Midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies: a qualitative study

Article

Chitongo, S., Pezaro, S., Fyle, J., Suthers, F. and Allan, H. 2022. Midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies: a qualitative study. Women and Birth. 35 (2), pp. 152-159. https://doi.org/10.1016/j.wombi.2021.05.005
TypeArticle
TitleMidwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies: a qualitative study
AuthorsChitongo, S., Pezaro, S., Fyle, J., Suthers, F. and Allan, H.
Abstract

Problem
Childbearing women from ethnic minority groups in the United Kingdom (UK) have significantly poorer perinatal outcomes overall.
Background
Childbearing women from ethnic minority groups report having poorer experiences and outcomes in perinatal care, and health professionals report having difficulty in providing effective care to them. Yet barriers in relation to providing such care remain underreported.
Aim
The aim of this study was to elicit midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies and how to overcome these barriers.
Methods
A qualitative study was undertaken in a single obstetric led unit in London, UK. A thematic analysis was undertaken to identify themes from the data.
Findings
A total of 20 midwives participated. They self-identified as White British (n=7), Black African (n=7), Black Caribbean (n=3) and Asian (n=3). Most (n=12) had more than 10 years’ experience practising as a registered midwife (range 2 – 35 years). Four themes were identified: 1) Communication, 2) Continuity of carer, 3) Policy and 4) Social determinants. Racism and unconscious bias underpin many of the findings presented.
Discussion
Co-created community hubs may improve access to more effective care for childbearing women from ethnic minority groups. A focus on robust anti-racism interventions, continuity of carer, staff wellbeing and education along with the provision of orientation and bespoke translation services are also suggested for the reduction of poorer outcomes and experiences.
Conclusion
Along with policies designed to promote equality and irradicate racism, there is a need for co-created community hubs and continuity of carer in perinatal services. Further research is also required to develop and evaluate culturally safe, and evidence-based interventions designed to address the current disparities apparent.

PublisherElsevier
JournalWomen and Birth
ISSN1871-5192
Electronic1878-1799
Publication dates
Online29 May 2021
Print14 Mar 2022
Publication process dates
Submitted22 Feb 2021
Accepted20 May 2021
Deposited01 Jun 2021
Output statusPublished
Accepted author manuscript
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Open
Copyright Statement

© 2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/

Digital Object Identifier (DOI)https://doi.org/10.1016/j.wombi.2021.05.005
Scopus EID2-s2.0-85107116234
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Magnusson, C., Allan, H., Horton, K., Johnson, M., Evans, K. and Ball, E. 2017. An analysis of delegation styles among newly qualified nurses. Nursing Standard. 31 (25), pp. 46-53. https://doi.org/10.7748/ns.2017.e9780
A qualitative study of advanced nurse practitioners’ use of physical assessment skills in the community: shifting skills across professional boundaries
Raleigh, M. and Allan, H. 2017. A qualitative study of advanced nurse practitioners’ use of physical assessment skills in the community: shifting skills across professional boundaries. Journal of Clinical Nursing. 26 (13-14), pp. 2025-2035. https://doi.org/10.1111/jocn.13613
Editorial: the anxiety of caring and the devaluing of nursing
Allan, H. 2017. Editorial: the anxiety of caring and the devaluing of nursing. Journal of Clinical Nursing. 26 (3-4), pp. 299-301. https://doi.org/10.1111/jocn.13380
Emergency management of the patient and resuscitation
Hernández-Padilla, J. and Suthers, F. 2016. Emergency management of the patient and resuscitation. in: Moore, T. and Cunningham, S. (ed.) Clinical skills for nursing practice London, United Kingdom Routledge. pp. 291-326
Development and psychometric evaluation of the basic electrocardiogram interpretation self-efficacy scale
Hernández-Padilla, J., Granero-Molina, J., Suthers, F., Füge, K., São Romão-Preto, L. and Fernández-Sola, C. 2016. Development and psychometric evaluation of the basic electrocardiogram interpretation self-efficacy scale. Resuscitation 2016, ERC Congress on Education. Reykjavik, Iceland 24 - 25 Sep 2016 Elsevier. pp. e12 https://doi.org/10.1016/j.resuscitation.2016.07.028
Editorial: Ethnocentrism and racism in nursing: reflections on the Brexit vote
Allan, H. 2017. Editorial: Ethnocentrism and racism in nursing: reflections on the Brexit vote. Journal of Clinical Nursing. 26 (9-10), pp. 1149-1151. https://doi.org/10.1111/jocn.13627
From transformative learning to social change? Using action research to explore and improve informal complaints management in an NHS trust
Odelius, A., Allan, H., Hunter, B., Bryan, K., Knibb, W. and Shawe, J. 2015. From transformative learning to social change? Using action research to explore and improve informal complaints management in an NHS trust. International Practice Development Journal. 5 (1).
