Considering inclusivity in birth reflections services

Dalvir is a midwife—and has been for the past 15 years. Over the years, she’s had the privilege of working with countless families through one of the most transformative moments of their lives. These days, her focus is a little different but no less rewarding. She spends her time working to make maternity services more inclusive for everyone who needs them. She shares three vital insights.

I want to share some reflections on how NHS maternity services can better support inclusivity when it comes to birth reflection services. This service may be referred to by a different name in some places, but their goal is about giving people the chance to process and reflect on their birth experiences. This could be because things did not go quite to plan, perhaps there are some niggling unanswered questions and some services can even provide support and guidance for emotional and mental health.

Whilst these services are incredibly valuable, I’ve noticed that their uptake and use can vary significantly across different demographics and that’s something we need to address.

Here are three relatively simple steps to get started on providing an inclusive birth reflections service:

1. Collect data and use this to inform development changes

My advice would be for people who lead these services to ensure demographic data is being collected. Only through this, can services know where the gaps are and where to focus efforts. For example, local data collection has shown me that the service is almost exclusively used by English speaking people and predominately from affluent areas which is disproportionate to the population of the general community. One thing I’ve noticed is that, all too often, health professionals unintentionally make assumptions about who can access these services. For example, I’ve seen cases where it’s assumed that birth reflection services can only be accessed by English speaking people. This is an example of unconscious bias, it is not intentional, but still a barrier. These services should be accessible to everyone, and that includes patients who don’t speak English as their first language. A simple but meaningful way to address this is to ensure patients know that interpreters are available. By sharing that the interpreter will keep confidentiality and is free of charge for the patient, it further supports the uptake of this provision. Adding that where possible, a female interpreter can be sourced if requested additionally may add to confidence in the use of this service. Supporting language access as a clear priority is one of those small but powerful changes to achieving an inclusive service.

“Only through demographic data can services know where the gaps are and where to focus efforts”

2. Evaluate how the service is being delivered

Some people may be put off by accessing birth reflections because of the location of the service. For example, if the service is provided in a hospital, this can be triggering for some. Ideally, there should be different access options for all - including telephone, video calls and home visits. In addition, there should be some consideration providing some level of birth reflection service for individuals while they remain inpatients on the ward. Although this level of care may differ from that offered during outpatient appointments, it is crucial in supporting individuals to recognise their personal right to identify what they find triggering or traumatic. This empowerment should take precedence over clinicians defining these experiences for them and can support access to the birth reflections service in months and years to come.

“There should be different access options for birth reflection services - including telephone, video calls and home visits”

3. Review which professionals are aware of the service

Making a wider range of staff professions aware of the service will support an increased uptake of referrals and awareness. This extends beyond midwives as for many people, they require access to the service months or years after they been under the care of midwives. Professionals such as GPs and Health Visitors should be informed about the service so they can signpost. In addition, considering where else to make people aware of this service, e.g. in perinatal pelvic health services.

“A wider range of staff professions will support an increased uptake of referrals and awareness”

These are just a few suggestions for implementing tangible, relatively quick changes to create a more inclusive service. This is by no means an exhaustive list, as there are many other ways to foster inclusivity. Furthermore, it is important to conduct thorough research to identify any perceived barriers within the service, alongside collaborating to co-create solutions with the demographics and communities this is directly affecting.

If you have any feedback or have implemented any of these suggestions, we would love to hear from you. Please send us an email at hello@makebirthbetter.org

Dalvir13 February 2025