National Health Service Maternity Research Articles

Birth Afterthoughts: Accessible to Global Majority Mothers?

This paper describes preparatory steps taken in planning a quality improvement (QI) project in a National Health Service maternity unit on the south coast of England. A questionnaire (see Appendix A) was used as a pilot, data to be shared in a future publication. It was used to understand the reach of the service and feelings about fear and trauma in general and gather ideas for improvement. The tiny number of women from non-white backgrounds making use of the service is out of proportion with local population data. Lessons we have learned in the process are also shared.

The OBS UK Dashboard: an interactive tool for representative trial site selection to facilitate equality and diversity in maternity research

BackgroundObstetric Bleeding Study UK (OBS UK) (award ID: 152057) is a National Institute for Health and Care Research (NIHR)-funded stepped wedge cluster randomised controlled trial of a complex intervention for postpartum haemorrhage. This was developed in Wales and evaluated in a feasibility study, with improvements in maternal outcomes observed. Generalisability of the findings is limited by lack of control data and limited ethnic diversity in the Welsh obstetric patient population compared to the United Kingdom (UK): 94% of the Welsh population identifies as White, versus 82% in the UK. Non-White ethnicity and socioeconomic deprivation are linked to increased risk of adverse maternal outcomes. Traditionally, decisions regarding site selection are based on desire to complete trials on target in ‘tried and tested’ research active institutions. To ensure widespread applicability of the results and investigate the impact of ethnicity and social deprivation on trial outcomes, maternity units were recruited that represent the ethnic diversity and social deprivation profiles of the UK.MethodUsing routinely collected, publicly available data, an interactive dashboard was developed that demonstrates the demographics of the population served by each maternity unit in the UK, to inform site recruitment. Data on births per year, ethnic and socioeconomic group of the population for each maternity unit, across the UK, were integrated into the dashboard.ResultsThe dashboard demonstrates that OBS UK trial sites reflect the ethnic and socioeconomic diversity of the UK (study vs UK population ethnicity: White 79.2% vs 81.7%, Asian 10.5% vs 9.3%, Black 4.7% vs 4.0%, Mixed 2.5% vs 2.9%, Other 3.0% vs 2.1%) with variation in site demography, size and location. Missing data varied across sites and nations and is presented.ConclusionThe NIHR equality, diversity and inclusion strategy states studies must widen participation, facilitating individuals from all backgrounds to engage. The development of this novel interactive dashboard demonstrates an innovative way of achieving this. National Health Service (NHS) maternity researchers should consider using this tool to enhance diversity in research, address health disparities and improve generalisability of findings. This approach could be applied to healthcare settings beyond maternity care and across different global populations.Trial registrationISRCTN 17679951. Registered on August 30, 2023.

Reading for refusal in UK maternity care: entangling struggles for border and reproductive justice

Research has shown that women with insecure immigration statuses in the United Kingdom (UK) are more likely to register later in their pregnancy with National Health Service (NHS) maternity care providers. This late engagement with healthcare services is framed in academic debates as one of the key reasons for poor outcomes for these women and their children during and after birth. Interventions, therefore, have focused on how to remove barriers to accessing maternity care for these women. In this paper, we argue that this approach fails to account for the agency of the women adequately, which needs to be understood in the context of state harms and violence towards women with insecure immigration statuses and, in particular, their reproductive lives. We seek to shift these debates by framing this lack of early engagement with state-provided maternity services as a form of refusal that denotes an active disengagement by bordered women from intersecting structures of harm and oppression that are embedded in the UK’s National Health Service, particularly through the charging regime. We argue that the politics of refusal in this case are embedded in struggles not only for border but also reproductive justice. Drawing on participant observation and data from secondary sources, we illustrate how refusal of early antenatal care opens pathways for bordered women to seek the care-ful conditions they need and want during pregnancy.

Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010–2023

BackgroundLarge-scale improvement programmes are a frequent response to quality and safety problems in health systems globally, but have mixed impact. The extent to which they meet criteria for programme quality,...

Provision of interpreting support for cross-cultural communication in UK maternity services: A Freedom of Information request

BackgroundLanguage, communication and understanding of information are central to safe, ethical and efficient maternity care. The National Health Service (NHS) commissioning board, NHS England, describes how healthcare providers should obtain language support through professionally trained interpreters. Providers of interpreters are commissioned to deliver remote/face to face interpretation across the NHS. Services can be booked in advance or calls can be made in real time. However, women report infrequent use of professionally trained interpreters during their maternity care, often relying on friends and family as interpreters which can compromise confidentiality, disclosure and accuracy. MethodsTo determine the demand for, and provision of, professionally trained interpreters in practice, we sent a Freedom of Information (FOI) request to 119 NHS Trusts delivering maternity services in England in November 2022. For the financial years 2020/2021 and 2021/2022, we asked how many women in the maternity service were identified as needing an interpreter, the number and mode of interpreter sessions, and the annual spend on interpreting services. Data were analysed using descriptive statistics. ResultsOne hundred maternity Trusts responded by 21st April 2023 (response rate 100/119–84 %). Of these, 56 (56 %) recorded a woman's need for an interpreter. Nineteen Trusts relied on documentation in paper notes and 37 Trusts recorded the information on a digital system. From the 37 Trusts where this information could be digitally retrieved, women requiring interpreter support reflected between 1 and 25 % of the annual birth rate of the Trust (average 9 %) and received an average of three interpreter sessions across their pregnancy, birth and postnatal journey. Telephone was the dominant mode used for interpreting sessions, though 11 Trusts favoured face to face interpreting. Financial spend on interpreting services varied across Trusts; some funded their own in-house interpreting services, or worked with local community groups in addition to their contracted interpreting provider. ConclusionInformation obtained from this FOI request suggests that documentation of a woman's interpreting need is not complete or consistent across NHS maternity services. As a result, it is not clear how many women require an interpreter, the mode of provision or how frequently it is provided, and the cost involved. However, the limited information available suggests a failure to provide interpreter support to women at each scheduled care encounter. This raises questions about, the risk of women not understanding the care being offered, and the increased risk of uninformed, unconsented care as women traverse pregnancy and birth. TweetableThere appears to be failure to provide interpreter support to women at each scheduled maternity care encounter increasing the risk of uninformed, unconsented care.

Risk of low birthweight and late antenatal care initiation in an ethnically diverse maternal cohort

Abstract Background Babies born with low birthweight (LBW,< 2500 g) are vulnerable to infant mortality, restricted growth, poorer development, and long-term health complications. Antenatal care (ANC) can improve maternal and infant outcomes; women are recommended to have first antenatal visit by 10 weeks’ gestation. Ethnic minority women are significantly more likely to initiate ANC later than recommended gestational week compared to white women. This study examined associations between late ANC initiation (first appointment >10 weeks gestation) and LBW in an ethnically diverse maternal cohort in the UK. Methods A retrospective cross sectional study using routinely collected anonymous data of singleton births during April 2015 - October 2022 from a large UK National Health Service maternity unit in an ethnically diverse area. Logistic regression models were used to examine associations between late ANC initiation and prevalence of low (<2500 g); very low (VLBW, <1500 g) and extremely low (ELBW, <1000g) birth weight. Results Of 39,785 singleton births recorded, more than one third (34.6%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds. Birthweight was reported for 39,698 (99.78%) neonates; among them 8.9% had LBW, including 1.0% VLBW and 1.1% ELBW. More than one third (34.8%) of mothers had first appointment at > 10 weeks, including 26% during 11-19 weeks and 8.8% at > 20 weeks. Late ANC initiation was associated with increased risk of LBW for neonates: OR = 1.15 [95% CI: 1.07, 1.23] and 1.60 [1.44, 1.78] for ANC initiation at > 10 weeks and ≥20 weeks respectively (vs ≤ 10 weeks). Mothers who started care at ≥ 20 weeks were 5.37 times (95% CI: 4.31, 6.70) more likely to have a baby born with ELBW (vs ≤ 10 weeks). Conclusions Neonates born to mothers who started antenatal care late in ethnically diverse neighborhoods are more likely to have low birthweight, highlighting the need for targeted primary and secondary interventions. Key messages • Neonates born to mothers who started antenatal care late in ethnically diverse neighborhoods are more likely to have low birthweight. • Targeted programmes and services are needed to support mothers in ethnically diverse neighborhoods to start antenatal care on time.

