Facilitators and Barriers to Access to Midwife-Led Birth Settings for Racialized Women in the UK: A Scoping Review

Background: In UK maternity care, racialized women have worse experiences and clinical outcomes than White women. Midwife-led birth settings (MLBS), including home births and midwife-led units, both freestanding and alongside hospitals, are all available as choices for low-risk women in the UK. MLBS deliver optimal outcomes for low-risk women with uncomplicated pregnancies, including for racialized women, and can offer culturally specific care, possibly mitigating existing social inequalities. Evidence suggests that racialized women access MLBS less than White women.

Aim: To map existing literature on facilitators and barriers to accessing MLBS for racialized women and to identify emerging themes.

Method: A scoping review of UK literature over the last 10 years using OVID, Ebsco Host, and gray literature. Search, selection, and data extraction were performed using PRISMA and JBI guidelines. Data were analyzed using inductive thematic analysis.

Results: Fourteen articles met the inclusion criteria, only one addressing the research question directly and others containing some relevant material. Six themes were identified: admission criteria, information giving, the role of antenatal groups, bias and assumptions, beliefs about birth, and MLBS as empowering.

Conclusions: There is a lack of research on racialized women's access to MLBS. Community outreach, having midwifery services embedded in the community, defaulting to MLBS for women categorized as low risk, continuity of carer, and interventions achieving a reduction in care-giver bias may improve access and outcomes.