Survey of women׳s experiences of care in a new freestanding midwifery unit in an inner city area of London, England: 2. Specific aspects of care

Objective to describe and compare women׳s experiences of specific aspects of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area. Design telephone surveys undertaken in late pregnancy and about six weeks after birth. Two separate waves of interviews were conducted, Phase 1 before the birth centre opened and Phase 2 after it had opened. Setting Tower Hamlets, a deprived inner city borough in east London, 2007–2010. Participants 620 women who were resident in Tower Hamlets and who satisfied the Barts and the London Trust’s eligibility criteria for using the birth centre. Of these, 259 women were recruited to Phase 1 and 361 to Phase 2. Measurements and findings the replies women gave show marked differences between the model of care in the birth centre and that at the obstetric unit at the Royal London Hospital with respect to experiences of care and specific practices. Women who initially booked for birth centre care were more likely to attend antenatal classes and find them useful and were less likely to be induced. Women who started labour care at the birth centre in spontaneous labour were more likely to use non-pharmacological methods of pain relief, most notably water and less likely to use pethidine than women who started care at the hospital. They were more likely to be able to move around in labour and less likely to have their membranes ruptured or have continuous CTG. They were more likely to be told to push spontaneously when they needed to rather than under directed pushing and more likely to report that they had been able to choose their position for birth and deliver in places other than the bed, in contrast to the situation at the hospital. The majority of women who had a spontaneous onset of labour delivered vaginally, with 28.6 per cent of women at the birth centre but no one at the hospital delivering in water. Primiparous women who delivered at the birth centre were less likely to have an episiotomy. Most women who delivered at the birth centre reported that they had chosen whether or not to have a physiological third stage, whereas a worrying proportion at the hospital reported that they had not had a choice. A higher proportion of women at the birth centre reported skin to skin contact with their baby in the first two hours after birth. Key conclusions and implications for practice significant differences were reported between the hospital and the birth centre in practices and information given to the women, with lower rates of intervention, more choice and significant differences in women’s experiences. This case study of a single inner-city freestanding midwifery unit, linked to the Birthplace in England Research Programme, indicates that this model of care also leads to greater choice and a better experience for women who opted for it

Racial differences in the association between partner abuse and barriers to prenatal health care among asian and native Hawaiian/other Pacific Islander women

Objectives Prenatal health care (PNC) is associated with positive maternal and infant health outcomes. There is limited knowledge regarding Native Hawaiians/Other Pacific Islanders (NHOPI) and Asian women’s access to PNC especially among those with partner abuse (PA) experience. The objectives of this paper were to (1) describe and examine factors associated with PNC access barriers among mothers, by race; and, (2) determine the association between PA and PNC access, by race. Methods We analyzed 2004–2007 data from Hawai‘i’s Pregnancy Risk Assessment Monitoring System (n = 7,158). The outcome is ≥1 experience with a PNC access barrier. PA is experience with physical violence from a partner. Descriptive statistics, and bivariate and multivariate logistic regression analyses stratified by race were conducted. Results The respondents included 35.7% NHOPI, 37.4% Asian, 20.1% White and 6.6% Other. More than 6% experienced PA, and 25.9% reported ≥1 PNC access barrier. Experience with PA was significantly associated with NHOPI and Asians reporting ≥1 barrier to accessing PNC, but was non-significant with Whites. Conclusions Programs should address barriers to accessing PNC, and target NHOPI and Asian mothers with PA experience to reduce the healthcare disparity and improve quality of life