Pregnancy as an ideal time for intervention to address the complex needs of black and minority ethnic women: Views of British midwives

Aquino, Maria Raisa Jessica; Edge, Dawn; Smith, Debbie

doi:10.1016/j.midw.2014.11.006

Cited by 33 publications

(38 citation statements)

References 13 publications

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“…Similarly, women's own unmet expectations regarding antenatal care were also seen to inhibit the creation of a good midwife–woman relationship. These findings are supported by the existing literature, which suggests that migrant women who have limited knowledge of UK maternity care often expect care similar to that provided in their country of origin, and can therefore become dissatisfied with care which differs from these expectations …”

Section: Discussionsupporting

confidence: 79%

“…Whilst accountability is arguably applicable in all cases where care decisions are shared with women themselves, midwives may feel more concern about decisions regarding practices they are unfamiliar with, compared to more familiar decisions made by UK‐born women. This may explain research findings which suggest that midwives describe their job and relationships with women as more demanding, difficult and stressful when working with migrant women . Consequently, these findings suggest that more needs to be done to address midwives' concerns around the safety of unfamiliar practices, for example having standardized evidence‐based information on such practices available to give to women.…”

Section: Discussionmentioning

confidence: 99%

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The midwife–woman relationship in a South Wales community: Experiences of midwives and migrant Pakistani women in early pregnancy

Goodwin

Hunter

Jones

2017

Health Expectations

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BackgroundIn 2015, 27.5% of births in England and Wales were to mothers born outside of the UK. Compared to their White British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. Existing literature highlights the importance of midwife–woman relationships in care satisfaction and pregnancy outcomes; however, little research has explored midwife–woman relationships for migrant and minority ethnic women in the UK.MethodsA focused ethnography was conducted in South Wales, UK, including semi‐structured interviews with 9 migrant Pakistani participants and 11 practising midwives, fieldwork in the local migrant Pakistani community and local maternity services, observations of antenatal appointments, and reviews of relevant media. Thematic data analysis was undertaken concurrently with data collection.FindingsThe midwife–woman relationship was important for participants' experiences of care. Numerous social and ecological factors influenced this relationship, including family relationships, culture and religion, differing health‐care systems, authoritative knowledge and communication of information. Marked differences were seen between midwives and women in the perceived importance of these factors.ConclusionsFindings provide new theoretical insights into the complex factors contributing to the health‐care expectations of pregnant migrant Pakistani women in the UK. These findings may be used to create meaningful dialogue between women and midwives, encourage women's involvement in decisions about their health care and facilitate future midwifery education and research. Conclusions are relevant to a broad international audience, as achieving better outcomes for migrant and ethnic minority communities is of global concern.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

The midwife–woman relationship in a South Wales community: Experiences of midwives and migrant Pakistani women in early pregnancy

Goodwin

Hunter

Jones

2017

Health Expectations

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“…The many barriers that exist for both women and health care providers affect the successful initiation of behavioural change during pregnancy [ 44 ]. Midwives describe pregnancy as an ideal time for interventions concerning health among pregnant women, and say that they require support and better cooperation with other healthcare professionals to be able to carry forward greater collaboration with the women they care for [ 55 ]. Person-centred care in pregnancy is sparsely studied, and the extent to which person-centred care may improve health outcomes and satisfaction with care in this population needs further research [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

Mighty Mums – a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity

et al. 2018

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BackgroundObesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes.MethodsThe intervention was performed in a city in Sweden 2011–2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790).ResultsIn the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG < 7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (− 0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population.ConclusionPregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting.Trial registrationThe study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. May 10 2017, retrospectively registered.

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“…An inductive data-driven thematic analysis has been utilised for this study as it provides a theoretically flexible approach, capable of providing detailed accounts and exploring patterned meaning across the whole data set (Braun & Clarke, 2006). Thematic analysis has been used extensively across health and wellbeing research (Braun, Clarke, & Terry, 2014) and is particularly relevant to applied research settings, such as midwifery (Aquino, Edge, & Smith, 2015). This paper reports data collected with midwives delivering antenatal care from two antenatal care services in Liverpool (England, UK) and Ulster (Northern Ireland, UK).…”

Section: Methodsmentioning

confidence: 99%

A qualitative study exploring midwives' perceptions and knowledge of maternal obesity: Reflecting on their experiences of providing healthy eating and weight management advice to pregnant women

McCann

Newson

Burden

et al. 2017

Maternal & Child Nutrition

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Midwives are responsible for providing advice regarding the complex issues of healthy eating and weight management during pregnancy. This study utilised an inductive data-driven thematic approach in order to determine midwives' perceptions, knowledge, and experiences of providing healthy eating and weight management advice to pregnant women. Semistructured interviews with 17 midwives were transcribed verbatim and data subjected to thematic analysis. The findings offer insight into the challenges facing midwives in their role trying to promote healthy eating and appropriate weight management to pregnant women. Three core themes were identified: (a) "If they eat healthily it will bring their weight down": Midwives Misunderstood; (b) "I don't think we are experienced enough": Midwives Lack Resources and Expertise; and (c) "BMI of 32 wouldn't bother me": Midwives Normalised Obesity. The midwives recognised the importance of providing healthy eating advice to pregnant women and the health risks associated with poor diet and obesity. However, they reported the normalisation of obesity in pregnant women and suggested that this, together with their high workload and lack of expertise, explained the reasons why systematic advice was not in standard antenatal care. In addition, the current lack of UK clinical guidance, and thus, possibly lack of clinical leadership are also preventing delivery of tailored advice. Implementation literature on understanding the barriers to optimal health care delivery and informing clinical practice through research evidence needs to be further investigated in this field. This study has recommendations for policy makers, commissioners, service providers, and midwives.

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Pregnancy as an ideal time for intervention to address the complex needs of black and minority ethnic women: Views of British midwives

Cited by 33 publications

References 13 publications

The midwife–woman relationship in a South Wales community: Experiences of midwives and migrant Pakistani women in early pregnancy

The midwife–woman relationship in a South Wales community: Experiences of midwives and migrant Pakistani women in early pregnancy

Mighty Mums – a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity

A qualitative study exploring midwives' perceptions and knowledge of maternal obesity: Reflecting on their experiences of providing healthy eating and weight management advice to pregnant women

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