UK midwives' perceptions and experiences of using Facebook to provide perinatal support: Results of an exploratory online survey.

Seeking support from Facebook groups during pregnancy is now widespread and social media has been widely used by the United Kingdom National Health Service (NHS) maternity services to communicate with service users during the COVID-19 pandemic. Despite this, little is currently known about midwives' attitudes towards, and experiences of social media in practice. Research is needed to understand barriers and solutions to meeting mothers' expectations of online support and to improve services. This study explored midwife involvement in Facebook groups, exploring experiences and perceptions of its use to communicate with and support mothers. An online survey consisting of open and closed questions was completed by 719 midwives and student during August- September 2020. Quantitative questionnaire data was analysed descriptively using SPSS v26. Qualitative data gathered from free text responses was analysed using reflexive thematic analysis. Few participants were involved in providing Facebook support, and most of these were unpaid. There was a consensus on a range of benefits for mothers, but widespread concern that engaging with mothers online was a personal and professional risk, underpinned by a lack of support. Experience of being involved in midwife moderation increased belief in its benefits and reduced fear of engaging online, despite a lack of renumeration and resources. Midwives and students felt they were discouraged from offering Facebook support and sought further training, guidance and support. Although limited, experiences of providing Facebook group support are positive. Perceptions of risk and a lack of support are significant barriers to midwives' involvement in using Facebook groups to support mothers. Midwives seek support and training to safely and effectively engage with mothers using Facebook. Engaging with mothers via social media is embedded in UK national policy and NHS digital strategy, and progress is needed to fulfil these, to improve services and meet mothers' expectations. Midwives' experiences suggest extending opportunities to provide Facebook support would benefit midwives, services and families. Consultation to revise local policy to support midwives and students in line with strategic goals is recommended.

A longitudinal qualitative study of women’s experiences of postnatal care following hypertensive disorders of pregnancy

ProblemThere has been little focus on women’s views of care and recovery following pregnancy complicated by hypertensive disorders of pregnancy [HDP] despite long-term implications for maternal health. BackgroundIncreasingly in clinical research, areas of interest include the extent to which women are involved in postnatal care planning, perceived value of routine postnatal contacts, lifestyle behaviour advice, and extent to which ongoing concerns about HDP could be discussed with healthcare professionals. AimThis study explored women’s experiences of birth-recovery up to 12 months following HDP. MethodsA longitudinal qualitative study using semi-structured interviews at four and 12 months postpartum. Twenty-four women who each had a form of HDP, were recruited using a maximum variation, purposive sampling strategy from four National Health Service maternity units in London, 21 of whom were interviewed at both time points. Data were collected and analysed by timepoint following a recurrent, cross-sectional cohort approach using template analysis methodology. FindingsFour main themes and ten sub-themes were identified. Main themes included: assumptions about blood pressure; perinatal experiences; postnatal care pathways; and managing complex health conditions. DiscussionPostnatal care needs to be tailored to women’s individual needs following HDP, with ongoing review by relevant clinicians during and beyond the first six weeks. Many women with HDP have ongoing information needs about hypertensive status, treatment and prognoses, and future birth planning. ConclusionPolicy makers, health providers and funders cannot continue to ignore the need to ensure postnatal services meet the needs of women who have experienced medically complex pregnancies.

