Understanding choice of maternity care in Barking and Dagenham, and across North East London

Healthwatch Barking and Dagenham together with other Healthwatches in North East London carried out engagements earlier this year and spoke with 403 people to hear about:

•            whether they felt they could make choices

•            why they chose to have their maternity care at their chosen hospital, birth centre or a home birth.

•            how they felt issues of cultural sensitivity and associated barriers impacted their choice.

Situation across North East London

Women can choose to give birth at home, in midwife-led units, or in labour wards. The latter are more suited to the needs of higher-risk mothers. The proportion of complex pregnancies is higher in more disadvantaged areas (e.g., LBBD) and has increased more widely because of increases in maternal obesity and related gestational diabetes.[1] NEL-wide report found that complex health conditions were at times perceived to be less important when diagnosed in the first trimester. Some service users felt that they were only taken seriously when their pregnancy was considered viable. Issues of gestational diabetes and high blood pressure were mentioned in relation to this differential.

Most respondents …

• … (over 80%) had antenatal appointments in a hospital-based location.
• …travelled for under 30 minutes to their antenatal appointments by car and found travel times reasonable.
• …in the inner London hospitals (Newham, Royal London, Homerton) were more likely to use public transport.
• …from ethnic minorities experiencing language barriers were more likely to depend on their GP for this.
• …referred by their GP were less likely to actively choose where to have appointments.
• …chose a location for their antenatal appointments that were in close proximity to home.
• …had positive feedback on their antenatal experience and felt listened to by midwives;
• … who are facing inequality, are negatively impacted by lack of availability of free antenatal classes.

Some respondents reported their appointments running late causing them to spend a long time in waiting rooms and subsequently being rushed during appointments. Respondents from different cultural backgrounds have reported their preferences that include the following:

• White Eastern European ethnics were more likely to say that it is important for them to receive antenatal care from professionals familiar with their culture, while those of South Asian ethnicities perceived it as less important.
• Access to healthcare professionals who speak their first language was important for those with basic and conversational English, but less so for fluent non-native speakers.
• Polish and Pakistani respondents were less likely to report having access to professionals who speak their language.
• Respondents of Black ethnicities were more likely to say it is important for them to be looked after by professionals who are similar to them (in terms of cultural background, age etc.), but less likely to say that those currently providing them with antenatal care are similar to them.
• Service users from Black African, Turkish, Pakistani and Eastern European communities are less likely to experience the choice of maternity unit because they rely on GP referrals.

Overview of the situation in Barking and Dagenham

42 respondents were from Barking and Dagenham and over half of them (57%) were from Black, Asian and Minority Ethnic communities. In contrast with NEL-wide findings, 56% of respondents from B&D who had to travel for more than 30 minutes thought that that was somewhat reasonable. Almost half (47%) who travelled by public transport, had to spend more than 30 minutes travelling.

In accordance with NEL findings, self-referral was linked to having more choice in regards to antenatal appointments. Out of those 60% who had self-referred, 96% had a choice about where to have antenatal appointments. In contrast, less than half (44%) of respondents referred by GP had a choice about where to have their appointments.

For most respondents:

• (55%) proximity to an antenatal clinic was the most important factor when choosing.
• agreed or strongly agreed that they were listened to, felt confident discussing care and birth, were able to express concerns and ask questions.
•  (55%) it was very important to receive care from medical professionals of their preferred gender and 43% of respondents said that most healthcare professionals were of their preferred gender.

Following the findings from NEL wide report, recommendations include areas concentrated on:

• scoping of GP and self-referral procedures.
• management of antenatal service capacity and clear information for service users on antenatal clinic waiting times.
• increase training for staff on cultural sensitivities and trauma-informed care.
• improve interpreting services for those with less than conversational English
•  improved parking facilities for units where cars in the main mode of transport
• greater awareness of the nature of health inequality across North East London.

To access NEL wide report and B&D report, please download the link. Please note that the B&D report should be read in conjunction with a North East London wide report.