Experiences Of Maternity Care Research Articles

Measuring autonomy and respect: a qualitative, cross-cultural adaptation of the Mothers Autonomy in Decision Making scale and Mothers on Respect index instruments in Danish

ObjectiveDecision-making is important in user-involved maternity care and patient experience instruments Mothers Autonomy in Decision Making scale (MADM) and Mothers on Respect index (MORi) are used internationally to measure the user involvement quality and users’ experiences of autonomy and respect. This study aimed to translate and qualitatively adapt the original MADM and MORi instruments to the Danish language and culture. MethodsA forward and backward translation using a standard guideline. Subsequently, qualitative interviews to refine the translation and cultural adaptation by pilot testing the scales. ResultsThe translation process showed cultural differences linked to linguistic variations between Danish and English. Cognitive interviews with 14 diverse pregnant women revealed challenges in women's understanding of decision-making in maternity care. Changes in wording and assisting descriptive texts were made. Further, the order of the MADM items was changed to improve the understanding of decision-making. DiscussionPrimarily, the discussion concerns how decision-making can be understood in the context of maternity care and why women's understanding of decision-making in Danish maternity care in the MADM scale items was challenged. ConclusionThe qualitative pilot test using cognitive interviews after translation of the instruments was a valuable method for cultural adaptation providing important knowledge on women's understanding and perceptions of item contents. The cognitive interviews provided a comprehensive understanding of decision-making and contributed to a thoroughly worked Danish version of the MADM and MORi instruments.

Immigrant women's experiences of childbirth in Swedish maternity care: a systematic review of the qualitative and quantitative literature

<p><strong>Aim</strong> To investigate immigrant women's experiences of childbirth in Swedish maternity care.<br /><strong>Methods</strong> A systematic search was conducted in PubMed, Embase, CINAHL, and Web of Science for qualitative and quantitative literature on immigrant women's experiences with Swedish maternity care. An inductive thematic analysis generated themes and subthemes.<br /><strong>Results</strong> Sixteen studies were included in this research. The three main themes were access to healthcare, professional treatment, and feeling significant in care. Key findings revealed that immigrant women struggled with trauma, difficult interactions with midwives, communication issues, interpreter problems, lack of detailed information, the role of doulas, and future concerns.<br /><strong>Conclusion</strong> Immigrant women's experiences of Swedish maternity care were marked by information gaps, ignorance, and disrespect, leading to mistrust and delayed help-seeking. Language barriers with midwives caused misunderstandings. A sense of belonging to Swedish society was crucial for a positive experience. More qualitative research, education in transcultural care, and training in interpreter use are needed to improve maternity care for foreign women.</p>

Factors influencing women's and men's place of birth decisions in rural Western Highlands Province of Papua New Guinea: A qualitative descriptive study.

Evidence shows that birthing with a skilled birth provider improves maternal and neonatal health outcomes. However, whilst most women in the Western Highlands Province of Papua New Guinea seek skilled health care during pregnancy in a health facility, more than half give birth at home or in the village without a skilled birth provider. To explore the factors influencing women's and men's decisions about place of birth in rural Western Highlands Province of Papua New Guinea. A qualitative-descriptive study was conducted. Semi-structured, in-depth interviews were conducted with 20 participants (16 women who were pregnant or recently given birth and four men whose partners were pregnant or recently gave birth). Interviews were audio-recorded and transcribed verbatim. The data was thematically analysed. Three key themes associated with the place of birth decision factors were identified from the study findings: (1) health service accessibility and availability, (2) socio-cultural influences, and (3) previous maternity care experiences. Participant experiences influenced their choice of place of birth, resulting in many giving birth at home in their village without a skilled birth provider. Maternal and child health services need to be appropriately tailored to improve accessibility and meet the unmet needs of pregnant women in Papua New Guinea. Additionally, health education programs should address socio-cultural factors influencing the uptake of healthcare services, especially in rural areas where health disparities are more evident. Further research is required to explore health worker perspectives, patriarchal control, and respectful care regarding health service utilisation in this study context.

Young mothers' experiences of maternity care: A synthesis of qualitative research.