Adherence to ‘pressure-relief’ regimen for pressure ulcer (PrU) prevention in spinal cord injury (SCI)
Liu, L., Chapman, S., Deegan, R., Allan, H., Traynor, M. and Gall, A. 2016. Adherence to ‘pressure-relief’ regimen for pressure ulcer (PrU) prevention in spinal cord injury (SCI). The 55th ISCoS Annual Scientific Meeting. Vienna, Austria 14 - 16 Sep 2016
Development and psychometric evaluation of the arterial puncture self-efficacy scale
Hernández-Padilla, J., Granero-Molina, J., Marquez-Hernández, V., Suthers, F. and Fernández-Sola, C. 2016. Development and psychometric evaluation of the arterial puncture self-efficacy scale. Nurse Education Today. 40, pp. 45-61. https://doi.org/10.1016/j.nedt.2016.02.008
Executive summary of the RESPONSE project (responding effectively to services users (patients and cares) and practitioners' (nurses and midwives) perspectives on care concerns: developing sustainable responses through educational action research
Allan, H., Shawe, J., Odelius, A., Knibb, W., Gallagher, A., Hunter, B. and Bryan, K. 2014. Executive summary of the RESPONSE project (responding effectively to services users (patients and cares) and practitioners' (nurses and midwives) perspectives on care concerns: developing sustainable responses through educational action research. University of Surrey.
An investigation into newly qualified nurse' ability to recontextualise knowledge to allow them to delegate and supervise care(AaRK)
Magnusson, C., Westwood, S., Ball, E., Curtis, K., Evans, K., Horton, K., Johnson, M. and Allan, H. 2014. An investigation into newly qualified nurse' ability to recontextualise knowledge to allow them to delegate and supervise care(AaRK). University of Surrey.
Understanding sociology in nursing
Allan, H., Traynor, M., Kelly, D. and Smith, P. 2016. Understanding sociology in nursing. London SAGE Publications.
New role raises questions
Traynor, M., Allan, H., Allan, H., Dyson, S., Corbett, K. and Centre for Criitcal Research in Nursing and Midwifery 2016. New role raises questions. Nursing Standard. 30 (29), pp. 26-27. https://doi.org/10.7748/ns.30.29.26.s25
Delegation and supervision of health care assistants’ work in the daily management of uncertainty and the unexpected in clinical practice: invisible learning among newly qualified nurses
Allan, H., Magnusson, C., Evans, K., Ball, E., Westwood, S., Curtis, K., Horton, K. and Johnson, M. 2016. Delegation and supervision of health care assistants’ work in the daily management of uncertainty and the unexpected in clinical practice: invisible learning among newly qualified nurses. Nursing Inquiry. 23 (4), pp. 377-385. https://doi.org/10.1111/nin.12155
Survey of the Commissioning Nurse Leaders’ Network membership 2015: summary of results
Allan, H. and O'Driscoll, M. 2016. Survey of the Commissioning Nurse Leaders’ Network membership 2015: summary of results. Middlesex University.