Stories for Change:The impact of Public Narrative on the co-production process.

Involving service users in health service design and delivery is considered important to improve the quality of healthcare because it ensures that the delivery of healthcare is adapted to the needs of the users. Co-production is a process used to involve service users, but multiple papers have highlighted the need for the mechanisms and values guiding co-production to be more clearly stated. The aim of this paper was to evaluate the mechanisms and values that guided the co-production approach of the Stories for Change project, which used Public Narrative as part of the co-design process to create change in National Health Service maternity services. This study was conducted using a rapid feedback evaluation approach. Semistructured interviews (n = 16) were the main source of data, six of which were maternity service users, with observations (5 h) and documentary analysis also carried out in parallel. RREAL sheets were used for data analysis to organize data based on key topics of interest. This study identified three broad mechanisms and values underpinning the co-production approach: creating an open and safe space to share ideas, learning how to tell stories using Public Narrativeand having service providers who play a key role in strengthening the health system listen to stories compelling them to action. This study identified the main areas for improvement of the Stories for Change project related to recruitment, the inclusion of participants, the co-design process, the Skills Sessionand the Learning Event. Our study provided a deeper understanding of the co-production approach that addresses the need to uncover the mechanism and values underlying co-production and co-design approaches. This study expands on the literature pertaining to the influence of storytelling in creating meaningful change in health care. We propose a co-design methodology that uses Public Narrative as a model for service user engagement to help inform future healthcare development processes. The experiences and perceptions of maternity service users and health professionals informed this evaluation. The project organizers were involved in the manuscript preparation stage by providing feedback, and service users wrote a commentary on the project from the lived experience perspective.

Role of ethnicity in high-level obstetric clinical incidents: a review of cases from a large UK NHS maternity unit

IntroductionWomen from ethnic minority groups are at more risk of adverse outcomes in pregnancy compared with those from white British groups; suboptimal care may contribute to this increased risk. This...

Spatial analysis of the association between area deprivation and neonatal outcomes in an ethnically diverse maternal cohort in England: a retrospective cross-sectional study

BackgroundMaternal socioeconomic disadvantage and ethnic minority status are linked to increased risk of adverse neonatal outcomes. Neighbourhoods are structural and contextual conditions in which babies are born, but associations between area deprivation and neonatal outcomes in ethnically diverse areas are seldom examined. We examined spatial variations in neonatal outcomes using area deprivation at small-area levels in an ethnically diverse maternal cohort in the east of England. MethodsThis was a retrospective cross-sectional study using routinely collected anonymous data of singleton births between April 1, 2015, and Feb 28, 2022, in a UK National Health Service maternity unit. Primary outcomes were low birthweight (ie, under 2500g) and preterm birth (ie, before 37 weeks of gestation). We did geospatial analyses of maternal residence postcode areas to understand associations between primary outcomes and area deprivation based on 2019 Indices of Multiple Deprivation using generalised linear regression, optimised hotspot, and spatial autocorrelation (Global Moran's I) in ArcGIS Pro 3.0.2. FindingsOf 36 359 singleton births, 12 491 (34·4%) were to mothers from Black Caribbean, Black African, Indian, Pakistani, or Bangladeshi backgrounds. The prevalence of low birthweight (3319 [9·1%] of 36 359) and preterm birth (3147 [8·7%] of 36 359) was higher than the national average (6·8% and 7·4%, respectively). Low birthweight varied across Indices of Multiple Deprivation deciles, from 4 (3·9%) of 103 in the least deprived areas to 48 (10·5%) of 456 in the most deprived areas, with significant clustering in the most deprived areas (Moran's I 0·061; p<0·0001). Mean birthweight differed by 228g between the least (3402g) and most (3174g) deprived areas. An inverse linear association between birthweight and area deprivation was evident (R2 0·18). Preterm birth varied from 7 (6·8%) of 103 in the least deprived areas to 45 (9·9%) of 456 in the most deprived areas, but showed no significant association with area deprivation (R2 0·06). InterpretationNeonates born to mothers in the most deprived areas of ethnically diverse neighbourhoods are more likely to have adverse outcomes, particularly low birthweight, highlighting the need for targeted primary and secondary interventions. Spatial analysis of routine data can be used to examine health inequalities at the small-area level to inform spatially targeted resources. FundingWellbeing of Women, in partnership with the Burdett Trust for Nursing (grant reference RG2245).

