title: Pregnancy as an ideal time for intervention to address the complex needs of black and minority ethnic women: views of British midwives.
abstract: BACKGROUND
  maternal health inequalities exist across the world. In the United Kingdom, whilst there are variations within and between groups, Black and Minority Ethnic (BME) women tend to have worse maternal health outcomes than White British women. However, there is limited information about BME women's experience of maternity services. Midwives are central to the provision of safe maternity care but little is known about their perceptions of ethnically-based inequalities in maternal healthcare. Therefore, this study explored a cohort of midwives' experiences of providing care for BME women, focussing on their views on the relationship between maternal health inequalities and service delivery.
  
  
  METHODS
  using a specifically-designed topic guide, 20 semi-structured interviews were conducted with qualified midwives in one National Health Service (NHS) Trust in the North West of England over a two-month period. Data were subsequently transcribed and thematically analysed.
  
  
  RESULTS
  three main and seven sub-themes were identified. Firstly, 'language' summarised difficulties midwives experienced in engaging with women whose English was limited. Secondly, 'expectations of maternity care' outlined the mismatch between midwives and women's expectations of maternity care. Finally, 'complex needs extending beyond maternity care' highlighted the necessity of inter-agency working to address women's care holistically when their needs transcend the scope of maternity services.
  
  
  CONCLUSIONS
  Midwives' accounts indicated that they strive to provide equitable care but encountered numerous barriers in doing so. Paradoxically, this might contribute to inequalities in service delivery. In midwives' view, unrestricted access to interpretation and translation services is essential for provision of effective, holistic maternity care. Participants also advocated education for both women and midwives. For the former, this would improve BME women's understanding of health and care systems, potentially leading to more realistic expectations. Improving midwives' cultural competence would better equip them to respond to the needs of an ethnically diverse population. Finally, midwives highlighted that many minority women's complex care needs were identified during pregnancy. Hence, they regarded pregnancy as an ideal time for interventions to improve the health of women and their families and, as such, antenatal care cannot be treated as an isolated event. According to midwives in this study, delivering safe, effective maternity services in the 21st century requires greater collaboration with the women they care for and other health and care agencies (including independent sector providers).
authors.affiliation: Centre for Maternal and Child Health Research, School of Health Sciences, City University London, UK.
authors.forename: Maria Raisa Jessica V
authors.initials: MR
authors.lastname: Aquino
authors.affiliation: School of Psychological Sciences, University of Manchester, UK.
authors.forename: Dawn
authors.initials: D
authors.lastname: Edge
authors.affiliation: Manchester Centre for Health Psychology, The School of Psychological Sciences, Coupland Building, Oxford Road, Manchester, M13 9PL, UK. Electronic address: Debbie.smith-2@manchester.ac.uk.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Smith
mesh_terms: D000328:Adult; D003144:Communication Barriers; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D000068097:Maternal Health / Q000592:standards*; D008913:Minority Groups; D009721:Nurse Midwives / Q000193:education* / Q000523:psychology / Q000706:statistics & numerical data; D009774:Obstetrics / Q000379:methods; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D006113:United Kingdom
keywords: Black and Minority Ethnic (BME) women; Health inequalities; Maternal health; Midwifery; Qualitative research; United Kingdom