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Garti I, Gray M, Tan JY, Bromley A. Midwives' knowledge of pre-eclampsia management: A scoping review. Women Birth 2020; 34:87-104. [PMID: 32928690 DOI: 10.1016/j.wombi.2020.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pre-eclampsia is a multi-organ disease affecting pregnant women from the second trimester onwards resulting in multiple adverse outcomes. Sub-optimal treatment of pre-eclampsia is linked with unfavorable outcomes. It is critical for midwives as primary providers to be competent in the diagnosis and management of pre-eclampsia especially in low-and middle-income countries. AIM To identify what midwives' around the world know about pre-eclampsia management. METHODS A scoping review using the JBI three-step search strategy was used to identify relevant research articles and grey literature on the subject. Database searches in PubMed, CINAHL, Cochrane Databases, Web of Science, and Scopus yielded twenty papers in addition to nine guidelines from Google Scholar. The findings were synthesised using a metasynthesis approach and presented as themes. FINDINGS Four themes were identified from the extracted data: Foundational knowledge of pre-eclampsia; Knowledge and management of a woman with pre-eclampsia according to guidelines; Knowledge of being prepared for emergency procedures and management of emergencies; Factors influencing knowledge. The first three themes addressed diagnosis and management whilst the last theme described how contextual factors led to either increased or decreased knowledge of pre-eclampsia. CONCLUSION Worldwide, practicing midwives lack knowledge on several aspects of pre-eclampsia diagnosis and care. Policies on in-service training should be oriented to include innovative non-traditional methods that have the potential to increase midwives' knowledge.
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Affiliation(s)
- Isabella Garti
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia.
| | - Michelle Gray
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Jing-Yu Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Angela Bromley
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
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102
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Han Q, Guo M, Ren F, Duan D, Xu X. Role of midwife-supported psychotherapy on antenatal depression, anxiety and maternal health: A meta-analysis and literature review. Exp Ther Med 2020; 20:2599-2610. [PMID: 32765754 PMCID: PMC7401497 DOI: 10.3892/etm.2020.9011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
The onset of depression and anxiety during the antenatal stage of pregnancy is common. Despite the conception of numerous interventions in the past decades, studies show no signs of decline in the prevalence of antenatal depression and anxiety. Recently, the use of midwife-supported psychotherapy to treat these psychosomatic disorders has garnered a lot of attention. However, no attempt to date has been made to synthesize the evidence evaluating the influence of midwife-supported psychotherapy on antenatal depression, anxiety, and overall maternal health-status. The aim of the present meta-analysis was to demonstrate the effectiveness of midwife-supported psychotherapy on depression, anxiety, and maternal health-status outcome during the antenatal stage of pregnancy. A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE and CENTRAL. A meta-analysis evaluated the influence of midwife-supported psychotherapy on depression, anxiety, and maternal health-status outcome as compared to conventional obstetric care. Of the 1,011 records, 17 articles, including 6,193 pregnant women (mean age: 28.9±2.2 years) were included in this meta-analysis. Eleven studies compared the effects of midwife-supported therapy on depression, 14 compared its effects on anxiety and 2 compared its effects on maternal health-status outcome. The meta-analysis reveals the beneficial effects of midwife-supported psychotherapy for reducing depression (Hedge's g: -0.9), anxiety (-0.8) and enhancing maternal health-status outcome (0.1), as compared to conventional obstetric care. The current systematic review and meta-analysis recommend the use of midwife-supported psychotherapy for the reduction of depression, anxiety and enhancing maternal health-status during the antenatal stage of pregnancy.
