Background
Methods
Aim
Design
Setting
Materials
Mothers with a normal birth outcome | Bereaved mothers | Healthcare professionals |
---|---|---|
Perceptions of pregnancy | Rapport building | Information about maternity services |
Knowledge and information | Mothers story, background and context | Using maternity services |
Views on low birthweight, still birth and infant mortality | Mothers experience of maternity services and healthcare professionals | Providing services to diverse ethnic groups |
Experiences of current services and maternity healthcare professionals | Knowledge and information | Views on high-risk pregnancies |
Service improvements | Views on stillbirth | Service improvements |
Service improvements |
Data analysis
Results
Stratification | Focus group/interview | Participants (N) | Lanugage of FG/interview | Ethicity | Duration of FG/interview | Lowest education level | Highest education level | Age range |
---|---|---|---|---|---|---|---|---|
Mothers with normal birth outcome | FG1 | 5 | English | WB | 70 | GCSE | NVQ – level 2 | 23–42 |
FG2 | 5 | English | WB | 69 | GCSE | A Level | 25–40 | |
FG3 | 4 | English | Pakistani | 84 | NVQ level 2 | Masters | 28–38 | |
FG4 | 6 | English | Pakistani | 134 | BSc | MBA | 27–40 | |
FG5 | 4 | English | Bangladeshi | 73 | BSc | MSc | 24–39 | |
FG6 | 3 | English | Pakistani | 88 | A level | MSc | 32–41 | |
FG7 | 4 | Slyheti | Bangladeshi | 81 | GCSE | BSc | 26–32 | |
FG8 | 8 | Slyheti | Bangladeshi | 64 | GCSE | BA (hons) | 26–42 | |
FG9 | 7 | Urdu | Pakistani | 62 | Year 8 | MPA | 23–49 | |
Bereaved mothers | B1 | 1 | English | WB | 135 | B-Tec | ||
B2 | 1 | English | Pakisani | 49 | A level | |||
B3 | 1 | English | Pakistani | 32 | GCSE | |||
B4 | 1 | English | Pakistani | 40 | A level | |||
B5 | 1 | English | WB | 124 | A level | |||
B6 | 1 | English | Bangladeshi | 102 | B-Tec | |||
Focus group/interview | Participants (N) | Staff role | Ethnicty | |||||
Health care professionals | FG1 | 2 | Hospital Midwives | WB | ||||
FG2 | 10 | Community midwives | WB | |||||
FG3 | 9 | Community midwives, | WB, Pakistani | |||||
Interview 1 | 1 | Health visitor | WB | |||||
Interview 2 | 1 | Practice Nurse | Black African | |||||
Interview 3 | 1 | GP | Pakistani |
Findings from mothers
Limited knowledge on risk factors associated with adverse outcomes
Well you hear in the media that taking folic acid, that is not just the first 12 weeks but they recommend that you take it 3 months prior to conception, as well - so if you are planning, so I had been taking folic acid for 12 months before falling pregnant this time (White British mother).Vitamins, folic acid they say is very important - important for the baby’s mental development. Before conceiving and after, we should continue taking it, as the mother’s and baby’s body becomes stronger (Bangladeshi mother).When I went to the doctors, they told me that when I was trying… To take folic acid so I did throughout my pregnancy (Bangladeshi mother).
You find out, as soon as you register yourself really, that is when they prescribe it [folic acid] when you take it is the first three months isn’t it? (Bangladeshi mother).I started taking it [folic acid] as soon as I found out I was pregnant. I spoke to the midwife, and they gave me like a prescription to go and get erm, folic acid (White British mother).
I was a bit scared taking folic acid tablets and all the tablets for pregnancy; I was a bit scared of that, just in case like, I dunno, like there are all these scary (White British mother).I think, psychologically I can’t take any medication when I’m pregnant I just feel it is better for the baby (White British mother).The other thing with science, my sister-in-law is expecting, and my brother-in-law is really into his science stuff, and he doesn’t agree with folic acid because he says it’s not pure enough he said it’s got folate or something, or something else which I don’t know about, anyway but that is the thing, it depends on how deeply you go into things and you always find alternatives and things that are better but you have to read up on it don’t you? (Pakistani mother).
Mothers’ awareness of genetic risk factors
It’s [Downs Syndrome] in your genes as well, isn’t it? (Pakistani mother).I have got, like…. Back in Bangladesh, like quite a few members of my family are disabled and they have Down syndrome, and all of that, so you do… You do think it could become passed down (Bangladeshi mother).
Lots of people saying that [cousin marriage increases risk of genetic problems] to be honest, but we are cousin married as well (Pakistani mother).I think they [cousins] have more genetic problems, don't they? (Pakistani mother).
Barriers to consuming folic acid
It [folic acid] is not something that example a 16-year-old would even think about; I don’t think there’s that much information out there (Pakistani mother).
Because my mum took folic acid and she lost her baby so you can’t really say can you? Do you know I mean? There is people that take it and they have problems (White British mother).No, I mean I could get the vouchers for it [folic acid] because I get the appropriate benefits, but I just never, I didn’t really know how to do it or how to apply for it. So I just didn’t bother it seemed pointless (White British mother).
For me I didn’t know [I was pregnant], I had a fall, went to the hospital. They asked me if I was pregnant I said I don’t know if I had missed my periods… I said I don’t know. They checked – I was pregnant! My mum had figured it out by me being reluctant to eat certain foods. I was happy but felt embarrassed too (Bangladeshi mother).
My step-dad was looking up on the Marmite, and you know that it said folic acid on there and erm, so I was a bit scared…so then I was taking it, and then if I forgot to take a tablet, I’d have a bit of marmite. (White British mother).
Findings from healthcare professionals
It’s interesting because not lots of them take the folic acid, though …(White British).Preconceptually? – no [folic acid] … (White British mother).
Yes, most people have [taken folic acid] (White British mother).I think that they do, [take folic acid] – I mean from the diabetic perspective I am aware that we need to prescribe it because they are meant to have a high dose of folic acid … I think that that awareness is there (Practice Nurse, White British).
…but the folic acid they have that in the first few weeks, most of the time they would have had it before we go in, but when I’m doing my assessment. I go through that, I say, ‘have you had you folic acid?’ some of them don’t remember what they’ve had, they having their pregnancy vitamin (HV1).
Using maternity services
I think that is quite likely, [taking folic acid] because …I think that a lot of the Asian ladies that we see it is not always the first child or they are not necessarily first generation Asian that are over here so basically they are British Asian as they were born here… so therefore the Asians may have a good concept of the services that are provided by the NHS (Practice Nurse, White British).
No not everyone. Just the healthy start. They get the vitamin C and folic acid - is all in the healthy start (MW).