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

Rayment-Jones, H; Harris, J; Harden, A; Khan, Z; Sandall, J

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

Rayment-Jones, H

Harris, J

Harden, A Khan, Z Sandall, J

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Publication Type:: Journal Article
Citation:: Birth, 2019, 46 (3), pp. 461 - 474
Issue Date:: 2019-01-01

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Field	Value	Language
dc.contributor.author	Rayment-Jones, H https://orcid.org/0000-0002-3027-8025	en_US
dc.contributor.author	Harris, J https://orcid.org/0000-0001-7631-3757	en_US
dc.contributor.author	Harden, A	en_US
dc.contributor.author	Khan, Z	en_US
dc.contributor.author	Sandall, J https://orcid.org/0000-0003-2000-743X	en_US
dc.date.available	2019-07-08	en_US
dc.date.issued	2019-01-01	en_US
dc.identifier.citation	Birth, 2019, 46 (3), pp. 461 - 474	en_US
dc.identifier.issn	0730-7659	en_US
dc.identifier.uri	http://hdl.handle.net/10453/135738
dc.description.abstract	© 2019 The Authors. Birth published by Wiley Periodicals, Inc. 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.	en_US
dc.relation.ispartof	Birth	en_US
dc.relation.isbasedon	10.1111/birt.12446	en_US
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	Obstetrics & Reproductive Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Postnatal Care	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Social Isolation	en_US
dc.subject.mesh	Parents	en_US
dc.subject.mesh	Professional-Family Relations	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Qualitative Research	en_US
dc.subject.mesh	Socioeconomic Factors	en_US
dc.subject.mesh	Infant, Newborn	en_US
dc.subject.mesh	Maternal Health Services	en_US
dc.subject.mesh	Health Services Accessibility	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Stillbirth	en_US
dc.subject.mesh	Perinatal Death	en_US
dc.subject.mesh	United Kingdom	en_US
dc.title	How do women with social risk factors experience United Kingdom maternity care? A realist synthesis	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	46	en_US
utslib.for	1114 Paediatrics and Reproductive Medicine	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	open_access	*
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	46	en_US

Abstract:

© 2019 The Authors. Birth published by Wiley Periodicals, Inc. 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.

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http://hdl.handle.net/10453/135738