Maternal health services require robust evidence to inform service provision and improve the health outcomes of mothers and their babies. Young mothers have consistently reported feeling unsupported and facing systematic barriers to accessing maternity care. Our aim was to synthesise the published evidence about how young mothers (aged between 15 and 24 years) living in regional, rural, and remote areas in high income countries experience accessing and receiving maternity health care. This qualitative evidence synthesis used a meta-aggregative approach to systematically synthesize published articles between 1970 and 2022. Electronic databases searches of CINAHL, SCOPUS, ProQuest, EMBASE, PUBMED and Google Scholar identified 4120 articles. Of these 14 were included in this review. Three final themes were synthesised: Relationships, Access and use of services and Social context. Limited data exists for regional, rural, and remote contexts. Young mothers face many challenges during their maternity care journey. Identifying the young person's social and cultural care needs and building positive relationships with care providers will improve their experiences. Research is urgently required to design age and context appropriate maternity care for young mothers, who live in regional, rural, and remote areas.

Partnership in a hospital setting: Consumer perspectives of hospital midwifery care in Aotearoa New Zealand

Background: Midwives in Aotearoa New Zealand, regardless of the setting, practise within a model of midwifery partnership. Soliciting feedback on practice provides an essential mechanism for midwives to work towards improving their practice. The New Zealand College of Midwives provides such a process for consumers of midwifery services to give feedback on their experiences directly to the midwife, via online consumer feedback forms. Aim: To identify the characteristics of midwifery care that contribute to positive and negative midwifery care relationships within the hospital setting. Methods: A retrospective mixed methods approach was used to analyse the consumer feedback on hospital midwives received between 1 January and 31 December, 2019. Quantitative data from feedback forms were analysed descriptively in combination with an iterative and reflexive thematic approach for the qualitative data. The analysis sought to identify characteristics of care that contributed to a positive or negative midwifery care experience in a hospital setting. Findings: There were 1,284 online feedback forms received for hospital midwives. The majority of respondents who completed feedback questionnaires were satisfied with their care (92%), reporting that hospital midwives provided information/explanations to support informed decision-making (94.0%), that they felt involved in planning/decisions about their care (93.7%) and that they experienced respect for decisions made (93.7%); these characteristics having the highest levels of agreement. Via qualitative analysis, we identified four key themes as contributing to the midwifery care experience in a hospital setting. Positive experience themes included: Building trust quickly, Respecting decision-making and Fostering maternal confidence, resulting in Meaningful partnerships. The negative experience themes were found to be the inverse of a positive midwifery care experience in a hospital setting. Specifically, these were: Not giving time and Judgement and disrespect, resulting in an Unsafe space and an Absence of partnership. Conclusion: The data from consumer feedback forms for 2019 affirm that the quality of the relationship with a hospital midwife is important in shaping the maternity care experience of women and birthing whānau in Aotearoa New Zealand. The characteristics of care that contribute to a positive midwifery care relationship in hospital reflect the principles outlined in the model of midwifery partnership.

Maternity Care Experiences of African-Born Women Living in Melbourne, Australia: A Qualitative Descriptive Study

Maternity Care Experiences of African-Born Women Living in Melbourne, Australia: A Qualitative Descriptive Study

Being pregnant and obese: A qualitative study of the experiences of pregnancy and birth of women who are obese

ObjectivesThis study explored the views and experiences of maternity care of postnatal women identified as being obese. DesignA qualitative methodology was adopted using individual semi-structured interviews. Data was analysed using a framework approach. SettingTwo National Health Service Hospitals- a large tertiary unit in England, and a district general hospital in Scotland. Participants8 women with a body mass index of greater than 35 who had recently had a baby. FindingsThe overall interpretation ‘Being pregnant and obese; Obese women's experiences of pregnancy and birth’ was underpinned by three key emergent themes: embodiment of obesity; being pregnant and overweight, and resource intensive maternity care. These findings are encapsulated in a conceptual framework that was formed to demonstrate the trajectory from the embodiment of obesity to becoming pregnant as an obese woman, experiencing the maternity regime that is currently in place for the care of obese women and then finally returning to being an obese woman. Key conclusionsWomen who are obese have an intrinsic fear of pregnancy and birth, have a desire for normal birth and ‘obese pregnancy’ presents a window of opportunity for both short and long-term lifestyle change. Implications for practiceCurrently one-fifth of women in the UK are obese. There is increasing evidence of the detrimental effects obesity has on intrapartum outcomes and a lack of research on how to minimise the associated risks of obesity through non-medicalised interventions and how to support women who are obese to maximise their experience of birth. Addressing the intrapartum management through non-medicalised interventions is of paramount importance to maximise the experience of birth and reduce the associated morbidities.