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Affiliation(s)
- Qing Han
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Min Guo
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Fenfen Ren
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Dongyun Duan
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Xiufeng Xu
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
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Gu C, Wang X, Li L, Ding Y, Qian X. Midwives’ views and experiences of providing midwifery care in the task shifting context: a meta-ethnography approach. GLOBAL HEALTH JOURNAL 2020. [DOI: 10.1016/j.glohj.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gama SGND, Viellas EF, Medina ET, Angulo-Tuesta A, Silva CKRTD, Silva SDD, Santos YRP, Esteves-Pereira AP. Delivery care by obstetric nurses in maternity hospitals linked to the Rede Cegonha, Brazil - 2017. CIENCIA & SAUDE COLETIVA 2020; 26:919-929. [PMID: 33729347 DOI: 10.1590/1413-81232021263.28482020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess whether nurses' presence in delivery care in maternity hospitals linked to the Rede Cegonha program promotes access to best obstetric practices during labor and delivery. We conducted an evaluative study in 2017 in all 606 SUS maternity hospitals that joined this strategic policy in all Brazilian states. We collected data from maternity hospital managers and puerperae. The analysis was performed at two levels: hospital with or without a nurse in delivery care; and professionals that attended vaginal delivery, whether doctors or nurses. We used best practices and interventions for vaginal deliveries and cesarean section rates as dependent variables. We included 5.016 subjects for analyses of vaginal deliveries and 9.692 to calculate cesarean section rates. Multiple regressions were adjusted for geographic region, maternity hospital size, and puerperae skin color and parity. Maternity hospitals with nurses in delivery care used more the partograph and less oxytocin, lithotomy, episiotomy, and cesarean section. Deliveries attended by nurses had more frequent use of the partograph and a lower likelihood of lithotomy and episiotomy. The inclusion of nurses in vaginal delivery care has successfully brought women closer to a more physiological and respectful delivery.
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Affiliation(s)
| | - Elaine Fernandes Viellas
- Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | | | | | | | | | - Yammê Ramos Portella Santos
- Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Ana Paula Esteves-Pereira
- Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
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Eri TS, Berg M, Dahl B, Gottfreðsdóttir H, Sommerseth E, Prinds C. Models for midwifery care: A mapping review. Eur J Midwifery 2020; 4:30. [PMID: 33537631 PMCID: PMC7839165 DOI: 10.18332/ejm/124110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION According to WHO, midwives are found competent to provide evidencebased and normalcy-facilitating maternity care. Models for midwifery care exist, but seem to be lacking explicit epistemological status, mainly focusing on the practical and organizational level of care delivery. To make the values and attitudes of care visible, it is important to implement care models with explicit epistemological status. The aim of this paper is to identify and gain an overview of publications of theoretical models for midwifery care. METHODS A mapping review was conducted with systematic searches in nine databases for studies describing a theoretical model or theory for midwifery care that either did or was intended to impact clinical practice. Eligibility criteria were refined during the selection process. RESULTS Six models from six papers originating from different parts of the world were included in the study. The included models were developed using different methodologies and had different philosophical underpinnings and complexity gradients. Some characteristics were common, the most distinctive being the emphasis of the midwife-woman relationship, secondly the focus on woman-centeredness, and thirdly the salutogenic focus in care. CONCLUSIONS Overall, scarcity exists regarding theoretical models for midwifery care with explicit epistemological status. Further research is needed in order to develop generic theoretical models with an epistemological status to serve as a knowledge base for midwifery healthcare.
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Affiliation(s)
- Tine S. Eri
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marie Berg
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- The Obstretic Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Helga Gottfreðsdóttir
- Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland
- Women´s Clinic, Landspitali University Hospital, Reykjavík, Iceland
| | - Eva Sommerseth
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Christina Prinds
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Research, University College South Denmark, Haderslev, Denmark
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Swift EM, Zoega H, Stoll K, Avery M, Gottfreðsdóttir H. Enhanced Antenatal Care: Combining one-to-one and group Antenatal Care models to increase childbirth education and address childbirth fear. Women Birth 2020; 34:381-388. [PMID: 32718800 DOI: 10.1016/j.wombi.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND We designed and implemented a new model of care, Enhanced Antenatal Care (EAC), which offers a combined approach to midwifery-led care with six one-to-one visits and four group sessions. AIM To assess EAC in terms of women's satisfaction with care, autonomy in decision-making, and its effectiveness in lowering childbirth fear. METHODS This was a quasi-experimental controlled trial comparing 32 nulliparous women who received EAC (n=32) and usual antenatal care (n=60). We compared women's satisfaction with care and autonomy in decision-making post-intervention using chi-square test. We administered a Fear of Birth Scale pre- and post-intervention and assessed change in fear of birth in each group using the Cohen's d for effect size. To isolate the effect of EAC, we then restricted this analysis to women who did not attend classes alongside maternal care (n=13 in EAC and n=13 in usual care). FINDINGS Women's satisfaction with care in terms of monitoring their and their baby's health was similar in both groups. Women receiving EAC were more likely than those in usual care to report having received enough information about the postpartum period (75% vs 30%) and parenting (91% vs 55%). Overall, EAC was more effective than usual care in reducing fear of birth (Cohen's d=-0.21), especially among women not attending classes alongside antenatal care (Cohen's d=-0.83). CONCLUSION This study is the first to report findings on EAC and suggests that this novel model may be beneficial in terms of providing education and support, as well as lowering childbirth fear.
