A qualitative descriptive study of low-income women's access to midwifery services

Salena Francisco

doi:10.37532/2632-251X.2022.6(3).66-68

Salena Francisco^*

Editorial Office, Journal of Nursing Research and Practice, Windsor, Berkshire, UK, Email: editor.jnrp@pulsusinc.com

^*Correspondence: Salena Francisco, Editorial Office, Journal of Nursing Research and Practice, Windsor, Berkshire, UK, Email: editor.jnrp@pulsusinc.com

Received: 05-Mar-2022, Manuscript No. puljnrp-22-4417; Editor assigned: 07-Mar-2022, Pre QC No. puljnrp-22-4417(PQ); Accepted Date: Mar 19, 2022; Reviewed: 11-Mar-2022 QC No. puljnrp-22-4417(Q); Revised: 14-Mar-2022, Manuscript No. puljnrp-22-4417(R); Published: 20-Mar-2022, DOI: 10.37532/2632-251X.2022.6(3).66-68

Citation: Francisco S. A qualitative descriptive study of low-income women's access to midwifery services. J Nurs Res Pract. 2022;6(3):66-68.

This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact reprints@pulsus.com

Abstract

People of low socioeconomic position are less likely to get midwifery care in Ontario, Canada, despite public support, but little is known about the challenges they face. The goal of this study was to look into the hurdles and facilitators that people of low socioeconomic status face when seeking midwifery care. The research was conducted using a qualitative descriptive study approach. In Hamilton, semi-structured interviews were performed with 30 low-income pregnant and post-partum women. Open coding techniques were used to code transcribed interviews, which were then thematically examined. People of low socioeconomic class have limited access to midwifery care due to a lack of awareness about the profession and the fact that physicians frequently do not provide information on midwifery care when pregnant women first contact the health care system. Inequitable access to midwifery care may be compounded for people of low socioeconomic level by a lack of information of midwifery within socialnetworks and a tendency to move passively through the health care system, which typically favor’s physician care. To eliminate gaps in access to midwifery care, targeted measures to address this issue are required.

Keywords

Low-socioeconomic status; maternity care; healthcare services; midwifery; healthcare access

Introduction

ow Socioeconomic Status (SES) is a major factor in birth complications such as gestational diabetes, small for gestational age, low birth weight, intrauterine growth restriction, preterm birth, hypoxia, and neonatal mortality. The links between low socioeconomic status and poor prenatal outcomes are numerous and complicated. Even in a publicly financed health care system, people of low SES are less likely to receive proper prenatal care due to a variety of structural, economic, psychological, and attitudinal hurdles. Recent research suggests that continuity of care midwifery is linked to a lower risk of preterm birth, small-for-gestational-age birth, and low birthweight in people of low socioeconomic status [1]. Longer appointments and a nonjudgmental attitude are two elements of midwifery care that may help to overcome hurdles that prevent low-income women from receiving proper prenatal care. Additional qualities of midwifery care that strengthen midwives' ability to fulfil the needs of marginalised individuals include informed choice, choice of birthplace, continuity of care, and flexible community-based care that includes home visits.