Mixed-method study of women’s experiences of Respectful-Disrespectful Maternity Care in Cyprus

Abstract Background Since the WHO reports on Disrespect and Abuse (D&A) in childbirth, there was an increase in studies across Europe exploring women’s experiences. Even though contentious, a 2024 EU Committee report adopts the term obstetric violence. With the highest caesarean section (C/S) in the EU, the birth environment in Cyprus raises questions about informed choices. Methods The RESPECT mixed-method study gained insights into the experiences of women in Cyprus with focus groups (N = 6, 28 women) and survey (online and in-person) tapping on Rights for Respectful Maternity Care (RMC), as measured by Person-Centred Maternity Care scale (PCMC), autonomy in decision making (MADM), dignity and respect (MoRi) and mistreatment (MIST). Results Among 516 responses (61% first childbirth, 38.5% vaginal, 15% public sector, consistent with official statistics), the 35-item PCMC (range 0-100%) represents a continuum of quality standards deviations (Med=81, IQR=61-92). Lowest scores were recorded for “Communication & Autonomy”, with 28.5% reporting ‘feeling pushed into a decision’, with associations observed with younger age, first-time birth, mode and place of birth, highlighting social inequity. Based on MADM, 23.8%, 14.1% and 14.7% women were classified as having moderate, low or very low autonomy. For mistreatment, 32.0% reported at least one of 11 indicators, most commonly privacy violations and no freedom of movement. Formula feeding against wishes (13.6%), vaginal examinations (11.6%) and episiotomy (7.8%) where most common among 33.7% reporting procedures without consent. Deductive content analysis of narratives according to RMC triangulate findings of weak shared decision-making processes. Conclusions Given that C/S reduction was identified as a national priority in Cyprus, the RESPECT findings can widen the conversation about quality improvement and form the basis to engage with local stakeholders in an open-dialogue about RMC, guided by participatory action research principles. Key messages • In the medicalized birth environment of Cyprus, women report a range of sub-optimal practices, with ethical implications, primarily affecting the right to autonomy. • Adopting the Respectful Maternity Care framework, the findings can stimulate and shape quality improvement efforts in a participatory and inclusive process with local stakeholders.

African Immigrant Women's Experiences of Maternity Care in the United States.

African Immigrant Women's Experiences of Maternity Care in the United States.

‘I am happy to be listened to’: co-creation of a simple tool to measure women’s experiences of respectful maternity care in urban Tanzania

ABSTRACT Background Rights-based Respectful Maternity Care (RMC) is crucial for quality of care and improved birth outcomes, yet RMC measurements are rarely included in facility improvement initiatives. We aimed to (i) co-create a routine RMC measurement tool (RMC-T) for congested maternity units in Dar es Salaam, Tanzania, and (ii) assess the RMC-T’s acceptability among women and healthcare stakeholders. Method We employed a participatory approach utilizing multiple mixed methods. This included a scoping review, stakeholder engagement involving postnatal women, healthcare providers, health leadership, and global researchers through interviews, focus groups, and two surveys involving 201 and 838 postnatal women. Cronbach’s alpha and factor analysis were conducted for validation using Stata 15. Theories of social practice and Thematic Framework of Acceptability guided the assessment of stakeholder priorities and tool acceptability. Results The multi-phased iterative co-creation process produced the 25-question RMC-T that measures satisfaction, communication, mistreatment (including physical, verbal, and sexual abuse; neglect; discrimination; lack of privacy; unconsented care; post-birth clean-up; informal payments; and denial of care), supportive care (such as food intake and mobility), birth companionship, post-procedure pain relief, bed-sharing, and newborn respect. The pragmatic validation process prioritized stakeholder feedback over strict statistics, lowering Cronbach’s alpha from 0.70 in version 1 to 0.57 for the RMC-T. Women valued the opportunity to share their experiences. Conclusions The RMC-T is contextualized, validated, and acceptable for measuring women’s experiences of RMC. Routine use in facility-based quality improvement initiatives, along with targeted actions to address gaps, will advance rights-based RMC. Further validation and community-based studies are needed.

Maternity care experiences and outcomes of people seeking sanctuary in Wales: a data linkage study protocol

Maternity care experiences and outcomes of people seeking sanctuary in Wales: a data linkage study protocol

Maternal outcomes and pre, syn, and post-partum care in the united states and five high-income countries: An exploratory comparative qualitative study

