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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Understanding delayed access to antenatal care: a qualitative interview study

Authors: Rosalind Haddrill, Georgina L Jones, Caroline A Mitchell, Dilly OC Anumba

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

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Abstract

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.
Literature
1.
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. Edited by: Lewis G. 2007, London: CEMACH
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. 10.1111/j.1471-0528.2002.00524.x.CrossRefPubMed
4.
Redshaw M, Rowe R, Hockley C, Brocklehurst P: Recorded Delivery: A National Survey of Women’s Experience of Maternity Care 2006. 2007, Oxford: National Perinatal Epidemiology Unit
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. 10.1016/j.puhe.2008.05.011.CrossRefPubMed
6.
7.
Redshaw M, Heikkila K: Delivered with care: a national survey of women’s experience of maternity care. 2010, Oxford: National Perinatal Epidemiology Unit
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.CrossRefPubMed
9.
10.
National Collaborating Centre for Women’s and Children’s Health: NICE Clinical Guideline: Antenatal Care – Routine Care for the Healthy Pregnant Woman. 2008, London: RCOG Press
11.
Department of Health: The Pregnancy Book. 2009, London: Department of Health
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. 10.1016/S0029-7844(00)00780-8.PubMed
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. 10.1111/j.1471-0528.2007.01438.x.CrossRefPubMed
14.
Raatikainen K, Heiskanen N, Heinonen S: Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health. 2007, 7: 268-10.1186/1471-2458-7-268.CrossRefPubMedPubMedCentral
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. 10.1093/pubmed/fdg025.CrossRefPubMed
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. 2004, London: The Stationary Office
17.
Dartnall L, Ganguly N, Batterham J, for EdComs: Access to Maternity Services Research Report. 2005, London: Department of Health
18.
Callaghan M, Buller AM, Murray SF: Understanding 'late bookers’ and their social circumstances. Brit J Mid. 2011, 11 (1): 7-13.CrossRef
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. 10.1111/j.1471-0528.2008.02067.x.CrossRefPubMed
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. 2010, London: RCOG Press
21.
22.
Horsley S: Access to Maternity Services – Health Equity Audit, October 2010. 2010, Sheffield: Maternal and Child Health Planning and Commissioning Group
23.
Bryman A: Social Research Methods. 2008, Oxford: Oxford University Press, 3
24.
Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psych. 2006, 3: 77-101. 10.1191/1478088706qp063oa.CrossRef
25.
Lincoln YS, Guba EG: Naturalistic Inquiry. 1985, Newbury Park: SAGE Publications Inc.
26.
Jomeen J: The paradox of choice in maternity care. J Neonat Nurs. 2012, 18: 60-62. 10.1016/j.jnn.2012.01.010.CrossRef
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. 10.1023/A:1011301232549.CrossRefPubMed
28.
Hulsey TM: Association between early prenatal care and mother’s intention of and desire for the pregnancy. JOGNN. 2001, 30 (3): 275-282. 10.1111/j.1552-6909.2001.tb01545.x.CrossRefPubMed
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. 10.5993/AJHB.30.2.8.CrossRefPubMed
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. 10.1353/hpu.2007.0059.CrossRef
31.
Patterson ET, Freese MP, Goldenberg RL: Seeking safe passage: utilizing health care during pregnancy. Image – J Nursing Schol. 1990, 22 (1): 27-31. 10.1111/j.1547-5069.1990.tb00165.x.CrossRef
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. 10.1111/j.1745-7599.1994.tb00924.x.CrossRefPubMed
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. 10.1016/0277-9536(90)90351-R.CrossRefPubMed
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. 10.1111/j.1365-2648.1990.tb01812.x.CrossRef
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. 10.1023/A:1021889424627.CrossRefPubMed
36.
Lutz KF: Abused pregnant women’s interactions with health care providers during the childbearing year. JOGNN. 2005, 34 (2): 151-162. 10.1177/0884217505274580.CrossRefPubMed
37.
Sword W: Prenatal care among women of low income: a matter of “taking care of self”. Qual Health Res. 2003, 13: 319-332. 10.1177/0095399702250128.CrossRefPubMed
38.
Penchansky R, Thomas JW: The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981, 19 (2): 127-140. 10.1097/00005650-198102000-00001.CrossRefPubMed
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: 35-10.1186/1471-2288-6-35.CrossRef
40.
Omar MA, Schiffman RF: Recipient and provider perspectives of barriers to rural prenatal care. J Comm Health Nurs. 1998, 15: 237-249. 10.1207/s15327655jchn1504_5.CrossRef
41.
Mayer JP: Unintended childbearing, maternal beliefs and delay of prenatal care. BIRTH. 1997, 24 (4): 247-252. 10.1111/j.1523-536X.1997.tb00598.x.CrossRefPubMed
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. 10.1016/j.socscimed.2004.11.063.CrossRefPubMed
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. 10.1016/j.jmwh.2009.01.002.CrossRef
44.
Finer LB, Zolna MR: Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception. 2011, 84: 478-485. 10.1016/j.contraception.2011.07.013.CrossRefPubMedPubMedCentral
Metadata
Title
Understanding delayed access to antenatal care: a qualitative interview study
Authors
Rosalind Haddrill
Georgina L Jones
Caroline A Mitchell
Dilly OC Anumba
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-207

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