Towards Equitable Maternal Care in Obstetric Anal Sphincter Injuries (OASI): Co- developing strategies for reducing risks and improving the lived experience of women and families of ethnically diverse origin

Background: Women from minority ethnic groups are found to have the highest prevalence for obstetric anal sphincter injuries (OASI) or third and fourth degree occurring during childbirth. Co-producing strategies with the target individuals/community is key to producing care and services that will meet their needs, resulting in higher chances of effectiveness. Incorporating the voice of mothers experiencing higher risk of OASI to develop strategies to improve OASI care are required. Aim: To co-develop, with women and families at high risk for and with lived experience of OASI, strategies aimed at improving their care and well-being. Methodology: Women and families at high risk of, and with lived experience of OASI in Leicester, UK, were invited, through our local maternity and neonatal voices partnership, to participate in a virtual focus group discussion (FCD). Seven women of diverse ethnic background with lived experience of third- and fourth-degree perineal tear between 1 to 5 years, participated in the study. The discussion was recorded and transcribed. The data was analysed using the five-step thematic analysis approach by Braun and Clarke. Results: The group of women identified strategies that would provide culturally appropriate OASI care, namely: linguistically accessible prenatal resources, comprehensive midwifery training, updated prenatal education, standardized postpartum care, and the inclusion of fathers in prenatal education, empathetic care, and trust, as well as community engagement and education. Conclusion: This highlights the important role of co-developed care in improving maternal healthcare for women with OASI from diverse ethnic backgrounds. Integrating the voices of women directly affected by OASI can offer valuable insights for the development of culturally sensitive policy and practice in maternal care.