Pakistani Muslim women birthing in Northern England: Exploration of experiences and context.

This study examines Pakistani Muslim women's experiences of labour and maternity services against a backdrop of the National Health Service and the history of Black people in Britain. It sets out to develop an understanding of how Pakistani women see their relationships with midwives and to address the paucity of available research about their intrapartum experiences. The study also aims to contribute to the development of responsive and sensitive midwifery care, and midwifery knowledge and theory.An interpretive ethnographic approach was adopted to obtain narratives from twenty-seven participants: thirteen primigravidae Pakistani Muslim women, nine interpreters and five midwives. The primary method of data collection was conversational qualitative interviews, although a small number of participant observations of women's labours were conducted. Content analysis was utilised for data analysis.The findings of this study reveal that many Pakistani Muslim women generally reported a positive experience of their encounters with maternity services. They valued western obstetric and midwifery services, believing that the midwives and doctors know best; they were grateful for the care they received. The study revealed that adequate and timely information, constructive relationships with the midwives, and support during labour were some of the key factors that shaped women's experiences of labour. Whilst some women expressed satisfaction in these areas, others voiced concern about the variable levels of availability of information, and consequently women laboured without, knowledge of the available methods of pain relief and processes of care during labour. The findings show that Pakistani women value emotional support in labour. A minority of these women were supported by their husbands or female relatives, and some received support from midwives. However for many, when support from midwives was not forthcoming, 'Allah' was the only available source of support. Other key factors highlighted were communication and linguistic barriers, and the role of perceived stereotypes and discrimination, which shaped the context in which women birthed as well as underpinning women's experience of maternity services. The study highlighted that whilst women's ability to speak English played a role in developing relationships with midwives, a lot depended on the attitudes and behaviours of the midwives, and the way they responded to the women. Resources such as interpreters, which may have assisted in overcoming some of the communication barriers, were found to be lacking.The study showed that midwives were the orchestrators of women's labouring experiences, manifesting 'power' in terms of influencing or controlling women, birthing events, processes and resources. Many women appeared to be passive recipients of care; they did not exercise choice and control over the care they received, and the majority did not perceive that they were able to work in partnership with the midwives.These findings are discussed in the context of the way in which service delivery is organised. In addition, the findings are very timely in view of the NHS Plan and the NSF's commitment to women having informed choice and individualised care.