Table 1 Population-based studies of women’s experiences of maternity care
AUSTRALIA | ||
|---|---|---|
n=790, including 92 immigrant women from non-English speaking (NES) countries | ||
Postal survey, one week of births. | ||
Overall: 88% rated antenatal care as very good/good, 67% said care in labour and birth was managed as they liked. | ||
NES-immigrant women: 72% rated antenatal care as very good/good | ||
n=1336; including 142 immigrant women from non-English speaking (NES) countries. | ||
Postal survey, two weeks of births. | ||
Overall: 63% rated antenatal care as very good, 71% for care in labour and birth, and 52% for postnatal hospital care. | ||
NES-immigrant women: 45% rated antenatal care as very good, 42% for care in labour and birth, and 40% for postnatal hospital care | ||
n=1616; including 164 immigrant women from non-English speaking (NES) countries | ||
Postal survey, two weeks of births. | ||
Overall: 67% rated antenatal care as very good, 72% for care in labour and birth, and 51% for postnatal hospital care. | ||
NES-immigrant women: 49% rated antenatal care as very good, 55% for care in labour and birth, and 40% for postnatal hospital care | ||
Overall findings about what women want: all three surveys | Key findings for immigrant women: all three surveys | Conclusions and key recommendations: all three surveys |
Adequate information and explanations, concerns addressed | Immigrant women were under-represented in all three surveys, nevertheless: | Access to information, good relationships with caregivers and involvement in decision making were critical to enhancing women’s positive ratings of their care |
Active say in decisions about care | ||
Caregivers being helpful, not rushed, sensitive, kind and understanding | What immigrant women wanted was very similar to the overall findings, including: good explanations, an active say in decisions, helpful, kind caregivers and support with infant care after birth | Recommendations include: |
Knowing caregivers (eg knowing midwife before labour, birth centres, own doctor; knowing midwives on postnatal ward) | Women born overseas in non-English speaking countries were less positive about their maternity care than women born in Australia or than women born overseas in English speaking countries | Greater focus on continuity of care provision, improving staff communication and listening skills and more woman-centred, individualised care |
Receiving helpful, consistent and supportive advice about infant feeding and care | ||
CANADA | ||
n=6421; including 470 recent immigrants. | ||
Computer Assisted Telephone Interviews (CATIs) in French, English and 13 community languages. Sample drawn from Canadian Census. | ||
Overall: 54% rated their overall experience of labour and birth as “very positive”; | ||
79% felt they were shown respect; and 73% were happy with their participation in decision-making. | ||
Overall findings about what women want | Key findings for immigrant women | Conclusions and key recommendations |
Little data about factors contributing to satisfaction with care and what women wanted and valued. | Despite interviews conducted in English, French and 13 community languages, women reporting a first language other than English or French, were under-represented. | Recommendations not specifically focused on potential improvements to care based on women’s experiences. Rather recommendations focused on the need for more education for caregivers and women about evidence-based care practices (eg need to reduce the extent of routine use of electronic fetal monitoring and episiotomy, and supine position for birth). |
Women with a midwife as the primary birth attendant and those with no interventions in labour were more satisfied with care. | 17% of recent immigrant women reported not receiving care in a language they could understand. | |
Half the women thought having the same care provider for pregnancy, labour and birth was important. | No differences reported between groups (i.e., recent immigrants, non-recent immigrants, and Canadian-born women) in their satisfaction with the compassion, competence, privacy, or respect demonstrated by their health care provider or their own involvement in decision-making during the entire pregnancy, labour and birth, and immediate postpartum period [9]. | For immigrant women, recommendations focused on the need for education about improving health behaviors such as pre-conception use of folic acid, screening for postpartum depression, improving access to health care providers in the postpartum period, and removing language barriers to seeking care. |
SWEDEN | ||
National cohort study of women’s experiences of childbirth (KUB) 1999-2000[13–15] | ||
n=2746; 266 immigrant women | ||
Postal survey | ||
Overall: 53% very positive about intrapartum care and 35% about postpartum care | ||
Overall findings about what women want | Key findings for immigrant women | Conclusions and key recommendations |
Caregivers who provide adequate support and information, with enough time to answer questions and give help; and who are friendly, non-judgemental and respectful | Non-Swedish speaking women were excluded, nevertheless: women born outside Sweden were somewhat less happy with their care than Swedish-born women: | Authors recommend midwives support patients in a professional and caring manner, asking women about their needs for information and offering individualised care. |
