Provision Of Maternal Services Research Articles

Public Health Delivery Systems and the Provision of Maternal and Child Health Preventive Services

Public Health Delivery Systems and the Provision of Maternal and Child Health Preventive Services

Education provision for the newborn physical examination as a post-registration module: National survey

Aims This study aimed to assess the scope of newborn infant physical examination (NIPE) education in post-registration midwifery education, determine the structure and requirements for midwives undertaking NIPE training, and explore similarities and differences in pre- and post-registration preparation requirements. Methods In early 2015, all lead midwives for education in the UK were sent a link to an online questionnaire to assess the scope and practice of NIPE education across all midwifery curricula. This is the second of a two-part report, focusing on post-registration education; part A examined the education provision for the inclusion of NIPE in the midwifery curriculum. Findings NIPE education for midwives is popular and is well established in the post-registration curriculum. Variations exist in the length, content, assessment, levels of study and credits awarded for post-registration NIPE modules. This lack of standardisation raises questions about quality assurance. Conclusion The variation in module length has implications for commissioners and self-funding students, as longer NIPE modules are more costly. There is a strong argument for a standardised NIPE programme across the UK and for providers of maternity services to fully utilise midwives who have been trained in NIPE to avoid them becoming de-skilled.

Implementation research on community health workers' provision of maternal and child health services in rural Liberia.

ObjectiveTo assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme.MethodsThe Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation.FindingsBetween 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly.ConclusionWe identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.

Reaching the unreached through trained and skilled birth attendants in Ethiopia: a cluster randomized controlled trial study protocol

BackgroundDespite improvements since 1990 to 2014, maternal mortality ratio (MMR) remains high in Ethiopia. One of the key drivers of maternal mortality in Ethiopia is the very low coverage of Skilled Birth attendance (SBA) in rural Ethiopia. This cluster randomized trial piloted an innovative approach of deploying trained community reproductive nurses (CORN) to hard to reach/unreachable rural Ethiopia to improve the coverage of SBA.MethodsWe used a three-arm cluster randomized trial to test the effect of deploying CORN in rural communities in South Ethiopia to improve SBA and other maternal health indicators. A total of 282 villages/clusters (94 from each arm) were randomly selected in the three districts of the zone for the study. The intervention was implemented in four consecutive phases that aimed at of provision of essential maternal, neonatal and child health (MNCH) services mainly focusing on SBA. The CORN were trained and deployed in health centres (arm 1) and in the community/health posts (arm2). A third arm (arm 3) consisting control villages without the intervention. A baseline and end line assessment was conducted to compare the difference in the proportion of SBA and other MNCH service uptake across the three arms Data was entered into computer, edited, cleaned, and analyzed using Epi-data statistical software. The presentation followed the Consolidated Standards of Reporting Trials (CONSORT) statement guidelines for cluster-randomized trials.DiscussionThis trial is designed to test the impact of an innovative and newly designed means of distribution for the national health extension program strategy with additional service package with no change to the target population. The focus is on effect of CORN in revitalizing the Health Extension Program (HEP) through improving SBA service uptake and other maternal health service uptake indicators. The study findings may guide national policy to strengthen and shape the already existing HEP that has certain limitations to improve maternal health indicators. The competency based training methodology could provide feedback for health science colleges to improve the national nursing or midwifery training curriculum.Trial registrationclinicaltrails.gov NCT02501252 dated on July 14, 2015.

Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso

Performance-based financing (PBF) programs are increasingly implemented in low and middle-income countries to improve health service quality and utilization. In April 2011, a PBF pilot program was launched in Boulsa, Leo and Titao districts in Burkina Faso with the objective of increasing the provision and quality of maternal health services. We evaluate the impact of this program using facility-level administrative data from the national health management information system (HMIS). Primary outcomes were the number of antenatal care visits, the proportion of antenatal care visits that occurred during the first trimester of pregnancy, the number of institutional deliveries and the number of postnatal care visits. To assess program impact we use a difference-in-differences approach, comparing changes in health service provision post-introduction with changes in matched comparison areas. All models were estimated using ordinary least squares (OLS) regression models with standard errors clustered at the facility level. On average, PBF facilities had 2.3 more antenatal care visits (95% CI [0.446–4.225]), 2.1 more deliveries (95% CI [0.034–4.069]) and 9.5 more postnatal care visits (95% CI [6.099, 12.903]) each month after the introduction of PBF. Compared to the service provision levels prior to the interventions, this implies a relative increase of 27.7 percent for ANC, of 9.2 percent for deliveries, and of 118.7 percent for postnatal care. Given the positive results observed during the pre-pilot period and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health.

