Care associated with stillbirth for the most disadvantaged women: A multi‐method study of care in England. Issue 3 (13th February 2018)

• Record Type: Journal Article
• Authors: Redshaw, Maggie; Henderson, Jane
• Is Part Of: Birth. Volume 45:Issue 3(2018)
• Page Start: 275
• Page End: 285
• Publication Date: 2018-02-13
• Subjects: disadvantage -- maternity care -- stillbirth; Childbirth -- Periodicals; Obstetrics -- Periodicals; Newborn infants -- Care -- Periodicals; Natural childbirth -- Periodicals; 618.1
• DOI: 10.1111/birt.12335
• Languages: English
• ISSNs: 0730-7659

Abstract

Abstract: Background: Most research on women experiencing stillbirth relies on online user group surveys or qualitative interviews. The objective of this study was to investigate the experience of women who are at a higher risk of stillbirth, living in areas of greatest deprivation, and are commonly not well represented. Methods: This study used birth and death registrations in 2012‐2013 to identify a sample of mothers whose babies had died as a result of stillbirth. These women were sent a survey 6‐9 months after the stillbirth. We undertook descriptive analysis of quantitative data and used binary logistic regression with the Index of Multiple Deprivation as a measure of disadvantage. We used thematic analysis to describe free text responses. Results: The survey response rate was 30% (N = 473). Ethnic minority, younger age, and single parenthood were associated with disadvantage. Women residents in the most deprived areas perceived care more negatively: during labor they were significantly less likely to be spoken to by medical staff so they could understand (73% compared with 90%, adjusted odds ratio [aOR] 0.33 [95% confidence interval {CI} 0.18‐0.65]), or treated with respect by midwives (79% compared with 90%, aOR 0.41 [95% CI 0.22‐0.77]). The qualitative themes identified were: "Difficulty in accessing care, " "More could have been done, " "Ineffective communication, " and "Cared for and not cared for" which support the quantitative findings. Conclusion: Women living in the most deprived areas reported poorer experiences of care compared with more advantaged women. All women need compassionate and sensitive care around the time of a stillbirth.