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Affiliation(s)
- Emma Marie Swift
- Faculty of Nursing/Department of Midwifery, University of Iceland, Eirberg við Eiríksgötu, 101 Reykjavík, Iceland.
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavík, Iceland; Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Kathrin Stoll
- Division of Midwifery, University of British Columbia, Vancouver, Canada
| | - Melissa Avery
- University of Minnesota, School of Nursing, Minneapolis, MN, USA
| | - Helga Gottfreðsdóttir
- Faculty of Nursing/Department of Midwifery, University of Iceland, Eirberg við Eiríksgötu, 101 Reykjavík, Iceland; Women's Clinic, Landspitali University Hospital, 101 Reykjavik, Iceland
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González-de la Torre H, Miñarro-Jiménez S, Palma-Arjona I, Jeppesen-Gutierrez J, Berenguer-Pérez M, Verdú-Soriano J. Perceived satisfaction of women during labour at the Hospital Universitario Materno-Infantil of the Canary Islands through the Childbirth Experience Questionnaire (CEQ-E). ENFERMERIA CLINICA 2020; 31:21-30. [PMID: 32684375 DOI: 10.1016/j.enfcli.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/22/2020] [Accepted: 05/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the degree of satisfaction of women after childbirth at the Hospital Universitario Materno-Infantil of Gran Canaria (HUMIC) and to establish possible relationships between the degree of satisfaction and the variables studied. METHOD A cross-sectional, descriptive, observational study with an analytical component. The study population comprised women who gave birth at the HUMIC in November 2018, recruited through consecutive non-probabilistic sampling. The Spanish version of the Childbirth Experience Questionnaire (CEQ-E) was used (questionnaire with 4 domains: own capacity', professional support, perceived safety and participation/analytical model 2). In a first phase a descriptive analysis was made, and in a second phase an inferential analysis to explore the association between different variables. RESULTS The total sample comprised 257 women (n=257). The total score using the CEQ was 3.24 (SD .37 points). No statistically significant differences were found in the final CEQ score between the women who had a spontaneous delivery versus induction-stimulation (P=.563) or between primiparous versus multiparous women (P=.060). The women whose labour lasted 12hours or less (P=.024), without perineal trauma (P=.021) and those who had not undergone episiotomy (P=.002) achieved a better final CEQ score. Instrumental delivery (forceps) versus normal delivery is associated with lower scores with respect to the final CEQ-E score (P=≤.001). CONCLUSIONS Women's overall satisfaction after delivery in HUMIC was high. Instrumental delivery seems to be associated with lower perceived satisfaction. Aspects such as fear and fatigue in labour could affect satisfaction negatively. These aspects can be improved by establishing strategies to increase comfort and minimise pregnant women's fear of labour.
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Affiliation(s)
- Héctor González-de la Torre
- Universidad de La Laguna-Sede La Palma, Santa Cruz de Tenerife, España; Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, España.
| | - Sara Miñarro-Jiménez
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, España
| | - Inmaculada Palma-Arjona
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, España
| | - Julia Jeppesen-Gutierrez
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, España
| | - Miriam Berenguer-Pérez
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Facultad de Ciencias de la Salud, Universidad de Alicante, Alicante, España
| | - José Verdú-Soriano
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Facultad de Ciencias de la Salud, Universidad de Alicante, Alicante, España
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Zitha E, Mokgatle MM. Women's Views of and Responses to Maternity Services Rendered during Labor and Childbirth in Maternity Units in a Semi-Rural District in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145035. [PMID: 32668762 PMCID: PMC7400580 DOI: 10.3390/ijerph17145035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Abstract
Facility-based delivery is an important strategy to prevent poor labor outcomes, and midwives are at the center of maternal care. However, disrespectful and abusive maternal care by midwives is prevalent and leads to poor antenatal care utilization and increased numbers of home deliveries. The objective of the study was to assess the views of women about the care they received during labor and childbirth and describe the interactions between the women and the midwives. This was a qualitative study using in-depth interviews with women who had delivered in midwife obstetric units at a district hospital in Tshwane District, South Africa. Twenty-six women aged 18-41 years, and had delivered within the previous six months were selected, using purposive sampling. A thematic content analysis approach and NVivo11 computer software were used to identify emergent themes. Most women had had negative experiences of the maternity services they had received during labor and childbirth. Shouting and rude remarks by midwives caused tension between the midwives and the women and had created a major barrier for communication. The abuse and disrespect that the women were subjected to had created a hostile and uncaring environment for them. They felt stressed, fearful, and anxious throughout labor and childbirth. In response to the hostile environment, they employed manipulative tactics such as pushing before time in the hope of getting attention. These acts resulted in punitive responses from the midwives who joined forces against them, reprimanded, or ignored them. Good interactions, described as being respectful, approachable, and polite, and the sharing of information yielded positive experiences of maternity care. The state of maternity services rendered during labor and childbirth is counterproductive to the existing plan of increasing early antenatal care bookings and presentation to the facilities for labor and childbirth. There is a need to retrain midwives in the respectful care of women during labor and childbirth to facilitate a change in their attitudes.
