Background
- Do women with a longstanding mental health condition have more or less positive experiences of care than other mothers?
- Is healthcare responsive to the particular or additional needs of women with mental health conditions from their perspectives?
- Which types of experiences reflect the most pronounced disparities in experiences for mothers with mental health conditions?
Methods
- overall impressions (e.g. overall ratings, courtesy of doctors),
- emotional support (e.g. discussion of fears, confidence and trust),
- respect for preferences (e.g. treated with respect and involved in decisions),
- information and education (e.g. provided information with clear explanations)
- involvement of family (e.g. family given information and opportunity to talk to professionals)
- physical comfort (e.g. pain management, assistance)
- coordination of care (e.g. organised, appointments on time, no conflicting information)
- continuity and transition (e.g. support in management of condition, know what to do next, told about side effects).
Overall impressions • Overall, antenatal care was ‘very good’ • Overall, hospital care during birth was ‘very good’ • Overall, hospital care following delivery was ‘very good’ • Overall, follow up care was ‘very good’ | Emotional support • Professionals discussed worries and fears during antenatal care • Professionals discussed worries and fears during labour • Had confidence and trust in professionals during labour and birth |
Respect for patient preferences • ‘Definitely’ had input about pain relief during labour and birth • ‘Always’ treated with respect and dignity during labour and birth • ‘Definitely’ involved in decisions during labour and birth • ‘Definitely’ involved in decisions about discharge | Information and education • Received enough information about pain relief prior to the birth • Professionals ‘always’ explained antenatal care clearly • Midwives/doctors ‘always’ explained labour and birth clearly • Professionals explained care following birth clearly • Professionals gave enough information self-care after birth |
Physical comfort • Professionals did everything to help manage pain after birth | Coordination • Antenatal care was ‘very well organised’ • No conflicting information during labour and birth • No conflicting information about self-care or care for baby |
Survey questions | Related guidelines |
---|---|
• Did the health professionals give you advice about the risks of consuming alcohol while pregnant? | As part of providing ‘education about nutrition and ceasing smoking, substance use and alcohol intake in pregnancy’ |
• Did the health professionals give you advice about the risks of exposure to tobacco smoke while pregnant? | |
• During a follow-up appointment, did a midwife or nurse ask you how you were feeling emotionally? | As part of ‘monitoring for early signs of relapse, particularly as medication is often ceased before or during pregnancy’ |
• Did the health professionals ask you how you were feeling emotionally during your pregnancy? | |
• After the birth, did the health professionals give you enough information about how to care for yourself? |
Results
Percentage (Number of respondents) | Mental health group (n = 353) | No condition group (n = 4315) | Total (n = 4668) | ||
---|---|---|---|---|---|
Age | 18–24 | 16% (62) | 7% (339) | 8% (401) | p < 0.001 |
25–29 | 22% (88) | 24% (1142) | 24% (1230) | ||
30–34 | 38% (127) | 40% (1682) | 40% (1809) | ||
35+ | 24% (76) | 29% (1152) | 28% (1228) | ||
Language spoken at home | English | 93% (338) | 72% (3540) | 74% (3878) | p < 0.001 |
Non-English | 7% (14) | 28% (749) | 26% (763) | ||
Born in Australia | Yes | 83% (311) | 55% (2926) | 57% (3237) | p < 0.001 |
No | 17% (42) | 45% (1389) | 43% (1431) | ||
Education | Post graduate/higher degree | 13% (49) | 19% (718) | 19% (767) | p < 0.001 |
Trade or technical certificate | 26% (98) | 24% (1089) | 24% (1187) | ||
University degree | 23% (73) | 34% (1439) | 34% (1512) | ||
Completed Year 12 | 23% (73) | 14% (643) | 14% (716) | ||
Less than Year 12 | 14% (60) | 9% (415) | 9% (475) | ||
Socioeconomic status of postal code area | Quintile 1: Most disadvantaged | 17% (68) | 19% (751) | 19% (819) | p = 0.676 |
Quintile 2 | 15% (82) | 17% (997) | 17% (1079) | ||
Quintile 3 | 22% (85) | 24% (1028) | 24% (1113) | ||
Quintile 4 | 26% (69) | 22% (816) | 22% (885) | ||
Quintile 5: Least disadvantaged | 19% (49) | 18% (720) | 18% (769) | ||
Rurality* | Major cities | 65% (140) | 79% (2282) | 78% (2422) | p < 0.001 |