Late antenatal care initiation and neonatal outcomes in an ethnically diverse maternal cohort

Abstract Background Ethnic minority status and maternal socio-economic deprivation are linked to delayed access to health care during pregnancy. The link between late antenatal care initiation and neonatal outcomes in settings with high ethnic diversity and social disadvantage is seldom explored. This study examined associations between late antenatal care initiation (first antenatal appointment &amp;gt;12 weeks gestation) and neonatal outcomes of preterm birth (&amp;lt;37 weeks gestation) and low birth weight (&amp;lt;2500 g) in an ethnically diverse socially disadvantaged maternal cohort. Methods A retrospective cross sectional study using routinely collected anonymous data of singleton births between April 2007 - March 2016 from a large UK National Health Service maternity unit in an ethnically diverse, socially disadvantaged area. Univariate and multivariate logistic regression models were used to examine the associations between late antenatal care initiation and prevalence of preterm birth and low birth weight. Results Of the 46,307 singleton births recorded, more than one third (34.8%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi mothers. Gestational week at first antenatal appointment was available for 99.31% births among which 79.2% had their first appointment at ≤ 12 weeks, 12% at 13-20 weeks, and 8.8% at &amp;gt; 20 weeks. Mothers who booked at 13+ weeks were significantly more likely to have a preterm and/or low birth weight baby. Compared to mothers who booked at ≤ 12 weeks, those booking at &amp;gt; 20 weeks were 4.08 times (95% CI: 3.29,5.07) as likely to have an extremely preterm baby (&amp;lt;28 weeks of gestation) and 3.12 (CI 2.66, 3.67) times as likely to have a baby born with extremely low birthweight (&amp;lt;1500g). Conclusions Mothers in ethnically diverse socially deprived areas who started antenatal care late were at increased risk of adverse neonatal outcomes. Targeted intervention programmes and services are needed to support these mothers. Key messages

A case study on the use of Public Narrative as a leadership development approach for Patient Leaders in the English National Health Service.

BackgroundIn 2016 the National Health Service (NHS) England embraced the commitment to work for maternity services to become safer, more personalized, kinder, professional and more family-friendly. Achieving this involves including a service users' organizations to co-lead and deliver the services. This article explores how Public Narrative, a framework for leadership development used across geographical and cultural settings worldwide, can enhance the confidence, capability and skills of service-user representatives (or Patient Leaders) in the National Health Service (NHS) in England. Specifically, we analyse a pilot initiative conducted with one cohort of Patient Leaders, the Chairs of local Maternity Voices Partnerships (MVPs), and how they have used Public Narrative to enhance their effectiveness in leading transformation in maternity services as part of the NHS Maternity Transformation Programme.MethodsQualitative two-phase case study of a pilot training and coaching initiative using Public Narrative with a cohort of MVP Chairs. Phase 1 consisted of a 6-month period, during which the standard framework was adapted in co-design with the MVP Chairs. A core MVP Chair Co-Design Group underwent initial training and follow-up coaching in Public Narrative. Phase 2 consisted of qualitative data collection and data analysis.ResultsThe study of this pilot initiative suggests two main ways in which Public Narrative can enhance the effectiveness of Patient Leaders in service improvement in general and maternity services in specific. First, training and coaching in the Public Narrative framework enables Patient Leaders to gain insight into, articulate and then craft their lived experience of healthcare services in a way that connects with and activates the underlying values of others (“shared purpose”), such that those experiences become an emotional resource on which Patient Leaders can draw to influence future service design and decision-making processes. Second, Public Narrative provides a simple and compelling structure through which Patient Leaders can enhance their skills, confidence and capability as “healthcare leaders,” both individually and collectively.ConclusionsThe Public Narrative framework can significantly enhance the confidence, capability and skills of Patient Leaders, both to identify and coalesce around shared purpose and to advance genuine co-production in the design and improvement of healthcare services in general and maternity services in specific.