Women\u2019s descriptions of childbirth trauma relating to care provider actions and interactions

BackgroundMany women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women’s experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes.MethodsAs part of a large mixed methods study, 748 women completed an online survey and answered the question ‘describe the birth trauma experience, and what you found traumatising’. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process.ResultsFour themes were identified in the data: ‘prioritising the care provider’s agenda’; ‘disregarding embodied knowledge’; ‘lies and threats’; and ‘violation’. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women’s own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider’s clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault.ConclusionCare provider actions and interactions can influence women’s experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

Predictors of Women's Satisfaction with Hospital-Based Intrapartum Care in Asmara Public Hospitals, Eritrea.

Background Exploring patient satisfaction contributes to provide quality maternity care, but there is paucity of epidemiologic data in Eritrea. Objectives To determine the predictors of women's satisfaction with intrapartum care in Asmara public maternity hospitals in Eritrea. Methods A cross-sectional study among 771 mothers who gave birth in three public Hospitals. Chi-square tests were done to analyze the difference in proportion and logistic regression to assess the predictors of satisfaction with intrapartum care. Results Overall, only 20.8% of the participants were satisfied with intrapartum service. The key predictors of satisfaction with intrapartum care were provision of clean bed and beddings (AOR = 18.87, 2.33–15.75), privacy during examinations (AOR = 10.22, 4.86–21.48), using understandable language (AOR = 8.72, 3.57–21.27), showing how to summon for help (AOR = 8.16, 4.30–15.48), showing baby immediately after birth (AOR = 8.14, 2.87–23.07), control of the delivery room (AOR = 6.86, 2.65–17.75), receiving back massage (AOR = 6.43, 3.23–12.81), toilet access and cleanliness (AOR = 6.09, 3.25–11.42), availability of chairs for relatives (AOR = 5.96, 3.14–11.30), allowing parents to stay during labour (AOR = 3.52, 1.299–9.56), and request for permission before any procedure (AOR = 2.39, 1.28–4.46). Conclusion To increase satisfaction with intrapartum care, maternity service providers need to address the general maternity ward cleanliness, improve the quality of physical facilities, and sensitize health providers for better communication with clients. Policy makers need to adopt strategies that ensure more women involvement in decision making and consideration of privacy and reassurance needs during the whole delivery process.

Maternity Care Services Provided by Family Physicians in Rural Hospitals

The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P < .001). In hospitals providing maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P < .001), the percentage of FPs who do cesarean deliveries (mean, 66%; range, 0-100%; P < .001), and the percentage of all physicians who provide maternity care who are FPs (mean, 63%; range, 10-88%; P < .001) varied widely by state. Most hospitals (83%) had no firm numbers of procedures required to obtain privileges. FPs continue to provide the majority of maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce.

The Provision of Clinical and Non-Clinical Maternal and Child Health Services: Does Public Health Joint Production Matter

The Provision of Clinical and Non-Clinical Maternal and Child Health Services: Does Public Health Joint Production Matter

Effect of Educational Nursing Program on Nurses’ Awareness About Cervical Cancer at Assiut Women's Health Hospital

Background: Worldwide, cervical cancer is the third most common type of cancer in women, it is claims the life of almost half a million women worldwide each year. Aim: To assess the effect of educational program on nurse’s awareness about cervical cancer. Subject and method: A quiz experimental study design was used in this study, the sample included all nurses working in the Assiut Women's Health Hospital, they were 66 nurse. Pre and post test done to evaluate nurse’s awareness about cervical cancer based on evaluation of nurses knowledge and attitude about cervical cancer .Results: The majority of the sample lived in rural area and had a diploma degree in nursing. The mean age of nurses were 29.3±9.6year, near to three-quarter of nurses had adequate knowledge about cervical cancer and more than two-thirds of them had positive attitude toward Pap smear as a screening test after implementation of the educational program, also it was observed a statistical significant relation for nurse’s knowledge in pre and post test. Conclusion: There was an improvement in nurses’ level of knowledge and their attitude become positive toward cervical cancer screening. Recommendations: Provide educational program about cervical cancer and its preventive measurements for nurse in all areas that provide maternity services.

Models of maternity care: evidence for midwifery continuity of care.

There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects. Non-randomised studies have shown benefits of midwifery continuity of care for specific groups, such as Aboriginal and Torres Strait Islander women. There are also benefits for midwives, including high levels of job satisfaction and less occupational burnout. Implementing midwifery continuity of care in public and private settings in Australia has been challenging, despite the evidence in its favour and government policy documents that support it. A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.

