Table 4.

Review findings and CERQual grading for theme 4 ‘experiences of care’

Review finding	Contributing papers	Supporting quote	CERQual grade*
Continuity of care Some participants discussed the lack of continuity of maternity care provider through their pregnancy and at the birth as a challenge in their postnatal care. This was especially important to women with pre-existing conditions or concerns, as well as to women who were new to the country and expressed the importance of creating rapport with the provider	5 studies: Crowther and Lau,44 Hill et al,64 Lee et al,65 Riggs et al,54 Sami et al57	‘The only problem is that he (her gynaecologist) works only at a private clinic, not at the public hospital, so I already said goodbye to him about 2 weeks ago’. (Sami et al57 immigrants from several countries in Switzerland)	Moderate
Ability to express pain or feelings Some women, mainly from studies with a heterogeneous population of women with different legal statuses, as well as asylum seekers or refugees stated that they were unable to freely communicate how they were feeling and/or if they were in pain. Others mentioned that their own expressions of pain or feelings were interpreted differently by healthcare providers, resulting in lack or delay in services	6 studies: Doering et al,68 Higginbottom et al,69 Kim et al,28 Skoog et al,78 Stewart et al,77 Wikberg et al58	‘I said I couldn't sleep and was suffering, but the specialist did not recognise that I was having a hard time … The midwife had probably not realised that, either. I might not have told them the entire truth … The midwife told me that she saw me having the maternity glow … I was thinking it was really different from how I was feeling. It seemed my pain wasn’t obvious on the outside. I knew that they didn’t see that. I just said, ‘Really? I am really painful. I am not like that’. [in a small voice]. That’s all I said … I should have told them about my pain more, but I didn’t’. (Doering et al68 Japanese immigrants in New Zealand) ‘I didn’t even have painkillers because the baby already came, because they hadn’t really believed me because I wasn’t crying or speaking for myself’. (Stewart et al77 Sudanese woman in Canada)	Moderate
Quality of the interaction with healthcare providers While some women, mainly from studies with a heterogeneous population of women with different legal statuses, asylum seekers or refugees, focused on the positive experiences they had with the information provided, and the postnatal check-ups of both baby and mother, others focused on negative interactions with healthcare providers, including doulas, leaving women unhappy and feeling caregivers spent little time explaining things, and showed a lack of compassion	7 studies: Akhavan and Edge,41 Higginbottom et al,47 Higginbottom et al,48 Hoban and Liamputtong,49 Riggs et al,55 Shafiei et al,62 Yelland et al59	‘They helped me a lot; checked the baby and myself … they came every hour and examined, checked me up, asked me lots of questions; for example, ‘what problem do you have?’ and I was very satisfied with these things (Sanaz, multipara)’. (Shafiei et al62 immigrants from Afghanistan in Australia) ‘After the birth in hospital, specifically I’d ring the buzzer maybe because I had pain, I couldn’t get up to change her or I really needed somebody just to give her to me; that it would take them for a long time to attend … so I found that not attending very disappointing (multipara)’ (Shafiei et al62 immigrants from Afghanistan in Australia)	High
Stigma and discrimination Some women, mainly from studies with a heterogeneous population of women with different legal statuses, asylum seekers or refugees, described feeling discriminated, especially if they were living in vulnerable situations, such as difficult social or financial conditions, or if they were living without a legal status. Further, many women identified feeling discriminated against by healthcare providers, including perceived racism by providers	8 studies: Chu,43 Davies and Bath,45 Gurman and Becker,46 Higginbottom et al,48 McLeish,51 Origlia Ikhilor et al,52 Sami et al,57 Shafiei et al74	‘No, I think they do that because we are not married. In my case, I felt it happened because I was alone, because they suggested it several times … I think it’s because of a financial matter’. (Sami et al57 migrants from several countries in Switzerland) ‘The problem was that we were informed that the unborn child was sick. And in the end, it was born healthy. We did not understand why [the doctor told us the child was sick), we then thought, maybe it was because we have a different skin colour—that’s what we think’. (Eritrean woman) (Origlia Ikhilor, immigrants from several countries in Switzerland) ‘In the end I got an infection in my scar … I went to the midwife and said I’m feeling cold, and all my body shakes … She looked at me like this and said, ‘You are OK’ … She said to another midwife, ‘These Africans … they come here, they eat nice food, sleep in a nice bed, so now she doesn’t want to move from, here!’ … When she said this, I didn’t say anything I just cried—she doesn’t know me, who I am in my country. And the other midwife said, ‘What’s wrong with them, these Africans?’ and some of them they laughed’. (McLeish51 immigrants from several countries in the UK)	Moderate

*High, moderate, low or very low.