O66 - Evaluation of the implementation of the Birmingham Symptom-specific Obstetric Triage System (BSOTS) in an Australian maternity service

Obstetric triage is usually undertaken by a midwife and involves identifying the woman’s presenting problem and conducting physiological and vital signs assessment. Triage of a pregnant woman poses challenges, as the physiological changes associated with pregnancy do not match the general parameters of standard emergency department triage measures. For these reasons, the Birmingham Symptom-specific Obstetric Triage System (BSOTS) was developed to standardise triage within maternity care. The BSOTS is currently being rolled out in all National Health Service maternity hospitals in the United Kingdom, however our site is the first in Australia to trial this approach. The aim of the study was to evaluate the implementation of the BSOTS in an Australian tertiary maternity service. A mixed-methods approach including surveys, focus groups, and retrospective data audit was undertaken. Participants included midwives and doctors who worked in the Maternity Assessment Centre (MAC) and women who had attended the MAC during the BSOTS implementation. Key outcome measures included: • knowledge and confidence in using BSOTS following the pre-implementation education • time to triage and time to treatment for women in accordance with the BSOTS prioritisation of care • staff experiences and satisfaction of the BSOTS implementation • women’s satisfaction of triage following the BSOTS implementation The findings showed that staff valued the BSOTS standardised approach to maternity triage. The clinical audit showed that women’s time to triage and treatment times were generally being achieved within auditable standards. Almost all women were satisfied with their experience of triage. Lack of knowledge amongst staff (especially medical staff) regarding the approach was perceived to be a barrier to effective implementation. The implementation of the BSOTS demonstrates an innovative midwife led practice change. The BSOTS is applicable to the Australian context, benefiting women, midwives, and the maternity service.

Novel device for assisted vaginal birth: using integrated qualitative case study methodology to optimise Odon Device use within a feasibility study in a maternity unit in the Southwest of England

ObjectiveWhen novel devices are used ‘in human’ for the first time, their optimal use is uncertain because clinicians only have experience from preclinical studies. This study aimed to investigate factors...

Women’s experiences of the Odon Device to assist vaginal birth and participation in intrapartum research: a qualitative study in a maternity unit in the Southwest of England

ObjectiveTo investigate women’s experiences of having a birth assisted by the Odon Device (an innovative device for assisted vaginal birth) and participation in intrapartum research.DesignQualitative semistructured interviews and observations undertaken...

OASI2: a cluster randomised hybrid evaluation of strategies for sustainable implementation of the Obstetric Anal Sphincter Injury Care Bundle in maternity units in Great Britain.