Maternity care administrations in Canada are managed and financed at the area/regional level. Birthing assistants in the territory of Ontario are self-directed by a College of Midwives and maternity care training includes a four-year baccalaureate degree or same [2]. The standard model of maternity care in Ontario includes coherence of care, in which a group of up to four maternity specialists is completely liable for a lady's consideration all through pregnancy, work, birth, and the initial a month and a half following birth. Maternity specialists work in community based birthing assistance practice gatherings and all offer intrapartum care in the two emergency clinics and local area based settings (home, birth focus, or facility) to ladies with okay pregnancies [3]. The expense of maternity care is freely financed for all inhabitants of Ontario. Contingent upon accessibility, people are allowed to pick between care from an obstetrician, a family doctor, or a maternity specialist for their pregnancy and birth; notwithstanding, just maternity specialists give intrapartum care outside of medical clinics. Just a minority of family doctors give intrapartum care. In 2017, maternity specialists went to 16% of births in Ontario and 10.8% cross country, and 83% of birthing assistant went to births in Ontario happened in emergency clinic. Low birthing assistance care participation across all populaces is affected by the generally ongoing coordination of maternity care into the medical care framework in Ontario in 1994. Past examination, not explicit to low SES, distinguished obstructions to ladies' agreeableness and use of maternity care, including unfortunate degrees of mindfulness and information, including misguided judgments and worries regarding the wellbeing and mastery of birthing specialists in crises [4].
Admittance to maternity care in Ontario in view of SES has not been all around portrayed. In a 1999 study directed five years after the guideline and formal incorporation of maternity care into the Ontario medical care framework, birthing specialists announced that public financing had expanded the variety of the birthing assistance client populace, with 94% of birthing assistance practice bunches revealing expanded usage by low pay ladies [5]. Albeit expanding admittance to maternity care for ladies from burdened bunches was expressly distinguished as an objective of guideline of birthing assistance, unpublished investigations by our exploration group proposes that individuals of low SES in Ontario are more averse to get to birthing assistance care. Little is had some significant awareness of hindrances pregnant individuals of low SES could insight in going into freely financed birthing assistance care and how they can be survived. The objective of this study was to comprehend the boundaries and facilitators to getting to birthing assistance care experienced by individuals of low SES. Our essential exploration question was "What the future held facilitators recognized by pregnant individuals of low SES connected with getting to maternity care?
Individuals were qualified to partake in the review assuming they were right now pregnant or had conceived an offspring inside the previous year and were of low SES, no matter what their decision of medical services supplier. We selected inhabitants of Hamilton, Canada, a southern Ontario city with a populace of 535,000 from January to May 2018. We selected through online media and banners at medical care and social administrations destinations including maternity care facilities, a between proficient local area based maternity care center, clinic based obstetrical centers and birth units, local area associations, and pre-birth programming [6]. Members were offered a little, $25 cash honorarium in acknowledgment of their time, notwithstanding any transportation costs caused in taking part in the meeting. Potential members straightforwardly reached the review group through online media, email, and phone. We screened individuals upon introductory contact by utilizing five inquiries connected with SES to decide their qualification to partake.
SES is a diverse build used to characterize social imbalance and is estimated by pay, occupation and instructive fulfillment. Screening questions tended to most elevated training level accomplished, business status, occupation, receipt of government pay backing, and family pay. Individuals who were beneath the low pay cut-off for the city of Hamilton or gotten government pay backing, and whose most significant level of instruction was secondary everyday schedule were qualified to take part in the review [7]. Low pay shorts from Statistics Canada were utilized to decide low-pay status for the city of Hamilton, in light of family pay and family size residing in the house. We were keen on selecting members whose most significant level of instruction was secondary everyday schedule, except because of the mind boggling manner by which SES is estimated, and given the high pace of secondary school finishing in Canada (88% in 2010) we additionally incorporated a few people who didn't meet this basis. For individuals who had low pay or gotten government pay support yet had finished more elevated levels of schooling, the foremost agent assessed reactions connected with occupation and business status, and members were enlisted assuming that they were jobless, utilized parttime, or utilized in ventures with lowwages or unstable work.
Members got the assent structure and all concentrate on data ahead of the meeting to audit. Informed assent was acquired from all members before the meeting, either composed or verbally relying upon whether their meeting was face to face or via telephone [8]. Verbal assent was sound recorded and acquired by the examination colleague who read and clarified the assent structure with the subject, who gave their verbal agree to partake. We had morals council endorsement to get assent thusly. Members were educated they could end the meeting or pull out from the review whenever, even after assent was gotten. All meetings were sound recorded. An accomplished examination right hand directed individual meetings utilizing a semi-organized interview guide. We settled on a systemic choice that the questioner wouldn't be a birthing assistant, or some other kind of medical services specialist, to increment member solace in offering open viewpoints and suppositions about maternity care. We offered the decision of a face to face or a phone interview. The semi-organized interview guides investigated members' boundaries and facilitators to getting to mind with their picked HCP, their explanations behind picking their HCP, and their encounters of care. A few inquiries were explicit to individuals who had gotten care from different clinicians, like family doctor, obstetrician, or medical caretaker professional [9]. These inquiries investigated whether they had at any point considered utilizing a maternity specialist, data they got from medical care suppliers about their choices for pregnancy and birth care, and their insight and assessments of birthing assistance care. Enrollment went on until information immersion in every one of the consideration supplier bunches was accomplished. Information immersion was laid out through steady iterative audit of the meetings to guarantee no new information was arising.

Results

One-hundred and 49 individuals were evaluated for possible qualification. Of those, 23 didn't answer to the Darling et al. BMC Pregnancy and Childbirth (2019) 19:416 Page 3 of 13 screening questions, and 84 were ineligible. Eight were qualified and welcomed to take part in a meeting yet were lost to follow-up and 4 extra were qualified, yet not talked with because of arriving at immersion. Thirty individuals took part: 13 had gotten care from maternity specialists and 17 had never gotten care from birthing assistants. Among the individuals who had never seen birthing assistants, 10 (33%) had seen obstetricians and 7 (23%) had seen a family doctor. Eight members had encountered both birthing assistance and doctor care, either in various pregnancies or as a result of an exchange of care. A few members considered birthing assistance care or endeavored to enter maternity care yet were dismissed because of an evaluation by either a birthing assistant or doctor, that considered them high gamble and not reasonable for maternity care. Interviews went from 11 to 76 min, with a mean length of 26 min.
The sociodemographic characteristics of the subjects. The average age was 29 years old, with a range of 17–46, and the bulk of the people were unemployed (80%), had a combined household income of less than $30,000 CND (60%) and rented their dwellings (73 percent). Twenty-seven percent of the population was born outside of Canada. Seventy-three percent of the participants resided in areas that ranked in the bottom two quintiles of overall rankings based on 24 healths, social, and economic factors.

Discussion

Our research explored factors that impacted access to midwifery care for people of low SES. Lack of awareness or knowledge, misconceptions, and personal beliefs about risk and safety were the predominant barriers to midwifery care identified by participants. Our findings are consistent with previous research regarding knowledge levels and misconceptions regarding midwifery, in addition to concerns about safety and level of expertise. Our findings are also in line with existing literature which has found that choice of care provider was associated with birth-related beliefs and expectations. While our findings are particular to the Canadian context, they may also be of relevance in other settings where midwives do not provide the majority of care within the maternity care system or where midwifery-led continuity of care models have been introduced recently.

Conclusion

Our examination recognized various hindrances and facilitators that sway the availability of birthing assistance care to individuals of low-SES. We found that when individuals of low SES experience birthing assistance care they view these administrations as adequate and fitting. In any case, in our unique situation, admittance to maternity care is obliged for individuals of low SES since absence of public mindfulness about birthing assistance restricts the congeniality of these administrations, and on the grounds that data about maternity care is regularly not given by doctors when pregnant individuals first contact the medical care framework. Unjust admittance to maternity care for individuals of low SES is exacerbated by absence of information about birthing assistance inside interpersonal organizations and a propensity to move latently through the medical services framework which generally inclines toward doctor care. Designated endeavors to raise information levels about maternity care among individuals of low SES and to change doctor reference conduct will be important to lessen inconsistencies in admittance to birthing assistance care.