Title: Exploring relationships between patient experience and ethnicity in the maternity healthcare setting

Authors – Nur Khan, Melissa Whitten

Objective: Background In the UK, there is a four-fold increase in maternal mortality in Black women and two-fold increase in Asian women. Reports of poor management, dismissal of concerns and maltreatment of BAME women has been prevalent in the media. This study aimed to explore the relationship between decision-making during pregnancy and birth, patient birthing experience and ethnicity in a central London teaching hospital.

 

Design: A mixed methods study conducted as part of service evaluation work within a central London maternity service.

 

Method: A paper-based survey including quantitative and qualitative questions was distributed to women on the postnatal ward during March-May 2022 using an opportunity sampling approach. Likert scale responses were analysed using SPSS (Mann-Whitney U-test; Kruskal-Wallis test for non-parametric data). A thematic analysis was undertaken using an inductive approach for free text questions.

 

Results: 100 responses were received, with respondents from across BAME and Non-BAME groups (White (50%), Other (20%), South Asian (50%) and Black (11%)). A statistically significant difference (p<0.05) between BAME and Non-BAME groups was identified for questions relating to feeling included in decision-making during pregnancy and during birth, and in having had a positive birthing experience. A statistically significant difference was found across non-parametric pairwise comparisons of ethnic groups; White-Asian and Black-White, for feeling included in decision-making during pregnancy.

 

Thematic analysis revealed both positive and negative birthing experiences. A number of common themes were identified across respondent groups around communication between HCPs and women, the importance of inclusion in decision making and a desire for accountability when experiences had been negative. Subthemes identified relating to communication included some instances of perceived rudeness or coldness, juxtaposed against more positive examples of kindness and caring approaches to support throughout the maternity pathway.

 

Conclusion: There are multi-factorial reasons for disparities in clinical outcomes relating to maternal health, including pre-existing co-morbidities, but also implicit bias. HCPs should be aware of the potential for inequalities of care and outcome specific to ethnic minorities, and informed about platforms to voice concerns around any inequality of care given. This study has identified areas where the local maternity service can focus efforts to help reduce any inequalities of care and enhance both patient experience and potentially clinical outcomes for all women using the service.