Understanding delayed access to antenatal care: a qualitative interview study

BMC Pregnancy and Childbirth

Dilly OC Anumba³  Caroline A Mitchell¹  Georgina L Jones²  Rosalind Haddrill² 

[1] Academic Unit of Primary Medical Care, Samuel Fox House, Northern General Hospital, University of Sheffield, Herries Road, Sheffield S5 7AU, UK;School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK;Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, The Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK

关键词: Qualitative study;    Late booking;    Access;    Antenatal care;    Pregnancy;   

Others  :  1127203
DOI  :  10.1186/1471-2393-14-207

 received in 2014-02-01, accepted in 2014-06-05,  发布年份 2014

【 摘 要 】

Background

Delayed access to antenatal care ('late booking’) has been linked to increased maternal and fetal mortality and morbidity. The aim of this qualitative study was to understand why some women are late to access antenatal care.

Methods

27 women presenting after 19 completed weeks gestation for their first hospital booking appointment were interviewed, using a semi-structured format, in community and maternity hospital settings in South Yorkshire, United Kingdom. Interviews were transcribed verbatim and entered onto NVivo 8 software. An interdisciplinary, iterative, thematic analysis was undertaken.

Results

The late booking women were diverse in terms of: age (15–37 years); parity (0–4); socioeconomic status; educational attainment and ethnicity. Three key themes relating to late booking were identified from our data: 1) 'not knowing’: realisation (absence of classic symptoms, misinterpretation); belief (age, subfertility, using contraception, lay hindrance); 2) 'knowing’: avoidance (ambivalence, fear, self-care); postponement (fear, location, not valuing care, self-care); and 3) 'delayed’ (professional and system failures, knowledge/empowerment issues).

Conclusions

Whilst vulnerable groups are strongly represented in this study, women do not always fit a socio-cultural stereotype of a 'late booker’. We report a new taxonomy of more complex reasons for late antenatal booking than the prevalent concepts of denial, concealment and disadvantage. Explanatory sub-themes are also discussed, which relate to psychological, empowerment and socio-cultural factors. These include poor reproductive health knowledge and delayed recognition of pregnancy, the influence of a pregnancy 'mindset’ and previous pregnancy experience, and the perceived value of antenatal care. The study also highlights deficiencies in early pregnancy diagnosis and service organisation. These issues should be considered by practitioners and service commissioners in order to promote timely antenatal care for all women.

