Experiences Of Maternity Services Research Articles

Teenage mothers' experiences of maternity services: a qualitative study

There is a plethora of literature examining the social, economical and psychological effects of teenage pregnancy, but there is a paucity of evidence that explores teenagers' perceptions of their local services before, during and after their pregnancy. Teenage Pregnancy Liaison Midwives collected data from interviews with teenage mothers between April 2005 and May 2006. These data were subsequently analysed by the midwives between May and October 2006 using a framework proposed by Diekelmann (1990). Eight participants were recruited from statutory and voluntary organizations across a county in south-west England. Accessing clinic venues and opening times were highlighted as major problems. The first six months of a pregnant teenager's confinement appears to be the most unstable, where breakdown in family relationships, housing issues and fear attribute to poor utilization of services. It is useful to identify which agencies teenagers feel are most supportive and how prepared they feel for pregnancy, labour and parenthood.

The Role of Whānau in Māori Women's Decisions about Breast Feeding

Objective This project investigated Māori women's decision making around breastfeeding within the context of whānau attitudes towards breastfeeding in order to describe the dynamic role played by the whānau whānui (extended family) in a woman's decision to breastfeed or not. Methods During late 2004 and early 2005, 30 women who had cared for a newborn within the previous three years and 11 family members were recruited from within Auckland (a major urban area) and small towns and rural areas in and around the Bay of Plenty. Purposive sampling was used to recruit a diverse demographic of Māori women and whānau members. Given the exploratory nature of the study, detailed qualitative data was collected during semi-structured face-to-face interviews with women alone or together with whānau. All participants self-identified as Māori and were over 16 years of age. Ethical approval for the study was obtained from the University of Auckland Human Participants Ethics Committee. Results A diverse range of women were interviewed in terms of age, socio-economic status, gravida, parity, pregnancy wantedness, birthing experience, baby's age and breastfeeding experience. Women who did not want to breastfeed and women who formula-fed their babies from early on were under-represented in this research. The women's partners, mothers, sisters and aunties were cited most often as having a role in the decision to breastfeed and in supporting breastfeeding. Most of the women and whānau thought it was the feeding mother's place to decide if she would breastfeed or not and for how long. Infant feeding usually came up for discussion around ordinary home life and meetings during one-on-one conversations. Sometimes infant feeding was not discussed with whānau until the mother encountered problems. Conclusion This research supports the assertion that whānau are central and that whānau could be mobilised to support healthy choices. Further research is needed to investigate fathers’ experience of maternity services to inform the development of health education materials to prepare partners for their role in supporting breastfeeding. Research should also seek to identify which healthcare policies undermine and minimise the role of the father and other whānau in pregnancy, birthing and infant care. Public health policies that encourage the delivery of health services to whānau in a culturally appropriate, accessible and effective way are important for promoting whānau ora (family health and well-being) and supporting Māori development.

Evaluating satisfaction with maternity care in women from minority ethnic communities: development and validation of a Sylheti questionnaire.

To develop a reliable and valid questionnaire to evaluate satisfaction with maternity care in Sylheti-speaking Bangladeshi women. Two-stage, psychometric study. Firstly, focus groups, in-depth interviews and iterative methods for translation and cultural adaptation were used to develop a Sylheti questionnaire, called the survey of Bangladeshi women's experience of maternity services from an English language questionnaire. Secondly, quantitative psychometric methods were used to field test and evaluate the acceptability, reliability and validity of this questionnaire. Four hospitals providing maternity services in London, UK. Two hundred and forty-two women from the London Bangladeshi communities, who were in the antenatal (at least 4 months pregnant) or postnatal phase (up to 6 months after delivery). Women spoke Sylheti; a language with no accepted written form. Two purposive samples of 40 women in the antenatal or postnatal phase, one convenience sample of six women in the antenatal phase and three consecutve samples of 60 women in the postnatal phase participated in stage one. In stage two, 135 women (main sample) completed the questionnaire two months after delivery (82% response rate); 50 women (retest sample) from the main sample completed a second questionnaire two weeks later (96% response rate). Women's views about maternity care elicited by qualitative methods and measured quantitatively using the survey of Bangladeshi women's experience of maternity services. The 121-item questionnaire was acceptable to women and showed good internal consistency (Cronbach's alphas 0.76-0.91), stability (test-retest reliability 0.72-0.84) and construct validity (e.g. able to detect group differences). By combining qualitative and quantitative methods, it is possible to adapt an instrument to provide an acceptable, reliable and valid Sylheti questionnaire. The approach taken in developing this questonnaire provides a model for developing outcome measures for use with other minority ethnic communities.