Many studies have documented differences in maternal health outcomes across high-income countries, noting higher and growing maternal mortality in the US. However, few studies have detailed the journeys of care that may underlie or influence differences in outcomes. This study explores how maternity care entitlements and experiences vary among the US and five high-income countries, to study variations in child delivery care practices. Health systems with different organizational structure, insurance coverage and with known differences in maternal care delivery and maternal health outcomes were selected. Data was collected using a structured questionnaire, comparison of secondary data, and literature scan. We find that, while prenatal care approaches were broadly similar across all six countries, there were some important differences in maternity care provision among the comparator countries: (1) the US has more fragmented coverage during pregnancy than comparator countries (2) there were differences with regards to the main provider delivering care, the US relied primarily on physician specialists rather than midwives for prenatal care and delivery which was more common in other countries, (3) the intensity of labor and delivery care varied, particularly with regards to rates of epidural use which were highest in the US and France and lowest in Japan, and (4), there was large variation in the use of postnatal home visits to assess health and wellbeing, notably lacking in the US. The US’ greater use of specialists and more intensive labor and delivery care may partially explain higher costs of care than in comparator countries. Moreover, US maternal mortality is concentrated in the pre- and postnatal periods and thus may be related to poorer access to prenatal care and the lack of an organized, community-based approach to postnatal care. Given the increase in maternal mortality across countries, policy makers should look across countries to identify promising models of care delivery, and should consider investing in more comprehensive coverage in pre- and postnatal care.

O17 - Experiences of maternity care in Australia and the national maternity Strategy: qualitative findings from a national survey

O17 - Experiences of maternity care in Australia and the national maternity Strategy: qualitative findings from a national survey

P13 - Larger bodied women's experiences of maternity care: a national photo-voice study [RADIANT Study]

P13 - Larger bodied women's experiences of maternity care: a national photo-voice study [RADIANT Study]

South Asian women’s views on and experiences of maternity care services in Hong Kong: A qualitative study

BackgroundHealth 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. ObjectiveTo understand South Asian women’s views and experiences regarding maternity care services in Hong Kong. MethodsA 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. FindingsFour 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. DiscussionSouth 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. ConclusionThe 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.

Experiences of attending prenatal ultrasounds during the COVID-19 pandemic in Australia: A cross-sectional survey.

Prenatal ultrasounds form an important part of routine maternity care in Australia and indeed internationally. The COVID-19 pandemic necessitated rapid changes in society and healthcare to curb transmission, with evidence demonstrating detrimental impacts on childbearing women associated with these restrictions. However, experiences with pandemic restrictions for prenatal ultrasounds in relation to distress, patient expectations, and satisfaction are largely unknown. This study aimed to explore the experiences of pregnant women attending prenatal ultrasound during the pandemic in Australia. A cross-sectional online survey of people in Australia who had undergone at least one prenatal ultrasound during the period of maternity care restrictions was performed. The survey included validated tools for assessing post-traumatic stress, satisfaction, and expectations with maternity care. A total of 1280 responses were obtained. Almost 37% of respondents returned a PCL-C score consistent with probable post-traumatic stress disorder. Unexpected ultrasound findings or a high PCL-C score were more likely to have higher expectations and lower levels of satisfaction with their maternity care experience. Having an ultrasound for pregnancy loss, fetal abnormality, and/or a prior post-traumatic stress disorder diagnosis were the strongest factors correlating with a high PCL-C score. The prevalence of post-traumatic stress symptoms in the study population is concerning and elucidates the distress experienced in association with prenatal ultrasounds during pandemic restrictions in Australia. Maternity services should acknowledge the high levels of service consumers with post-trauma symptoms and consider trauma-responsive maternity care adaptations in response to adverse perinatal outcomes for those afflicted with post-trauma and distress-related symptoms.

Freedom for some, but not for Mum: the reproductive injustice associated with pandemic 'Freedom Day' for perinatal women in the United Kingdom.

Healthcare services for pregnant and postpartum ('perinatal') women were reconfigured significantly at the advent and for the duration of the SARS-CoV-2 pandemic, and despite the United Kingdom announcing 'Freedom Day' on 19 July 2021 (whereafter all legal lockdown-related restrictions were lifted), restrictions to maternity (antenatal, intrapartum, and postnatal) services remained. This study presents data from eight perinatal women about their experiences of psychosocial wellbeing and maternity care in the post-'Freedom Day' epoch. Semi-structured interviews were conducted virtually, with data recorded, transcribed, and analysed by hand. Grounded theory analysis was employed with the final theory assessing the reproductive injustice of the pandemic 'Freedom Day'. Analysing iteratively and inductively led to four emergent themes: 'A Failing System, Failing Women'; 'Harm Caused by a State of Difference'; 'The Privileges (Not Rights) of Reproductive Autonomy, Agency, and Advocacy'; and 'Worried Women and Marginalised Mothers'. Together, these themes form the theory of 'Freedom for some, but not for Mum'. Women experienced a lack of high-quality reliable information about the pandemic, vaccination against the virus, and the changes to, and decision-making surrounding, their perinatal care. Women recognised healthcare professionals and maternity services were stretched and that maternity services were failing but often reported hostility from staff and abandonment at times when they were unsure about how to navigate their care. The most singular injustice was the disparity between women having to accept continuing restrictions to their freedom whilst receiving maternity care and the (reckless) freedom being enacted by the general public.

