Ethnic differences in women's worries about labour and birth

Abstract

Objective. To describe the worries experienced by pregnant Black and Minority Ethnic (BME) women about labour and birth and compare their experience to that of White women.

Design. Data were collected in England in a survey of experience of maternity care. A random sample of 4800 women selected from birth registration records and questionnaires were mailed at three months postpartum. A total of 2960 (63%) completed a checklist of common worries about labour and birth. For 2765 there were complete data on ethnicity and all potential confounders. Chi² tests and logistic regression models were used to investigate the associations of ethnicity with worries about labour. Unadjusted and adjusted models were run for each worry outcome. Adjustment was made for age, education, parity, relationship status and area deprivation (Index of Multiple Deprivation, IMD).

Results. Overall, the pattern of worries was similar, however, larger proportions of BME women worried about almost all the aspects of labour and birth investigated, including pain, uncertainty about labour onset and duration, possible medical interventions and embarrassment. After adjustment for age, education, relationship status, parity and socioeconomic position, the higher odds of worry in the BME group were most marked in relation to pain and discomfort, not knowing how long labour would take, embarrassment and having more worries overall. Further adjustment for factors likely to affect women's worries, namely depression, being admitted to hospital during the pregnancy, or having experienced medical problems in a previous pregnancy did not alter these findings.

Conclusion. Compared with White women, twice as many ethnic minority women worried about pain and discomfort, not knowing how long labour would take and about embarrassment during labour and birth. Additional research is needed to understand these concerns and how they might be ameliorated by the health professionals working directly with women and any services changes needed to improve the quality of maternity care. Implications for practice include improved information-giving and support in providing the individualised care that women need.

Keywords:

• worry
• childbirth
• worries
• Black and ethnic minority women
• ethnicity

Acknowledgements

This article reports on an independent study undertaken by the authors at the National Perinatal Epidemiology Unit which receives funding from the Policy Research Programme at the Department of Health, London. Additional funding for the survey was provided by the Department of Health, the Care Quality Commission (formerly Healthcare Commission) and the NHS Information Centre, London. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. Particular thanks also to the women who participated in the survey and to Chris Hockley and Rachel Rowe who worked on the initial survey.