Continuity of care: small numbers of care providers preferred Attention paid to partners’ needs | Acknowledgement that non-Swedish speaking women were excluded, thus those foreign-born women recruited were likely to be more integrated into Swedish society. | |
Pre-birth visits to labour ward | ||
UNITED KINGDOM | ||
First class delivery: A national survey of women’s views of maternity care 1995[16] | ||
n=2406; numbers of immigrant women not reported | ||
Postal survey | ||
Recorded delivery: A national survey of women’s experiences of maternity care[17] 2006 | ||
n=2966; 229 black and ethnic minority women born outside UK | ||
Postal survey | ||
Overall: 48% very satisfied with antenatal care; 56% with care for labor and birth; and 39% with postnatal care | ||
Towards Better Births: a survey of recent mothers 2007[18] | ||
n=26,325; numbers of immigrant women not reported | ||
Postal survey, sample drawn from NHS Trusts in England | ||
Overall: 68% rated antenatal care as excellent or very good; 75% for care in labor and birth; and 69% for postnatal care | ||
Delivered with care: a national survey of women’s experiences of maternity care 2012[19] | ||
n=5,333; 1,152 immigrant women | ||
Postal or online survey:4,945 postal respondents; 407 online respondents | ||
Overall: 88% very satisfied or satisfied with antenatal care; 87% with care for labor and birth; 76% with postnatal care | ||
Overall findings about what women want: all four surveys | Key findings for immigrant women: two surveys | Conclusions and key recommendations: all four surveys |
Being treated as an individual, with personalised care | Analyses for women born outside the UK are only available for the 2006 and 2010 surveys, for black and minority ethnic (BME) groups: | Recommendations focused on the need for: |
Caregivers who are supportive, kind, sensitive, and not rushed | Individualised care for a diverse childbearing population | |
Care from a small number of staff; knowing the midwives involved in care | Women in these groups were - | Women to be given more choice about place of birth and care provider |
Feeling involved in decisions about care and having choices about care options | Less likely to feel spoken to with respect and understanding, and in a way they could understand | More information and opportunity for discussion about care and more involvement for women in decision-making. |
Not being left alone in labour | Less likely to feel they had options in care or adequate information | |
Being listened to, and spoken to in a way that is understandable | Less likely to describe care providers positively (eg as kind, informative, supportive, sensitive, considerate) | |
Being given information and explanations when needed | Less likely to be satisfied with care | |
USA | ||
‘Listening to Mothers’: First national US survey of women’s childbearing experiences[20, 21] 2002 | ||
n=1583 (1447 online surveys; 136 telephone interviews); numbers of immigrant women not reported | ||
Overall: For labour and birth, 85-90% reported doctors/midwives and nurses as supportive, understanding and informative, BUT 25% found doctors/midwives rushed and >25% gave less than the highest rating for: information given in a way they could understand; | ||
Listening to Mothers II’: Second national US survey of women’s childbearing experiences[22, 23] 2005 | ||
n=1573 (1373 online surveys; 200 telephone interviews); numbers of immigrant women not reported | ||
Care for labour and birth from doctors rated as ‘excellent’ by 71% of women; from midwives and nursing staff by 68% | ||
35% rated the maternity care system as ‘excellent’; 47% as ‘good’; 16% as ‘fair’ or ‘poor’ | ||
‘Listening to Mothers III’: Third national US survey of women’s childbearing experiences[24] | ||
n=2400; 167 immigrant women | ||
Online survey | ||
Overall: 80% of women reported their care providers to be ‘completely’ or ‘very trustworthy’ in relation to information about pregnancy and birth | ||
30% of women said they didn’t ask a question at least once because their care provider seemed rushed | ||
15% reported that their care provider had used words they did not understand ‘always’ or ‘usually’ | ||
36% rated the maternity care system as ‘excellent’; 47% as ‘good’; 17% as ‘fair’ or ‘poor’ | ||
Overall findings about what women want: all three surveys | Key findings for immigrant women | Conclusions and key recommendations: all three surveys |
Being treated with kindness and understanding | No findings have been reported in any of the surveys to date specifically comparing immigrant and non-immigrant women | Key recommendations for care improvements include: |
Supportive, unrushed care | Better access for women to effective, safe and appropriate maternity care | |
Feeling comfortable to ask questions | Improved education of women about their rights to truly informed choice, with full and clear explanations about all aspects of care | |
Receiving information they needed | Active involvement of women in decision-making | |
Full and clear explanations understanding what was done and why | ||
Involvement in decision-making about care | ||
Non–discriminatory care | ||
Intervention (only) when needed | ||