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Mattison CA, Lavis JN, Wilson MG, Hutton EK, Dion ML. A critical interpretive synthesis of the roles of midwives in health systems. Health Res Policy Syst 2020; 18:77. [PMID: 32641053 PMCID: PMC7346500 DOI: 10.1186/s12961-020-00590-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwives' roles in sexual and reproductive health and rights continues to evolve. Understanding the profession's role and how midwives can be integrated into health systems is essential in creating evidence-informed policies. Our objective was to develop a theoretical framework of how political system factors and health systems arrangements influence the roles of midwives within the health system. METHODS A critical interpretive synthesis was used to develop the theoretical framework. A range of electronic bibliographic databases (CINAHL, EMBASE, Global Health database, HealthSTAR, Health Systems Evidence, MEDLINE and Web of Science) was searched through to 14 May 2020 as were policy and health systems-related and midwifery organisation websites. A coding structure was created to guide the data extraction. RESULTS A total of 4533 unique documents were retrieved through electronic searches, of which 4132 were excluded using explicit criteria, leaving 401 potentially relevant records, in addition to the 29 records that were purposively sampled through grey literature. A total of 100 documents were included in the critical interpretive synthesis. The resulting theoretical framework identified the range of political and health system components that can work together to facilitate the integration of midwifery into health systems or act as barriers that restrict the roles of the profession. CONCLUSIONS Any changes to the roles of midwives in health systems need to take into account the political system where decisions about their integration will be made as well as the nature of the health system in which they are being integrated. The theoretical framework, which can be thought of as a heuristic, identifies the core contextual factors that governments can use to best leverage their position when working to improve sexual and reproductive health and rights.
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Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
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Goemaes R, Beeckman D, Verhaeghe S, Van Hecke A. Sustaining the quality of midwifery practice in Belgium: Challenges and opportunities for advanced midwife practitioners. Midwifery 2020; 89:102792. [PMID: 32653612 DOI: 10.1016/j.midw.2020.102792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/10/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Midwifery practice is essential in achieving high-quality maternal and newborn care in all settings and countries. However, midwifery practice has become more complex over the past decades. Considerable demands are being placed on midwives to meet increasing epidemiological, socio-economic, and technological challenges. These require a well-trained midwifery workforce ready to shape the care in the near and long-term future. OBJECTIVE To discuss advanced midwife practitioner role implementation in Belgium as a possible answer to healthcare-related challenges that impact midwifery practice. Furthermore, to stimulate a debate within the profession at all levels in Belgium and in countries considering advanced midwife practitioner roles. METHOD The framework by De Geest et al. (2008) served as a basis for discussing the drivers for advanced midwife practitioner role implementation: the legal, policy and economic context, workforce issues, education, practice patterns, and healthcare needs of the population. FINDINGS A legal basis for advanced midwife practitioner role implementation is lacking in Belgium. Remuneration opportunities for the non-clinical part of these roles (e.g. leadership and innovation activities) are missing. It might be challenging for healthcare organisations to support the implementation of such roles, as immediate revenues of non-clinical activities are absent. However, sufficient potential resources are available to fill in future advanced midwife practitioner positions. Additionally, advanced midwife practitioner specific master programmes are being planned in the near future. CONCLUSIONS Although several barriers for the implementation of advanced midwife practitioner roles were identified, a discussion should be held on the opportunities of implementing these roles to facilitate the development of new models of care that meet current and future challenges in midwifery practice and healthcare. After initial discussions amongst midwives in academic, managerial, and policy positions, stakeholders such as obstetricians, general practitioners, associations representing healthcare organisations, and policy makers should be involved as a next step.
