Women with learning disability have equal rights to maternity care that meets their needs, but many have poor pregnancy and birth outcomes compared to other women in the UK.
NPEU researchers Reem Malouf, Jenny McLeish, Ron Gray and Maggie Redshaw, with Sara Ryan of Oxford University’s Department of Primary Care, carried out an in-depth qualitative study to explore the maternity experiences of nine mothers with learning disability.
The mothers were very conscious of feeling different from other mothers. Most were pleased with their maternity care and liked their midwives, but some had been denied opportunities to make informed choices, or encountered disrespectful staff attitudes. Their experiences of communicating with professionals were also mixed: some described midwives taking time to explain things that the mothers found confusing, while others had encountered midwives who gave the impression that they were too busy to communicate effectively. The mothers were aware that to succeed as parents they needed to have good support from family or professionals, and several who had been well supported were flourishing. Others described the stress of having their parenting ability formally assessed immediately after birth, and their distress and guilt when they were not allowed to care for their babies.
The aim of this review was to investigate the existing evidence regarding specialist preterm clinics for women who are at risk of preterm birth. Reem Malouf and Maggie Redshaw found eleven studies which looked at the effect of the clinic with regards to preterm birth and other important outcomes.
The evidence from the five randomised controlled trials showed that there was no significant difference between care at a specialist clinic and standard care for most of the neonatal outcomes. However, these studies were conducted before 1990 and the intervention was limited to increasing the number of antenatal visits in addition to educating the women about signs and symptoms of preterm labour. In contrast, the five most recent cohort studies in which new tests are used such as the foetal Fibronectin screening test (fFN), showed some positive neonatal outcomes.
In this review we only found one qualitative study where women expressed their anxiety about being labelled as high-risk of preterm birth and being reassured about interventions and treatments received in the clinic. In this study, women reported that their partners were struggling to cope emotionally. Further clarification is necessary on the optimal referral and standardized management plan in the clinic.
Pregnancy and the postnatal period are times when women may be vulnerable to poor mental health. It is UK policy that all women are asked about their mental health and wellbeing early in pregnancy and following the birth to help detect potential problems. This study analysed data from a national maternity survey in 2014 to find out which women are asked about their mood and mental health during pregnancy and postnatally, and about offer and uptake of treatment.
Maggie Redshaw and Jane Henderson found that most women recalled being asked about their mental health in pregnancy and in the postnatal period. However, those women most likely to be in need of support and treatment were least likely to be offered it and may be at risk of serious adverse outcomes.
There have been many changes in maternity care policy and practice over the last 20 years and women’s experience and satisfaction with care have become more important over this period. This study used secondary analysis of data collected in four postal surveys of maternity care experiences in 1995, 2006, 2010 and 2014 to see how women's experiences have changed. Jane Henderson and Maggie Redshaw found that, in the antenatal period, an increasing proportion of women had early first contact with a healthcare professional, screening for Down’s syndrome, both dating and anomaly scans, and the total number of ultrasound scans increased over the period. Rates of intervention during labour and birth have increased and women were less likely to be cared for by a known midwife. In the postnatal period, length of hospital stay declined over time but the proportion of women who considered their length of stay too short remained constant. The number of postnatal home visits also declined and there was a substantial increase in the proportion of women who would have liked more visits. Overall satisfaction with care remained high especially for care during pregnancy, labour and birth.