Holding it all together

How do women experience care during pregnancy, birth and early motherhood amid severe disadvantage? And how do those experiences relate to women's rights to safe and appropriate care, dignity, autonomy and choice, and respect for private and family life?

It was these questions that led Birth Companions and Birthrights to embark on joint research, funded by the charitable foundation Trust for London, exploring the experiences of women in London and the professionals who care for them.

Two years later, we are launching ‘Holding it all together’, a project that seeks to capture the reality for both women and professionals. The title is a direct quotation, taken from one of the specialist midwives who took part.

The report brings together insights from 12 in-depth interviews with women who faced significant disadvantages during their perinatal journey, ranging from mental health issues, housing problems and domestic abuse, to substance misuse, poverty, asylum-seeking, immigration, trafficking and many more. We also interviewed 26 midwives, health visitors, family nurse practitioners and birth supporters. Their views have much to tell us all about what women in the most difficult circumstances need from the maternity system, what they feel they get, and the factors that make it easier and harder to support them. Without making use of these insights and the growing base of evidence gathered from women experiencing multiple disadvantages, we will struggle to realise the commitment to addressing health and social inequalities that was made in the NHS Long Term Plan (NHS, 2019), or the ambitions of Better Births (National Maternity Review, 2016) to provide safer, kinder, more personalised care.