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Affiliation(s)
- Régine Goemaes
- PhD student University Centre for Nursing & Midwifery Department of Public Health and Primary Care Faculty of Medicine and Health Sciences, Ghent University. University Centre for Nursing & Midwifery Ghent University, U.Z. 5K3 Corneel Heymanslaan 10, B-9000 Ghent, Belgium.
| | - Dimitri Beeckman
- University Centre for Nursing & Midwifery Department of Public Health and Primary Care Faculty of Medicine and Health Sciences, Ghent University Centre for Nursing & Midwifery Ghent University, U.Z. 5K3 Corneel Heymanslaan 10, B-9000, Ghent, Belgium.
| | - Sofie Verhaeghe
- University Centre for Nursing & Midwifery Department of Public Health and Primary Care Faculty of Medicine and Health Sciences, Ghent University Centre for Nursing & Midwifery, Ghent University, U.Z. 5K3 Corneel Heymanslaan 10, B-9000, Ghent, Belgium.
| | - Ann Van Hecke
- University Centre for Nursing & Midwifery Department of Public Health and Primary Care Faculty of Medicine and Health Sciences, Ghent University Centre for Nursing & Midwifery, Ghent University, U.Z. 5K3 Corneel Heymanslaan 10, B-9000, Ghent, Belgium; Nursing Department, University Hospital Ghent, Corneel Heymanslaan 10, B-9000, Ghent, Belgium..
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Lewis L, Doherty DA, Conwell M, Bradfield Z, Sajogo M, Epee-Bekima M, Hauck YL. Spontaneous vaginal birth following induction with intravenous oxytocin: Three oxytocic regimes to minimise blood loss post birth. Women Birth 2020; 34:e322-e329. [PMID: 32546384 DOI: 10.1016/j.wombi.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND No evidence was identified in relation to the downward titration/cessation of intravenous oxytocin post spontaneous vaginal birth, in the absence of postpartum haemorrhage (PPH); suggesting clinicians' management is based on personal preference in the absence of evidence. AIM To determine the proportion of induced women with a spontaneous vaginal birth and PPH, when intravenous oxytocin was utilised intrapartum and ceased 15, 30 or 60minutes post birth. METHODS This three armed pilot randomised controlled trial, was undertaken on the Birth Suite of an Australian tertiary obstetric hospital. Incidence of PPH was assessed using univariable and adjusted logistic regression, which compared the effect of titrating intravenous oxytocin post birth on the likelihood of PPH, relative to the 15minute titration group. FINDINGS Postpartum haemorrhage occurred in 26% (30 of 115), 20% (23 of 116), and 22% (30 of 134) of women randomised to a 15, 30 and 60minute titration time post birth, with no statistically significant differences between groups. CONCLUSION There was no difference in the incidence of PPH between the three groups. Therefore, we question the benefit of delaying cessation of intravenous oxytocin for 60minutes post birth. Further investigation in this cohort is recommended, to compare the incidence of PPH when intravenous oxytocin is ceased either immediately, or 30minutes post birth. This research is warranted, as an evidence-based framework is lacking, to guide midwives globally in relation to their management of intravenous oxytocin post an induced spontaneous vaginal birth, in the absence of PPH.
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Affiliation(s)
- Lucy Lewis
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, 6008, Australia.
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, Perth, Western Australia 6009, Australia.
| | - Marion Conwell
- Labour and Birth Suite, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, 6008, Australia.
| | - Zoe Bradfield
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, 6008, Australia.
| | - Monica Sajogo
- Pharmacy Department, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, 6008, Australia.
| | - Mathias Epee-Bekima
- Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, Perth, Western Australia 6009, Australia; Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Subiaco, Perth, Western Australia 6008, Australia.
| | - Yvonne L Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, 6008, Australia.
