In the summer of 2018 Shortwork and 3Ps trained 15 women in participatory action research methods which they used to gather views on maternity services from families across North Central London.
Over five months the group engaged 179 participants, including 78 White / White British, 45 Black / Black British, 15 Asian / Asian British, 6 mixed heritage participants, and 21 from Other Ethnic Groups, in 20 participatory research sessions across 19 community venues in Barnet, Enfield, Haringey, Camden and Islington.
Many participants reported positive experiences of maternity care including:
- effective administration;
- quality facilities;
- good information and support in making choices over birth locations and options;
- continuity of care including access to the same midwife or small midwife team;
- postnatal support; and
- extra care for vulnerable and high-risk groups.
In particular, participants hugely appreciated staff who were both professional and caring, and who had a big impact on their experiences of pregnancy, birth and postnatal care. These included midwives and consultants who were experienced, strong and reassuring; friendly, kind and caring; patient and understanding; attentive but also respectful, good listeners and communicators.
The elements that made maternity care a negative experience for women and their families included:
- problems with administration such as accessing appointments and information;
- poor quality facilities;
- lack of resources and overstretched staff;
- poor information;
- lack of continuity of carer;
- lack of postnatal support; and
- lack of choice and empowerment.
Women were particularly impacted by staff who had a poor bedside manner, including those with poor social and communication skills; and those who lacked empathy and respect.
These issues were more likely to impact on black women and others from minority ethnic groups who reported that they had suffered poor treatment and discrimination. These included offensive stereotypes about a woman’s ability to bear the pain of labour and the number of children they would have; being ignored or not listened too; and a lack of support for women with language barriers.
Women felt that the care, or lack of care, they received had caused them additional and unnecessary pain, discomfort and complications, and that they had gone on to experience negative feelings and poor mental health as a result.
A number of recommendations were suggested. These included:
- improvements to administration and facilities;
- better and more accessible information provided in a variety of forms about pregnancy, birth, labour and looking after a newborn;
- access to the same midwife, or group of midwifes throughout;
- greater post-natal support including a longer stay in hospital, support for birth partners to stay overnight, and signposting to community support in the months following birth;
- access to interpreters, diversity training for professionals, and peer group support.
The importance of receiving friendly and professional treatment from staff is a central finding, which, as one participant put it, ‘shouldn’t be based on luck.’ Being treated like a fellow human being, with respect and compassion was seen to be the main way that services could be more tailored to the individual, and crucial to giving women real choice and agency during pregnancy and birth. Participants stressed that these skills could be learnt, and that more training should be provided for professionals to develop a better bedside manner.
The group of researchers have continued to work on participatory research projects, and are currently working on a project focused on the needs and perspective of black and minority ethnic women in particular. They have also developed a training pack and marketing campaign on the importance of good communication skills and empathy and the impact it has on women and their families for NHS staff.
The short version of the report can be downloaded below.