Developing consumer-led maternity services: a survey of women's views in a local healthcare setting.

OBJECTIVE: This paper describes a prospective study of women's views and experiences of maternity services. The aim was to examine the way women make choices and decisions about maternity care and the factors which influence decision making, with a view to developing services which best meet the needs of the population. Patient choice issues reviewed included: choice of place of birth, choice of lead professional and choices in labour management. DESIGN, SETTING AND PARTICIPANTS: A cohort of women attending maternity booking clinics, within the catchment area of Peterhead Maternity Unit (PMU) in north-east Scotland, were surveyed by means of postal questionnaires at three stages during their contact with maternity services. A subset of women also took part in in-depth interviews. RESULTS: Not all women were given information about all the available options for place of birth and many women were unclear of the differences between them. Factors influencing choice of place of birth can change, with the medical aspects of maternity care becoming more important as the pregnancy progresses. Women rated the importance of seeing the same staff at antenatal visits highly, but were less concerned with their ability to choose which professional to see. More importance was attached to being able to choose a particular midwife rather than a particular obstetrician. Women's choices with regard to labour management were largely met. Insufficient information, however, was provided about choices in pain relief. CONCLUSIONS: The survey revealed the importance of locally based research, involving all stakeholders, in developing services which best meet the needs of a population.

Identification of an ultrasonic attenuation heterogeneity in myocardium

maternal health inequalities exist across the world. In the United Kingdom, whilst there are variations within and between groups, Black and Minority Ethnic (BME) women tend to have worse maternal health outcomes than White British women. However, there is limited information about BME women׳s experience of maternity services. Midwives are central to the provision of safe maternity care but little is known about their perceptions of ethnically-based inequalities in maternal healthcare. Therefore, this study explored a cohort of midwives׳ experiences of providing care for BME women, focussing on their views on the relationship between maternal health inequalities and service delivery.using a specifically-designed topic guide, 20 semi-structured interviews were conducted with qualified midwives in one National Health Service (NHS) Trust in the North West of England over a two-month period. Data were subsequently transcribed and thematically analysed.three main and seven sub-themes were identified. Firstly, ‘language’ summarised difficulties midwives experienced in engaging with women whose English was limited. Secondly, ‘expectations of maternity care’ outlined the mismatch between midwives and women׳s expectations of maternity care. Finally, ‘complex needs extending beyond maternity care’ highlighted the necessity of inter-agency working to address women׳s care holistically when their needs transcend the scope of maternity services.Midwives׳ accounts indicated that they strive to provide equitable care but encountered numerous barriers in doing so. Paradoxically, this might contribute to inequalities in service delivery. In midwives׳ view, unrestricted access to interpretation and translation services is essential for provision of effective, holistic maternity care. Participants also advocated education for both women and midwives. For the former, this would improve BME women׳s understanding of health and care systems, potentially leading to more realistic expectations. Improving midwives׳ cultural competence would better equip them to respond to the needs of an ethnically diverse population. Finally, midwives highlighted that many minority women׳s complex care needs were identified during pregnancy. Hence, they regarded pregnancy as an ideal time for interventions to improve the health of women and their families and, as such, antenatal care cannot be treated as an isolated event. According to midwives in this study, delivering safe, effective maternity services in the 21st century requires greater collaboration with the women they care for and other health and care agencies (including independent sector providers).

Maternity consumer surveys

A package has been developed by OPCS to assist health authorities in undertaking consumer surveys of their maternity services. Included in the package is a pamphlet which has been produced by Joe Garcia, of the National Perinatal Epidemiology Unit, on behalf of the Department of Health entitled 'Getting Consumers’ Views of Maternity Care'. This pamphlet gives examples of how the OPCS survey manual can help. The survey manual is to assist district health authorities in monitoring the views of users of the maternity services, and describes how to carry out local surveys of women's experience of maternity services. Guidance is given on carrying out an antenatal survey and covers care received during pregnancy. The postnatal survey covers the care during pregnancy, childbirth and in the first few weeks after birth. The results of this survey should highlight the main areas of concern within the present maternity services system and may be used as a tool for those who wish to improve maternity care. However, it is important that those authorities which do survey mothers in their district have carefully thought out plans for evaluating services being provided and have a commitment to making changes in light of the findings.