90. Controlling for other factors, literate women had, on average, about 6-point higher PCMC scores than women who were not literate (β = 5.758, p = 0.006). Women whose first antenatal care (ANC) visit was in the second (β = -5.030, p = 0.006) and third trimester (β = -7.288, p = 0.003) had lower PCMC scores than those whose first ANC were in the first trimester. Women who were assisted by an unskilled attendant or an auxiliary nurse/midwife at birth had lower PCMC than those assisted by a nurse, midwife or clinical officer (β = -8.962, p = 0.016). Women who were interviewed by phone (β = -7.535, p = 0.006) had lower PCMC scores than those interviewed in person. Factors associated with PCMC include literacy, ANC timing and duration, and delivery provider. There is a need to improve PCMC in these settings as part of broader quality improvement activities to improve maternal and neonatal health.