Quality in provision of maternity services: the missing link in health-care investments in LMICs?

Overall this important area of quality of care will clearly require more research to be fully understood. Better quality monitoring tools also need to be developed with a focus on labour and labour outcome prediction. Meanwhile to complement Kruk and colleagues’ research efforts smaller facilities need to be better equipped with both the requisite and trained human resources for health care as well as with other inputs that are essential to quality provision of EmONC services. (Excerpt) Copyright © The Author(s). Published by Elsevier Ltd. Open Access.

Seasonal variation and socio-demographic factors affecting child- birth in Zaria, north-western Nigeria

BACKGROUNDThe high maternal morbidity and mortality in developing countries can be linked to the skewed manpower distribution and inadequate planning and provision of maternal health services. An understanding of the seasonal variation and effect of social as well as demographic factors on monthly birth rates will help decision makers in the allocation of scarce human and material resources to coincide with periods of high childbirth rates.&#x0D; OBJECTIVESThis study was carried out to determine the frequency of monthly childbirth and factors that affect such variations.&#x0D; METHODSIt was a cross sectional retrospective study of delivery records at Ahmadu Bello University Teaching hospital, Zaria from January 2009 to December 2011. Data was collected manually and analysed using SPSS version 20.0&#x0D; RESULTSThere were a total of 5015 deliveries over the study period with a yearly average of 1670. Forty five percent (45%) of parturient were aged between 25 30 years while 46.3% of them were primiparous. A bimodal distribution of peak birth rate was observed in months of March to May, and September to October respectively. There was a significant association between parity and monthly variation of childbirth which was more for primiparous women (rs= 0.01, α &lt;0.05).&#x0D; CONCLUSIONThere was an observed increase in the birth rate around the rainy and harmattan seasons. This knowledge can aid planning of health manpower distribution in order to ensure adequate coverage around these periods.

Maternal morbidity and mortality from severe sepsis: a national cohort study.

ObjectivesTo describe the incidence, characteristics and risk factors for critical care admission with severe maternal sepsis in the UK.DesignNational cohort study.Setting198 critical care units in the UK.Participants646 pregnant and recently pregnant women who had severe sepsis within the first 24 hours of admission in 2008–2010.Primary and secondary outcome measuresSeptic shock, mortality.ResultsOf all maternal critical care admissions, 14.4% (n=646) had severe sepsis; 10.6% (n=474) had septic shock. The absolute risk of maternal critical care admission with severe sepsis was 4.1/10 000 maternities. Pneumonia/respiratory infection (irrespective of the H1N1 pandemic influenza strain) and genital tract infection were the most common sources of sepsis (40% and 24%, respectively). We identified a significant gradient in the risk of severe maternal sepsis associated with increasing deprivation (RR=6.5; 95% CI 4.9 to 8.5 most deprived compared with most affluent women). The absolute risk of mortality was 1.8/100 000 maternities. The most common source of infection among women who died was pneumonia/respiratory infection (41%). Known risk factors for morbidity supported by this study were: younger age, multiple gestation birth and caesarean section. Significant risk factors for mortality in unadjusted analysis were: age ≥35 years (unadjusted OR (uOR)=3.5; 95% CI 1.1 to 10.6), ≥3 organ system dysfunctions (uOR=12.7; 95% CI 2.9 to 55.1), respiratory dysfunction (uOR=6.5; 95% CI1.9 to 21.6), renal dysfunction (uOR=5.6; 95% CI 2.3 to 13.4) and haematological dysfunction (uOR=6.5; 95% CI 2.9 to 14.6).ConclusionsThis study suggests a need to improve timely recognition of severe respiratory tract and genital tract infection in the obstetric population. The social gradient associated with the risk of severe sepsis morbidity and mortality raises important questions regarding maternal health service provision and usage.

Maternity care and Human Rights: what do women think?

