Search tips
Search criteria 


Logo of hsresearchLink to Publisher's site
Health Serv Res. 1991 December; 26(5): 651–669.
PMCID: PMC1069847

Using medical care: the views and experiences of high-risk mothers.


Two recurrent unsolved problems of health services practice and policy in modern industrial countries are those of social class inequalities and user dissatisfaction. This article presents data related to these issues drawn from a sample of British childbearing women deemed "at risk" by health professionals. A third focus is on the relationship between past experiences of maternity care, and the patterns of service provision and perceptions of needs and satisfaction revealed in a subsequent pregnancy. Findings show a tendency for patterns of care to be differentiated by social class, with working class women generally receiving comparatively poor service. Satisfaction with general practitioner (community-based) prenatal care is higher than with hospital care. The more socially disadvantaged women in the sample are more likely to be dissatisfied with their medical care. The three major pregnancy needs highlighted by the sample women are for more continuity of care, more sympathetic medical care, and help with household finances. Adverse previous childbearing experiences are related to more dissatisfaction in the subsequent pregnancy.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Heins HC, Jr, Miller JM, Sear A, Goodyear N, Gardner S. Benefits of a statewide high-risk perinatal program. Obstet Gynecol. 1983 Sep;62(3):294–296. [PubMed]
  • Grimes L, Mehl LE, McRae J, Peterson G. Phenomenological risk-screening for childbirth: successful prospective differentiation of risk for medically low-risk mothers. J Nurse Midwifery. 1983 Sep-Oct;28(5):27–30. [PubMed]
  • Hart JT. The inverse care law. Lancet. 1971 Feb 27;1(7696):405–412. [PubMed]
  • Heins HC, Jr, Miller JM, Sear A, Goodyear N, Gardner S. Benefits of a statewide high-risk perinatal program. Obstet Gynecol. 1983 Sep;62(3):294–296. [PubMed]
  • Heins HC, Jr, Nance NW, McCarthy BJ, Efird CM. A randomized trial of nurse-midwifery prenatal care to reduce low birth weight. Obstet Gynecol. 1990 Mar;75(3 Pt 1):341–345. [PubMed]
  • Jeffcoate JA. Improving communication in a Special Care Baby Unit. Early Hum Dev. 1979 Dec;3(4):341–344. [PubMed]
  • Larsen DE, Rootman I. Physician role performance and patient satisfaction. Soc Sci Med. 1976 Jan;10(1):29–32. [PubMed]
  • Locker D, Dunt D. Theoretical and methodological issues in sociological studies of consumer satisfaction with medical care. Soc Sci Med. 1978 Jul;12(4A):283–292. [PubMed]
  • McClain CS. Perceived risk and choice of childbirth service. Soc Sci Med. 1983;17(23):1857–1865. [PubMed]
  • Newton RW, Hunt LP. Psychosocial stress in pregnancy and its relation to low birth weight. Br Med J (Clin Res Ed) 1984 Apr 21;288(6425):1191–1194. [PMC free article] [PubMed]
  • O'Brien M, Smith C. Women's views and experiences of ante-natal care. Practitioner. 1981 Feb;225(1352):123–125. [PubMed]
  • Porter M, Macintyre S. What is, must be best: a research note on conservative or deferential responses to antenatal care provision. Soc Sci Med. 1984;19(11):1197–1200. [PubMed]
  • Shear CL, Gipe BT, Mattheis JK, Levy MR. Provider continuity and quality of medical care. A retrospective analysis of prenatal and perinatal outcome. Med Care. 1983 Dec;21(12):1204–1210. [PubMed]
  • Sokol RJ, Rosen MG, Stojkov J, Chik L. Clinical application of high-risk scoring on an obstetric service. Am J Obstet Gynecol. 1977 Jul 15;128(6):652–661. [PubMed]
  • Zander LI, Watson M, Taylor RW, Morrell DC. Integration of general-practitioner and specialist antenatal care. J R Coll Gen Pract. 1978 Aug;28(193):455–458. [PMC free article] [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust