Inequalities in childbirth experiences: A population-based cross-sectional survey in England during the Covid-19 pandemic

Background Recognising and addressing inequalities in maternity experiences is crucial to ensuring equitable maternity care and optimal outcomes for all women and their families. This study aimed to compare the childbirth experiences of women with different sociodemographic characteristics using data from a population-based cross-sectional survey in England. Methods Analysis was conducted using data from a national maternity survey in England (N = 4,611). Respondents had given birth in May 2020, during the first wave of the Covid-19 pandemic. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the association between maternal sociodemographic characteristics and childbirth experiences, with adjustment for birth-related factors. Results The majority of women reported positive childbirth experiences with 90.9% being satisfied with their overall care during childbirth. For a significant minority of women, however, childbirth experiences were unsatisfactory (9.1% were dissatisfied with their overall care during childbirth). After mutual adjustment for sociodemographic factors and birth-related factors, identifying as a minority ethnic group (aRR range = 1.41–2.74) and not cohabiting with the baby’s other parent (aRR range = 1.52–1.99) were associated with poorer childbirth experiences. In addition to these sociodemographic factors, primiparity (aRR range = 1.28–1.40) and instrumental birth (aRR range = 1.42–2.77) or unplanned caesarean section (aRR range = 1.83–3.88) were associated with poorer childbirth experiences. Conclusions A significant minority of women have poor childbirth experiences and are dissatisfied with their care. Sociodemographic characteristics and birth-related factors are both important in determining differences in childbirth experiences. Improved understanding of inequalities in childbirth experiences can help to inform interventions and policies to deliver better care to all women.