BackgroundA human rights approach to maternal health is considered as a useful framework in international efforts to reduce maternal mortality. Although fundamental human rights principles are incorporated into legal and medical frameworks, human rights have to be translated into measurable actions and outcomes. So far, their substantive applications remain unclear. The aim of this study is to explore women’s perspectives and experiences of maternal health services through a human rights perspective in Magu District, Tanzania.MethodsThis study is a qualitative exploration of perspectives and experiences of women regarding maternity services in government health facilities. The point of departure is a Human Rights perspective. A total of 36 semi-structured interviews were held with 17 women, between the age of 31 and 63, supplemented with one focus group discussion of a selection of the interviewed women, in three rural villages and the town centre in Magu District. Data analysis was performed using a coding scheme based on four human rights principles: dignity, autonomy, equality and safety.ResultsWomen’s experiences of maternal health services reflect several sub-standard care factors relating to violations of multiple human rights principles. Women were aware that substandard care was present and described a range of ways how the services could be delivered that would venerate human rights principles. Prominent themes included: ‘being treated well and equal’, ‘being respected’ and ‘being given the appropriate information and medical treatment’.ConclusionWomen in this rural Tanzanian setting are aware that their experiences of maternity care reflect violations of their basic rights and are able to voice what basic human rights principles mean to them as well as their desired applications in maternal health service provision.Electronic supplementary materialThe online version of this article (doi:10.1186/s12914-016-0091-1) contains supplementary material, which is available to authorized users.

Impact of Distance in the Provision of Maternal Health Care Services and Its Accountability in Murarai-II Block, Birbhum District

The maternal health issue was a part of the Millennium Development Goals (MDGs, Target-5). Now it has been incorporated into Target-3 of 17 points Sustainable Development Goal-2030, declared by the United Nations, 2015. In India, about 50% of newborn deaths can be reduced by taking good care of the mother during pregnancy, childbirth and postpartum period. This requires timely, well-equipped healthcare by trained providers, along with emergency transportation for referral obstetric emergency. Governments need to ensure physicians in the rural underserved areas. The utilisation of maternal healthcare services (MHCSs) depends on both the availability and accessibility of services along with accountability.This study is based on an empirical retrospective survey, also called a historic study, to evaluate the influences of distance on the provision of maternal health services and on its accountability in Murarai-II block, Birbhum District. The major objective of the study is to identify the influence of distance on the provision and accountability of the overall MHCSs. The investigation has found that there is a strong inverse relationship (-0.75) between accessibility index and accountability score with p-value = &lt;0.05, where the direct connectivity index seem to have no direct influence on the accountability score (as the ‘r’ is 0.56 and p-value= &gt;0.05). Tracking of pregnant women, identification of high risk pregnancy and timely Postnatal Care (PNC) have become the dominant factors of the maternal healthcare services in the first Principal Component Analysis (PCA), explaining 49.67% of the accountability system. Overall, institutional barriers to accessibility are identified as important constraints behind lesser accountability of the services, preventing the anticipated benefit. This study highlights the critical areas where maternal healthcare services are lacking. The analysis has highlighted the importance of physical access to health services in shaping the provision of maternal healthcare services.Drawing on empirical observations of operation of public distribution system in different states of India, the paper constructs a preliminary game theoretic model. It argues that an effective public distribution must be as universal as possible, delivery mechanism of fair price shops should be reformed, they should be make them commercially viable and that special attention should be paid to PDS at times of high food inflation.

A case study of community-based distribution and use of Misoprostol and Chlorhexidine in Sokoto State, Nigeria

ABSTRACTThe United States Agency for International Development/Targeted States High Impact Project supported Sokoto State, Nigeria government in the development of a community-based intervention aimed at preventing post-partum haemorrhage (PPH) and cord infection among women and children, respectively. This paper describes the innovative intervention within the Nigeria health delivery system. It then explains the case study approach to assessing this intervention and summarises findings. Ultimately, the intervention was received well in communities and both drugs were added to the procurement list of all health facilities providing maternity services in the State. Key factors leading to such success include early advocacy efforts at the state-level, broad stakeholder engagement in designing the distribution system, early community engagement about the value of the drugs and concerted efforts to monitor and ensure availability of the drugs. Implementation challenges occurred in some areas, including shortage of community-based health volunteers (CBHVs) and drug keepers, and socio-cultural barriers. To maximise and sustain the effectiveness of such interventions, state government needs to ensure constant drug supply and adequate human resources at the community level, enhance counselling and mobilisation efforts, establish effective quality improvement strategies and implement a strong M&E system.