Women’s experiences of maternity care in the first wave of the COVID-19 pandemic in Poland: a cross-sectional study

Background: The coronavirus disease-19 (COVID-19) pandemic significantly affected maternal care services.Aim of the study: This study aimed to identify the level of changes in care experienced by pregnant women during the first wave of the COVID-19 pandemic and to compare responses between three major modes of maternity care financing (public, fee-for-service and private healthcare subscriptions). Material and methods: This cross-sectional study of 685 pregnant women in Poland used the author’s questionnaire, which included questions on demographic data, maternity care mode of financing, and different aspects of care.Results: The vast majority (n=608, 95.6%) of respondents experienced during the COVID-19 pandemic. The most frequently reported modification was no possibility of a partner being present during prenatal consultations and medical examinations (n=558, 87.7%). Those who used a private healthcare subscription experienced more frequent medical appointment cancellations (p=0.000), a decrease in the number of consultations (p=0.000), reduced healthcare service duration (p=0.019). Over half of respondents used teleconsultations or e-consultations. The respondents who used a healthcare subscription had lower satisfaction with maternity care across all issues than women who used public and fee-for service care.Conclusions: The COVID-19 pandemic affected women’s maternity care experiences, with the financing mode differentiating their experiences. An increase in the use of telemedicine for maternity care during the SARS-CoV-2 pandemic may provide a beneficial solution for future crises.

The perceived quality of maternal care during childhood shapes attentional bias to infant faces in parents and nonparents.

While research has shown that the attentional bias to infant faces predicts the quality of infant care, the antecedents of this cognitive process have been less established. In particular, it remains unknown whether the attentional bias to infant faces might be affected by the interplay between different factors, including memories of past experiences of care, adults' sex, and the experience of parenthood. To extend previous results, we examined the attentional bias to infant faces in a mixed sample of parents (n = 99) and nonparents (n = 102), and whether it varied in relation to parental status, sex, the quality of past experiences of care, and the interactions between these factors. A modified go/no-go task was used to compare the effect of adult and infant faces in retaining adults' attention. Memories of past experiences of paternal and maternal care were collected using the short form of the Italian version of the Parental Acceptance-Rejection scale. Results confirmed that infant faces induced greater attentional interference compared to adult faces. A heightened attention to all types of faces was found in parents versus nonparent. Women, as compared to men, were slower in the task performance, and allocated more attention to infant versus adult faces. Consistent with previous evidence, the attentional prioritization of infant faces varied in relation to previous experiences of care with one's own mother; individuals who remembered a more accepting maternal care allocated more attention to infant versus adult faces. Parental status did not modulate this effect, but sex of participants did. Grounded in the interpersonal acceptance-rejection theory (IPARTheory), this study provides new insights for discerning processes that might regulate global adult caregiving. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Implementation of the Caring for Providers to Improve Patient Experience intervention in Migori County, Kenya: Challenges, successes, and lessons

Key drivers of poor person-centered maternal care (PCMC)—respectful and responsive care—include provider stress and bias. The Caring for Providers to Improve Patient Experience (CPIPE) intervention is a 5-component intervention including provider training, peer support, mentorship, embedded champions, and leadership engagement that addresses these drivers. This report describes the CPIPE implementation, challenges, and successes to demonstrate its feasibility and acceptability. CPIPE was piloted over 6 months in two health facilities in Migori County. Didactic and interactive content to promote PCMC and address stress, burnout, difficult situations, and bias, was delivered during a 2-day training. Facility-based embedded champions then led monthly refreshers and facilitated peer support groups. Twenty-four mentors provided mentorship across various topics with paired mentees, and facility and county leadership were engaged through a Community Advisory Board. Challenges included limited training time, hierarchical facility culture which hindered cross-cadre activities, varying levels of site engagement, competing demands, and leadership changes. Successes included high participation and engagement; positive perceptions about the intervention activities; provider commitments to stress management, bias mitigation, and provision of equitable PCMC; and leadership commitment to address sources of stress and provide mental health support for providers. CPIPE is an innovative and practical intervention that centers the experiences of the providers and the care of vulnerable women. The pilot’s success underscores the timeliness, relevance, feasibility, and acceptability of similar interventions in resource-constrained settings. CPIPE advances the evidence base for interventions to improve patient and provider experiences of maternal care.