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Table 1 Population-based studies of women’s experiences of maternity care

From: Immigrant and non-immigrant women’s experiences of maternity care: a systematic and comparative review of studies in five countries

AUSTRALIA
Survey of Recent Mothers in Victoria 1989[4, 5]
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
Survey of Recent Mothers in Victoria 1994[6, 7]
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
Survey of Recent Mothers in Victoria 2000[810]
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
Maternity Experiences Survey (MES) 2006[11, 12]
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[1315]
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