Inner regional | 27% (149) | 16% (1418) | 17% (1567) | ||
Outer regional, remote | 8% (64) | 5% (614) | 5% (678) | ||
Birth type | Vaginal birth | 56% (206) | 59% (2637) | 59% (2843) | p = 0.609 |
Assisted vaginal birth | 17% (47) | 13% (498) | 14% (545) | ||
Caesarean section (emergency) | 14% (51) | 14% (591) | 14% (642) | ||
Caesarean section (planned) | 13% (48) | 14% (568) | 14% (616) | ||
Induced | No | 59% (188) | 57% (2252) | 57% (2440) | p = 0.609 |
Yes | 41% (116) | 43% (1442) | 43% (1558) | ||
Given birth before (parity) | No | 52% (183) | 48% (1995) | 49% (2178) | p = 0.336 |
Yes | 48% (170) | 52% (2317) | 51% (2487) | ||
Hospital size | Large and specialist | 48% (63) | 54% (1035) | 54% (1098) | p = 0.088 |
Major | 40% (153) | 36% (1718) | 36% (1871) | ||
Small | 13% (137) | 10% (1562) | 10% (1699) | ||
Provider of most antenatal care | Midwife(s) | 62% (202) | 61% (2542) | 61% (2744) | p = 0.786 |
Obstetrician | 16% (52) | 17% (657) | 17% (709) | ||
GP | 14% (71) | 16% (850) | 15% (921) | ||
Other | 7% (28) | 6% (266) | 6% (294) |
Antenatal | Labour and birth | Hospital following birth | Follow up at home | ||
---|---|---|---|---|---|
New South Wales (NSW) | 63 | 75 | 60 | 67 | |
Age | 18–24 | 53 L | 64 L | 50 L | 61 L |
25–29 | 64 | 74 | 58 | 66 | |
30–34 | 63 | 77 | 62 | 69 | |
35+ | 65 | 76 | 62 | 68 | |
Immigrant | Born in Australia | 66 | 77 | 60 | 68 |
Not born in Australia | 59 | 72 | 60 | 66 | |
Language spoken at home | Non-English | 65 | 77 | 60 | 68 |
English | 57 | 70 | 59 | 66 | |
Longstanding mental health condition | No | 64 | 76 | 60 | 68 |
Yes | 55 L | 63 L | 52 L | 60 L | |
Socio-economic status of area | Quintile 1: Most disadvantaged | 58 | 68 | 59 | 66 |
Quintile 2 | 60 | 76 | 60 | 63 | |
Quintile 3 | 65 | 75 | 58 | 72H | |
Quintile 4 | 63 | 75 | 60 | 66 | |
Quintile 5: Least disadvantaged | 70H | 81H | 63 | 69 | |
Rurality | Major cities | 62 | 74 | 59 | 68 |
Inner regional | 67 | 76 | 62 | 66 | |
Outer regional and remote | 69 | 80 | 67H | 61 | |
Education | Post graduate/higher degree | 66 | 76 | 60 | 68 |
University degree | 62 | 74 | 59 | 67 | |
Trade or technical certificate | 63 | 77 | 61 | 67 | |
Completed Year 12 or equivalent | 62 | 72 | 60 | 66 | |
Less than Year 12 or equivalent | 62 | 77 | 59 | 69 | |
Survey mode | Hardcopy | 64 | 76 | 60 | 68 |
Online | 61 | 73 | 60 | 67 | |
Baby spent time in intensive care | No | 64 | 77 | 61 | 68 |
Yes | 58 | 67 | 57 | 63 | |
Type of birth | Assisted vaginal birth | 59 | 69 | 57 | 67 |
Caesarean section (emergency) | 59 | 67 | 56 | 62 | |
Caesarean section | 62 | 78 | 65 | 68 | |
Vaginal birth | 65 | 78 | 60 | 69 | |
Induced | No | 65 | 76 | 61 | 69 |
Yes | 61 | 73 | 57 | 66 | |
Given birth before (parity) | No | 63 | 73 | 56 | 64 |
Yes | 64 | 77 | 63 | 71H | |
Who provided most antenatal care | Midwives | 66 | 77 | 61 | 70 |
Obstetrician | 61 | 72 | 52 | 61 | |
GP | 56 | 72 | 63 | 65 | |
Hospital size | Large, or specialist hospitals | 61 | 75 | 59 | 67 |
Major hospitals | 63 | 73 | 59 | 68 | |
Smaller district hospitals | 74H | 82H | 72H | 67 |
Comparing differences in experiences for selected experience measures
Comparing differences across domains and stages of care
Experience domain | Stage of maternity care | ||||
---|---|---|---|---|---|
Antenatal (17 questions) | During birth (18 questions) | Hospital following birth (23 questions) | Follow up at home (6 questions) | Total (64 questions) | |
a) Number of measures where there were significant disparities for women with mental health conditionsa | |||||
Overall impression | 1 | 2 | 4 | 7 of 9 | |
Emotional support | 2 | 2 | 1 | 5 of 7 | |
Physical comfort | 2 | 6 | 8 of 9 | ||
Information and education | 2 | 1 | 3 | 6 of 11 | |
Involvement of friends and family | 1 | 1 | 2 of 2 | ||
Respect for patient preferences | 4 | 2 | 2 | 8 of 11 | |
Continuity and transition | 1 | 1 of 3 | |||
Coordination of care | 2 | 1 | 1 | 4 of 12 | |
Total (64 questions) | 7 | 13 | 19 | 2 | 41 of 64 |
b) Average percentage point difference between women with and without a mental health condition | |||||
Overall impression | -7 | −10 | −12 | − 8 | − 10 |
Emotional support | − 9 | −13 | − 13 | −1 | − 10 |
Physical comfort | −13 | −10 | −11 | ||
Information and education | −5 | −11 | −12 | 2 | −8 |
Involvement of friends/ family | −9 | − 8 | −8 | ||
Respect for patient preferences | −7 | −9 | −8 | −7 | |
Continuity and transition | −10 | 2 | −6 | ||
Coordination of care | −2 | −4 | −9 | −4 | |
Total (64 questions) | −5 | −8 | −11 | −3 | − 8 |