Is partograph being correctly filled or just giving false security

Context : Retrospective study was carried out to answer whether or not the partographs that are used to monitor mothers in labour are recorded to the standard. A fuller understanding of this process will be important to educate further the personnel filling the partograph and also to make policies and strategies in the provision of maternity care services. Objectives : To determine whether the partographs are correctly being filled To find out which part of the partograph is not being properly filled. Methods : 100 case records of women delivered in Kasturba Hospital and monitored by partograph, were randomly selected from a period of January – May 2015 (20 records per month) and retrospectively studied by a team of 2 assessors. After defining inclusion and exclusion criteria, data was collected through a pre-tested and structured checklist which was developed, after reviewing literature relevant to the problem under study and standard protocols were defined to identify correctly filled partographs and substandard ones. Results : Overall 69 % of the partographs were correctly filled. Fetal heart rate was recorded up to the recommended standard in 78(78%) of the partographs reviewed. In 20 (20%) moulding of fetal head was not recorded at all. The status of membranes was recorded in 78 (78%). Cervical dilatation was recorded in 96 (96%) of the partographs however, 9(9%) of these records were substandard while it was not recorded in 4(4%). Uterine contraction was not recorded in 10 (10 %) while recorded to the standard in 71(71%). Descent of the presenting part was not recorded in 49(49%). 90 (90%) women had their blood pressure monitored. Post delivery baby notes were recorded in 96 (96%) of the partographs. Conclusion : The present study revealed significant proportions of substandard and unrecorded parameters of labour on the modified WHO partograph. This indicates poor documentation, and perhaps monitoring and supervision of labour. Lack and suboptimal documentation of some parameters of the progress of labour could hinder early detection of complications, important to prevent maternal and perinatal mortality and morbidity. Pre-service and periodic on-job training of health workers on the completion of the partograph, regular supportive supervision, provision of guidelines and mandatory health facility policy are recommended.

Standards for maternity care professionals attending planned upright breech births: A Delphi study

Objectiveto establish a consensus of opinion on standards of competence for professionals attending upright breech births. Designa three-round Delphi e-survey. Settingmultinational. Participantsa panel of 13 obstetricians, 13 midwives and two user representatives. Clinicians had attended >20 upright breech births, or >10 upright among >40 total breech births. Mean level of experience=135 breech births, median=100 breech births. Methodsan initial survey contained open-ended questions. Answers were coded and amalgamated to form 164 statements in the second round and 9 further statements in the third round. Panellists were asked to evaluate their agreement with each statement using a 5-point Likert scale. The pre-determined level of consensus was 70% of respondents indicating agreement or strong agreement with the statement. Findingsthe panel returned a consensus-level agreement on 63 statements under the theme, ‘Standards of Competence.’ Panellists supported teaching breech as a ‘normal’ skill rather than an emergency, including optimal mechanisms and breech-specific progress measures, upright variations of classical manoeuvres, the initiation of resuscitation with the umbilical cord intact, birth videos as learning tools, and the development of breech teams to support the wider team in all maternity care settings. Conclusionsalthough every health professional should maintain basic competence to assist unanticipated breech births, establishing enhanced training and standards for those who support planned breech births may help protect users and providers of maternity services, while introducing greater choice and flexibility for women seeking the option of vaginal breech birth.

'We are all scared for the baby': promoting access to dental services for refugee background women during pregnancy.

BackgroundVulnerable populations such as people with refugee backgrounds are at increased risk of poor oral health. Given that maternal characteristics play a significant role in the development of dental caries in children, antenatal care offers an opportunity to both provide information to women about the importance of maternal oral health and accessing dental care. Although pregnant women are recognised for ‘priority’ care under Victorian state-government policy, rarely do they attend. This study aims to describe Afghan and Sri Lankan women’s knowledge and beliefs surrounding maternal oral health, barriers to accessing dental care during pregnancy, and to present the perspectives of maternity and dental service providers in relation to dental care for pregnant women.MethodsOne agency comprising both dental and maternity services formed the setting for the study. Using participatory methods that included working with bicultural community workers, focus groups were conducted with Afghan and Sri Lankan refugee background participants. Focus groups were also completed with midwives and dental service staff. Thematic analysis was applied to analyse the qualitative data.ResultsFour community focus groups were conducted with a total of 14 Afghan women, eight Sri Lankan women, and three Sri Lankan men. Focus groups were also conducted with 19 dental staff including clinicians and administrative staff, and with ten midwives. Four main themes were identified: perceptions of dental care during pregnancy, navigating dental services, maternal oral health literacy and potential solutions. Key findings included women and men’s perception that dental treatment is unsafe during pregnancy, the lack of awareness amongst both the midwives and community members of the potential impact of poor maternal oral health and the overall lack of awareness and understanding of the ‘priority of access’ policy that entitles pregnant women to receive dental care cost-free.ConclusionThis study highlights a significant policy-to-practice gap which if not addressed has the potential to widen oral health inequalities across the life-course. Stakeholders were keen to collaborate and support action to improve the oral health of mothers and their infants with the over-riding priority being to develop inter-service relationships to promote seamless access to oral health care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0787-6) contains supplementary material, which is available to authorized users.