Does continuity of carer matter to women from minority ethnic groups?

To explore the maternity care views and experiences of minority ethnic women who did not respond to a postal survey of mothers' responses to care and to assess whether the concept of continuity mattered to them.

A semi-structured narrative interview, at about six months following birth, designed to encourage women to describe their experiences of pregnancy, birth and maternity care in their own words and according to their own perspectives.

Maternity care in a London NHS Trust with two teaching hospital units, where women in a specific neighbourhood received caseload midwifery care as part of a pilot scheme and other women received conventional (normally 'shared') maternity care.

20 women, half receiving caseload midwifery care and half conventional maternity care.

The interviews were transcribed in full and the texts analysed by open coding and grouping into conceptual areas and linking themes. Key findings related to continuity of carer are highlighted in this paper but related concepts, such as that of control will be reported in more detail elsewhere. Although detailed views and requirements were specific to these women, underlying values and priorities were similar to those reported widely in consumer research in maternity care. The women valued concepts such as communication, support, and control highly but those receiving conventional care were disappointed with their care, particularly in hospital settings and did not feel it was focused on them as a person. Women receiving caseload midwifery care held more positive views and emphasised the role of having 'their own' midwife in supporting such concepts. They showed greater trust and confidence in the professionals and in the personal transition of giving birth.

This small study adds to an existing body of evidence that minority ethnic women do not receive a high quality of maternity care in conventional services and suggests that this is related to the institutional organisation of care. It does not support the assumption that the principles of Changing Childbirth, in particular that of continuity of carer, do not matter to them. Conversely, this group of women shared similar fundamental values and hopes of the service with the wider population of which they are a part but experience a greater dissonance between expectations and experience.

Organisation of maternity care should make caseload midwifery available as a choice for such women to facilitate more woman-centred care.