Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, North Wing St. Thomas' Hospital, King's College London, London, UK.
Elizabeth Garrett Anderson Wing, University College Hospital, London, UK.
Birth. 2019 Sep;46(3):461-474. doi: 10.1111/birt.12446. Epub 2019 Aug 5.
Echoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care.
Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0).
Three themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships.
The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes.
呼应国际趋势，英国最近关于婴儿和产妇死亡率的报告发现，社会风险因素较高的孕妇出现死产或新生儿死亡的可能性高出 50%，早产和产妇死亡的风险也增加。本真实主义综合研究旨在揭示影响女性分娩体验的机制。
使用真实主义方法，纳入了 22 篇探讨英国各种社会风险因素的女性体验分娩护理的研究。数据提取过程确定了背景（C）、机制（M）和结果（0）。
三个主题，资源、关系和资格，涵盖了八个 CMO 配置。对于不熟悉英国系统和生活混乱的女性，获得服务、适当的教育、翻译、实际支持和护理连续性尤为重要。对于有创伤经历或缺乏控制感的女性来说，与医疗保健专业人员建立信任关系是重新获得信任的关键。许多在怀孕期间有社会关怀介入的女性将医疗保健服务视为一种监控系统，而不是支持系统，这影响了她们的参与度。这一点，以及家长式护理和歧视的经历，可以通过建立信任关系来缓解。
研究结果为如何开发旨在减少女性体验和分娩结果不平等的安全服务提供了基础理论和实际指导。
