How do women with social risk factors experience United Kingdom maternity care? A realist synthesis

Abstract

Background Echoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care. Methods Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0). Results Three themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships. Conclusions The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes.

Living With Fear: Experiences of Danish Parents in Vulnerable Positions During Pregnancy and in the Postnatal Period

“…This mirrors how being in the target group of a supportive intervention may clash with the recipient’s self-image (Jakobsen & Overgaard, 2018; Kirkpatrick, 2007). This finding should be seen in the context of studies documenting common experiences of being judged or discriminated against among pregnant women in vulnerable positions (Downe et al, 2009; Landy et al, 2009; Origlia et al, 2017; Rayment-Jones et al, 2019). As argued by Goffman (2009), stigmatization involves the negative labeling of individuals who deviate from normal standards in society.…”

Project20: Does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study

“…The hospital environment has long been associated with increased stress, waiting times, unfamiliarity, fragmentation and impersonal care [30,[90][91][92]. When the stressful effects of the hospital environment are compounded by paternalistic care, a lack of choice and perceived stigma and discrimination often described by Black and minority ethnic women and those with social risk factors [28,30,93], poor outcomes and experiences can be exacerbated.…”

An Exploration of Black, Asian and Minority Ethnic Women’s Perceptions of Public Health Messages to Reduce Stillbirth in the UK: a Qualitative Study.

“…In addition to engaging community groups, the importance of receiving consistent health messages from a trusted health professional was also identified in our study. Continuity of care, which can support and facilitate a trusting and respectful relationship, has been shown to have a positive impact on perinatal outcomes (20,21).…”