BackgroundThe Obstetric Anal Sphincter Injury (OASI) Care Bundle comprises four primary and secondary prevention practices that target the rising rates of severe perineal tearing during childbirth, which can have severe debilitating consequences for women. The OASI Care Bundle was implemented in 16 maternity units in Britain in the OASI1 project (2017-2018), which demonstrated the care bundle’s effectiveness in reducing OASI rates. In OASI2, the care bundle will be scaled up to 20 additional National Health Service (NHS) maternity units in a hybrid effectiveness-implementation study that will examine the effectiveness of strategies used to introduce, implement and sustain the care bundle.MethodsOASI2 is a two-arm cluster-randomised control trial (C-RCT) of maternity units in England, Scotland and Wales, with an additional non-randomised study arm. C-RCT arm 1 (peer support, n = 10 units) will be supported by ‘buddy’ units to implement the OASI Care Bundle. C-RCT arm 2 (lean implementation, n = 10 units) will implement without external support. The additional study arm (sustainability, n = 10 units) will include some original OASI1 units to evaluate the care bundle’s sustainability and OASI rates over time, from before OASI1 and through the end of OASI2. Units in all three study arms will receive an Implementation Toolkit with training resources and implementation support. The C-RCT arms will be compared in terms of OASI rate reduction (primary effectiveness outcome) and clinicians’ adoption of the care bundle (primary implementation outcome). Clinical data will be collated from maternity information systems; implementation data will be collected through validated surveys with women and clinicians, supplemented by qualitative methods. Descriptive statistics and regression modelling will be used for analysis. Emergent themes from the qualitative data will be assessed using framework analysis.DiscussionOASI2 will study the impact of various implementation strategies used to introduce and sustain the OASI Care Bundle, and how these strategies affect the bundle’s clinical effectiveness. The study will generate insights into how to effectively scale-up and sustain uptake and coverage of similar interventions in maternity units. A locally adaptable ‘implementation blueprint’ will be produced to inform development of future guidelines to prevent perineal trauma.Trial registrationISRCTN26523605

Establishing the safety of waterbirth for mothers and babies: a cohort study with nested qualitative component: the protocol for the POOL study

IntroductionApproximately 60 000 (9/100) infants are born into water annually in the UK and this is likely to increase. Case reports identified infants with water inhalation or sepsis following birth...

Cohort profile: the eLIXIR Partnership—a maternity–child data linkage for life course research in South London, UK

PurposeLinked maternity, neonatal and maternal mental health records were created to support research into the early life origins of physical and mental health, in mothers and children. The Early Life...

A qualitative study of healthcare professionals\u2019 experiences of providing maternity care for Muslim women in the UK

BackgroundA growing Muslim population in the UK suggests the need for healthcare professionals (HCPs) to gain a better understanding of how the Islamic faith influences health related perceptions and healthcare seeking behaviour. Although some researchers have explored the experiences of Muslim women as recipients of healthcare, little attention has been paid to the challenges HCPs face as service providers on a day-to-day basis whilst caring for Muslim women. The aim of this study was to investigate HPCs lived experiences of providing maternity care for Muslim women.MethodData was collected through twelve semi-structured one-to-one qualitative interviews with HCPs in a large National Health Service (NHS) maternity unit located in the North West of England. Interview participants included Community and specialist clinic (e.g. clinic for non-English speakers), Midwives in a variety of specialist roles (7), Gynaecology Nurses (2), Breastfeeding Support Workers (2) and a Sonographer (1). The audio-recorded interviews were transcribed and analysed thematically.ResultsThe majority of participants expressed an understanding of some religious values and practices related to Muslim women, such as fasting the month of Ramadhan and that pregnant and breastfeeding women are exempt from this. However, HCPs articulated the challenges they faced when dealing with certain religious values and practices, and how they tried to respond to Muslim women’s specific needs. Emerging themes included: 1) HCPs perceptions about Muslim women; 2) HCPs understanding and awareness of religious practices; 3) HCPs approaches in addressing and supporting Muslim women’s religious needs; 4) Importance of training in providing culturally and religiously appropriate woman-centred care.ConclusionThrough this study we gained insight into the day-to-day experiences of HCPs providing care provision for Muslim women. HCPs showed an understanding of the importance of religious and cultural practices in addressing the needs of Muslim women as part of their role as maternity care providers. However, they also identified a need to develop training programmes that focus on cultural and religious practices and their impact on women’s health care needs. This will help support HCPs in overcoming the challenges faced when dealing with needs of women from different backgrounds.