Are senior nurses on Clinical Commissioning Groups in England inadvertently supporting the devaluation of their profession?: A critical integrative review of the literature
Allan, H., Dixon, R., Lee, G., O'Driscoll, M., Savage, J. and Tapson, C. 2016. Are senior nurses on Clinical Commissioning Groups in England inadvertently supporting the devaluation of their profession?: A critical integrative review of the literature. Nursing Inquiry. 23 (2), pp. 178-187. https://doi.org/10.1111/nin.12129
Nurses’ experiences of clinical commissioning group boards
Allan, H., O'Driscoll, M., Savage, J., Lee, G. and Dixon, R. 2016. Nurses’ experiences of clinical commissioning group boards. Nursing Standard. 30 (42), pp. 46-55. https://doi.org/10.7748/ns.2016.e9633
An evaluation of the impact of ‘Compassion in practice: nursing, midwifery and care staff - our vision and strategy’ on staff experience in NHS Trusts in England.
Allan, H., O'Driscoll, M., Liu, L., Corbett, K. and Department of Adult, Child and Midwifery, School of Health and Education, Middlesex University 2015. An evaluation of the impact of ‘Compassion in practice: nursing, midwifery and care staff - our vision and strategy’ on staff experience in NHS Trusts in England. School of Health and Education, Middlesex University.
Non-European nurses’ perceived barriers to UK nurse registration
Allan, H. and Westwood, S. 2016. Non-European nurses’ perceived barriers to UK nurse registration. Nursing Standard. 30 (37), pp. 45-51. https://doi.org/10.7748/ns.30.37.45.s41
Managing infertility in primary care
Allan, H. and Mounce, G. 2015. Managing infertility in primary care. Practice Nursing. 26 (9), pp. 440-443. https://doi.org/10.12968/pnur.2015.26.9.440
Development and psychometric assessment of the basic resuscitation skills self-efficacy scale
Hernández-Padilla, J., Suthers, F., Fernández-Sola, C. and Granero-Molina, J. 2016. Development and psychometric assessment of the basic resuscitation skills self-efficacy scale. European Journal of Cardiovascular Nursing. 15 (3), pp. e10-e18. https://doi.org/10.1177/1474515114562130
English language skills requirements for internationally educated nurses working in the care industry: barriers to UK registration or institutionalised discrimination?
Allan, H. and Westwood, S. 2016. English language skills requirements for internationally educated nurses working in the care industry: barriers to UK registration or institutionalised discrimination? International Journal of Nursing Studies. 54, pp. 1-4. https://doi.org/10.1016/j.ijnurstu.2014.12.006
White British researchers and internationally educated research participants: insights from reflective practices on issues of language and culture in nursing contexts
Allan, H. and Westwood, S. 2015. White British researchers and internationally educated research participants: insights from reflective practices on issues of language and culture in nursing contexts. Journal of Research in Nursing. 20 (8), pp. 640-652. https://doi.org/10.1177/1744987115618236
Effects of two retraining strategies on nursing students' acquisition and retention of BLS/AED skills: a cluster randomised trial
Hernández-Padilla, J., Suthers, F., Granero-Molina, J. and Fernández-Sola, C. 2015. Effects of two retraining strategies on nursing students' acquisition and retention of BLS/AED skills: a cluster randomised trial. Resuscitation. 93, pp. 27-34. https://doi.org/10.1016/j.resuscitation.2015.05.008
Early intervention screening involves more than “simple” screening
Lee, H., Lu, Z., Allan, H., Yeh, M. and Chang, S. 2015. Early intervention screening involves more than “simple” screening. International Journal of Healthcare, Insurance and Equity. 2 (1).
Factors perceived to influence exercise adherence in women with breast cancer participating in an exercise programme during adjuvant chemotherapy: a focus group study
Husebø, A., Karlsen, B., Allan, H., Søreide, J. and Bru, E. 2015. Factors perceived to influence exercise adherence in women with breast cancer participating in an exercise programme during adjuvant chemotherapy: a focus group study. Journal of Clinical Nursing. 24 (3-4), pp. 500-510. https://doi.org/10.1111/jocn.12633
Exercise: a path to wellness during adjuvant chemotherapy for breast cancer?
