Disparities In Access to the Northwest Ambulance Service during pregnancy, birth and postpartum period and its association with neonatal and maternal outcomes [DIAAS]

Background Women from Black, Asian and Minority Ethnic backgrounds (BAME) and those from socioeconomically disadvantaged backgrounds are at a higher risk of perinatal mortality and morbidity, potentially due to poorer access to care. Calling the ambulance service during and following pregnancy is a gateway to seeking maternity care.

However, disparities in accessing maternity emergency services, with a particular focus on vulnerabilities such as being from ethnic minority, migrant or deprived backgrounds, have not been previously investigated.

Research Aims This study will investigate access to ambulance services during pregnancy, birth and early postpartum period and will explore relevant maternal and infant outcomes for families who seek help from the emergency services.

Factors that influence women and families experiences of help seeking from the ambulance service will be explored, with a focus on intersectionality, ethnicity, and deprivation.

Additionally, we will specifically: Investigate the opportunities for alternative clinical decision making to address timely access to the most appropriate service, reducing risk factors for adverse outcomes and associated impact upon the emergency services.

Use findings to develop recommendations associated with requiring an ambulance transfer into the maternity unit during pregnancy, birth, and early postpartum to inform local interventions for at risk populations.

Share methods to explore factors affecting, and disparities in, access to ambulance services with UK ambulance services and Integrate Care Systems (ICSs) to reduce maternal health inequalities.

Methods This will be achieved through two convergent parallel work-packages (WP): (WP1) A retrospective cohort analysis of maternity care data will be undertaken to describe the characteristics of and outcomes for pregnant women and their neonates who are transferred via ambulance to Manchester University NHS Foundation Trust (MFT).

Descriptive statistics with comparative analyses and logistic regression models will be presented. (WP2) A qualitative content analysis of routinely collected free-text feedback will be undertaken on a sub-sample of 100 de-identified digital care records of women who arrived at the unit via ambulance.

The patient journey will be mapped, and patient profiles constructed to explore potential alternative clinical decision making and to identify factors that may influence accessing the ambulance service.

Recommendations from both WPs will inform safer and more user-friendly care-pathways for women at an increased risk of mortality and morbidity.

Anticipated impact and dissemination: Given the diverse profile of Manchester, insight to the intersectionality of access to emergency maternity care will impact service delivery across local and national NHS organisations.

Findings will support conversations around the reasons for seeking help from the ambulance service in the perinatal period and ways to improve access for underserved communities.

This work may reveal early indicators of risk which could inform initiatives in response to The Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK group (MBRRACE-UK) report. This will enable sharing of transferable findings and methods of exploring disparities in access across the UK.

This study will pave the way to construct a larger study across all 13 ambulance services and ICSs to inform national practice, policy, and training improvements.