【 授权许可】

   
2014 Haddrill et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lewis G (Ed): The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer - 2003–2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH; 2007.
• [2]Centre for Maternal and Child Enquiries (CMACE): Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011, 118(Suppl. 1):1-203.
• [3]Kupek E, Petrou S, Vause S, Maresh M: Clinical, provider and sociodemographic predictors of late initiation of antenatal care in England and Wales. BJOG 2002, 109:265-273.
• [4]Redshaw M, Rowe R, Hockley C, Brocklehurst P: Recorded Delivery: A National Survey of Women’s Experience of Maternity Care 2006. Oxford: National Perinatal Epidemiology Unit; 2007.
• [5]Rowe RE, Magee H, Quigley MA, Heron P, Askham J, Brocklehurst P: Social and ethnic differences in attendance for antenatal care in England. Public Health 2008, 122(12):1363-1372.
• [6]The Health and Social Care Information Centre: NHS Maternity Statistics. 2009–10. http://www.hscic.gov.uk/article/2021/Website-Search?productid=114&q=NHS+maternity+statistics+2009-2010&sort=Relevance&size=10&page=1&area=both#top webcite
• [7]Redshaw M, Heikkila K: Delivered with care: a national survey of women’s experience of maternity care. Oxford: National Perinatal Epidemiology Unit; 2010.
• [8]Wildman K, Blondel B, Nijhuis J, Defoort P, Bakoula C: European indicators of health care during pregnancy, delivery and the postpartum period. Eur J Obstet Gynecol Reprod Biol 2003, 111:S53-S65.
• [9]National Center for Health Statistics: Prenatal Care. 2006. http://205.207.175.93/VitalStats/TableViewer/tableView.aspx?ReportId=15101 webcite
• [10]National Collaborating Centre for Women’s and Children’s Health: NICE Clinical Guideline: Antenatal Care – Routine Care for the Healthy Pregnant Woman. London: RCOG Press; 2008.
• [11]Department of Health: The Pregnancy Book. London: Department of Health; 2009.
• [12]Braveman P, Marchi K, Egerter S, Pearl M, Neuhaus J: Barriers to timely prenatal care among women with insurance: the importance of pre-pregnancy factors. Obstet Gynecol 2000, 95:874-880.
• [13]Alderliesten ME, Vrijkotte TGM, van der Wal MF, Bonsel GJ: Late start of antenatal care among ethnic minorities in a large cohort of pregnant women. BJOG 2007, 114:1232-1239.
• [14]Raatikainen K, Heiskanen N, Heinonen S: Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health 2007, 7:268. BioMed Central Full Text
• [15]Rowe RE, Garcia J: Social class, ethnicity and attendance for antenatal care in the United Kingdom: a systematic review. J Public Health Med 2003, 25:113-119.
• [16]Department of Health: Government Response to the Health Select Committee’s Fourth, Eighth, and Ninth Reports of Session 2002–03 on the Provision of Maternity Services, Inequalities in Access to Maternity Services and Choice in Maternity Services. London: The Stationary Office; 2004.
• [17]Dartnall L, Ganguly N, Batterham J, for EdComs: Access to Maternity Services Research Report. London: Department of Health; 2005.
• [18]Callaghan M, Buller AM, Murray SF: Understanding 'late bookers’ and their social circumstances. Brit J Mid 2011, 11(1):7-13.
• [19]Downe S, Finlayson K, Walsh D, Lavender T: 'Weighing up and balancing out’: a meta-synthesis of barriers to antenatal care for marginalised women in high-income countries. BJOG 2009, 116(4):518-529.
• [20]National Collaborating Centre for Women’s and Children’s Health: NICE Clinical Guideline: Pregnancy and Complex Social Factors: A Model for Service Provision for Pregnant Women with Complex Social Factors. London: RCOG Press; 2010.
• [21]EURO-PERISTAT project: European Perinatal Health Report: The Health and Care of Women and Babies in Europe in 2010. 2013. http://www.europeristat.com/reports/european-perinatal-health-report-2010.html webcite
• [22]Horsley S: Access to Maternity Services – Health Equity Audit, October 2010. Sheffield: Maternal and Child Health Planning and Commissioning Group; 2010.
• [23]Bryman A: Social Research Methods. 3rd edition. Oxford: Oxford University Press; 2008.
• [24]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psych 2006, 3:77-101.
• [25]Lincoln YS, Guba EG: Naturalistic Inquiry. Newbury Park: SAGE Publications Inc.; 1985.
• [26]Jomeen J: The paradox of choice in maternity care. J Neonat Nurs 2012, 18:60-62.
• [27]Peacock NR, Kelley MA, Carpenter C, Davis M, Burnett G, Chavez N, Aranda V, Members of the Chicago Social Networks Project: Pregnancy discovery and acceptance among low-income primiparous women: a multicultural exploration. Matern Child Health J 2001, 5:109-118.
• [28]Hulsey TM: Association between early prenatal care and mother’s intention of and desire for the pregnancy. JOGNN 2001, 30(3):275-282.
• [29]Daniels P, Noe GF, Mayberry R: Barriers to prenatal care among black women of low socioeconomic status. Am J Health Behav 2006, 30:188-198.
• [30]Johnson AA, Hatcher BJ, El-Khorazaty MN, Milligan RA, Bhaskar B, Rodan MF, Richards L, Wingrove BK, Laryea HA: Determinants of inadequate prenatal care utilization by African American women. J Health Care Poor U 2007, 18(3):620-636.
• [31]Patterson ET, Freese MP, Goldenberg RL: Seeking safe passage: utilizing health care during pregnancy. Image – J Nursing Schol 1990, 22(1):27-31.
• [32]Johnson JL, Primas PJ, Coe MK: Factors that prevent women of low socioeconomic status from seeking prenatal care. J Am Acad Nurse Pract 1994, 6(3):105-111.
• [33]Lia-Hoagberg B, Rode P, Skovholt CJ, Oberg CN, Berg C, Mullett S, Choi T: Barriers and motivators to prenatal care among low income women. Soc Sci Med 1990, 30(4):487-495.
• [34]Leatherman J, Blackburn D, Davidhizar R: How postpartum women explain their lack of obtaining adequate prenatal care. J Adv Nursing 1990, 15:256-267.
• [35]Teagle SE, Brindis CD: Perceptions of motivators and barriers to public prenatal care among first time and follow-up adolescent patients and their providers. Matern Child Health J 1998, 2:15-24.
• [36]Lutz KF: Abused pregnant women’s interactions with health care providers during the childbearing year. JOGNN 2005, 34(2):151-162.
• [37]Sword W: Prenatal care among women of low income: a matter of “taking care of self”. Qual Health Res 2003, 13:319-332.
• [38]Penchansky R, Thomas JW: The concept of access: definition and relationship to consumer satisfaction. Med Care 1981, 19(2):127-140.
• [39]Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, Hsu R, Katbamna S, Olsen R, Smith L, Riley R, Sutton AJ: Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Meth 2006, 6:35. BioMed Central Full Text
• [40]Omar MA, Schiffman RF: Recipient and provider perspectives of barriers to rural prenatal care. J Comm Health Nurs 1998, 15:237-249.
• [41]Mayer JP: Unintended childbearing, maternal beliefs and delay of prenatal care. BIRTH 1997, 24(4):247-252.
• [42]Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, Campbell R: Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med 2005, 61:133-155.
• [43]Philippi J: Women’s perceptions of access to prenatal care in the United States: a literature review. J Midwifery Wom Heal 2009, 54(3):219-225.
• [44]Finer LB, Zolna MR: Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011, 84:478-485.