Husebø, A., Allan, H., Karlsen, B., Soreide, J. and Bru, E. 2015. Exercise: a path to wellness during adjuvant chemotherapy for breast cancer? Cancer Nursing. 38 (5), pp. E13-E20. https://doi.org/10.1097/NCC.0000000000000205
People, liminal spaces and experience: Understanding recontextualisation of knowledge for newly qualified nurses
Allan, H., Magnusson, C., Horton, K., Evans, K., Ball, E., Curtis, K. and Johnson, M. 2015. People, liminal spaces and experience: Understanding recontextualisation of knowledge for newly qualified nurses. Nurse Education Today. 35 (2), pp. e78-e83. https://doi.org/10.1016/j.nedt.2014.10.018
'Doing the writing' and 'working in parallel': How 'distal nursing' affects delegation and supervision in the emerging role of the newly qualified nurse
Johnson, M., Magnusson, C., Allan, H., Evans, K., Ball, E., Horton, K., Curtis, K. and Westwood, S. 2015. 'Doing the writing' and 'working in parallel': How 'distal nursing' affects delegation and supervision in the emerging role of the newly qualified nurse. Nurse Education Today. 35 (2), pp. e29-e33. https://doi.org/10.1016/j.nedt.2014.11.020
Supporting staff to respond effectively to informal complaints: findings from an action research study
Allan, H., Odelius, A., Hunter, B., Bryan, K., Knibb, W., Shawe, J. and Gallagher, A. 2015. Supporting staff to respond effectively to informal complaints: findings from an action research study. Journal of Clinical Nursing. 24 (15-16), pp. 2106-2114. https://doi.org/10.1111/jocn.12770
Gatekeeping access to the midwifery unit: managing complaints by bending the rules
Allan, H., Odelius, A., Hunter, B., Bryan, K., Knibb, W. and Shawe, J. 2015. Gatekeeping access to the midwifery unit: managing complaints by bending the rules. Health. 19 (6), pp. 652-669. https://doi.org/10.1177/1363459314567791
Developing a robust tool: Advancing the multiple mini interview in pre-registration student midwife selection in a UK setting
Callwood, A., Cooke, D. and Allan, H. 2014. Developing a robust tool: Advancing the multiple mini interview in pre-registration student midwife selection in a UK setting. Nurse Education Today. 34 (12), pp. 1450-1454. https://doi.org/10.1016/j.nedt.2014.04.023
Learning from people with long-term conditions: new insights for governance in primary health care
Ross, F., Smith, P., Byng, R., Christian, S., Allan, H., Price, L. and Brearley, S. 2014. Learning from people with long-term conditions: new insights for governance in primary health care. Health and Social Care in the Community. 22 (4), pp. 405-416. https://doi.org/10.1111/hsc.12097
Cervical screening and the aftermath of childhood sexual abuse: are clinical staff trained to recognise and manage the effect this has on their patients?
Walker, J. and Allan, H. 2014. Cervical screening and the aftermath of childhood sexual abuse: are clinical staff trained to recognise and manage the effect this has on their patients? Journal of Clinical Nursing. 23 (13-14), pp. 1857-1865. https://doi.org/10.1111/jocn.12390
Teachers' views of using e-learning for non-traditional students in higher education across three disciplines [nursing, chemistry and management] at a time of massification and increased diversity in higher education
Allan, H., O'Driscoll, M., Simpson, V. and Shawe, J. 2013. Teachers' views of using e-learning for non-traditional students in higher education across three disciplines [nursing, chemistry and management] at a time of massification and increased diversity in higher education. Nurse Education Today. 33 (9), pp. 1068-1073. https://doi.org/10.1016/j.nedt.2012.04.003
Experiences of supernumerary status and the hidden curriculum in nursing: a new twist in the theory-practice gap?
Allan, H., Smith, P. and O'Driscoll, M. 2011. Experiences of supernumerary status and the hidden curriculum in nursing: a new twist in the theory-practice gap? Journal of Clinical Nursing. 20 (5-6), pp. 847-855. https://doi.org/10.1111/j.1365-2702.2010.03570.x