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Commentary: Creating a definition for global midwifery centers. Midwifery 2020; 85:102684. [DOI: 10.1016/j.midw.2020.102684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 11/24/2022]
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Anna MA, Olga CV, Rocío CS, Isabel SP, Xavier ET, Pablo RC, Montserrat PA, Cristina GB, Ramon E. Midwives' experiences of the factors that facilitate normal birth among low risk women in public hospitals in Catalonia (Spain). Midwifery 2020; 88:102752. [PMID: 32521407 DOI: 10.1016/j.midw.2020.102752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal birth has major benefits for women and infants. Nevertheless, during the last few decades, the advancement in technology and an increasing domination of obstetrician-led childbirths have resulted in the medicalization of childbirth. Midwives are interested in amending this trend and aim to support women to achieve the best possible birth experience for them. OBJECTIVE This study aimed to explore midwives' experiences on the facilitators and barriers of normal birth in conventional obstetric units. DESIGN A descriptive qualitative study. Three focus groups were audio recorded and transcribed verbatim. Recurrent themes were identified and formulated. Feedback from data were analysed using thematic analysis. Investigator triangulation was used during the analysis. SETTING Midwives from eleven different public hospitals in Catalonia participated in the study. PARTICIPANTS A purposive sample of 33 midwives participated in the focus groups. FINDINGS Midwives identified several factors that complicated their task of facilitating normal birth. Barriers included: (1) inadequate institutional support; (2) existing obstetrician-led practices, (3) lack of evidence-based practice and (4) midwives' lack of awareness of professional competencies. Factors facilitating normal birth included: (1) midwives' positive perceptions of normal birth, (2) midwives' additional effort and (3) women's awareness of normal birth. KEY CONCLUSIONS Midwives wishing to promote normal birth in obstetric units face a number of challenges and often feel unsupported. Nonetheless, the midwives perceive the increasing women's demand for normal births as an opportunity to implement changes in such a way that women are involved in the decision-making process and midwives act as their advocates. IMPLICATIONS FOR PRACTICE There is a need to increase the midwifery workforce and enhance regulations and funding strategies to support their practice as well as normal birth. Policy makers in settings without well-functioning midwife-led care should consider implementing this model after successfully scaling up of the number of midwives and ensuring an effective midwifery training.
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Affiliation(s)
- Martin-Arribas Anna
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.; School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Canet-Velez Olga
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Casañas Sanchez Rocío
- Escola Superior d'Infermeria del Mar (ESIM), Universidad Pompeu Fabra (UPF), Carrer Dr. Aiguader 80, 08003 Barcelona, Spain.; Centre d'Higiene Mental Les Corts, CHM Salut Mental Barcelona, Carrer de Numància 103 Baixos, 08029 Barcelona, Spain..
| | - Salgado Poveda Isabel
- Vall d'Hebron University Hospital, Carrer Vall d'Hebron 119-129, 08035 Barcelona, Spain..
| | - Espada-Trespalacios Xavier
- Obstetric care area. Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Bacelona, Spain..
| | - Rodriguez Coll Pablo
- Maternal and Child Healthcare Department. Fundació Sanitària de Mollet, Ronda Pinetons 8, 08100 Mollet del Vallès, Bacelona, Spain..
| | | | - González-Blázquez Cristina
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain..
| | - Escuriet Ramon
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain..
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Anggraini D, Abdollahian M, Marion K, Asmu'i, Meilania GT, Annisa AS. Improving the Information Availability and Accessibility of Antenatal Measurements to Ensure Safe Delivery: A Research-Based Policy Recommendation to Reduce Neonatal Mortality in Indonesia. Int J Womens Health 2020; 12:369-380. [PMID: 32440231 PMCID: PMC7212777 DOI: 10.2147/ijwh.s247213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/30/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose Assessing the risks and preventable causes of maternal and neonatal mortality requires the availability of good-quality antenatal information. In Indonesia, however, access to reliable information on pregnancy-related results remains challenging. This research has proposed a research-based policy recommendation to improve availability and accessibility to vital information on antenatal examinations. Patients and Methods Descriptive statistics were used to characterize midwives’ capabilities in routinely gathering and recording antenatal information during pregnancy. The investigation was carried out among 19 midwives in South Kalimantan, Indonesia, from April 2016 to October 2017. Antenatal data on 4946 women (retrospective study) and 381 women (prospective study) have been accessed through a scientific and technical training program. Results To date, lack of timely access to antenatal information has hampered the process of reducing neonatal mortality in Indonesia. The post-training statistical analysis showed that the training has significantly improved midwives’ scientific knowledge and technical abilities in providing more reliable data on antenatal measurements. Conclusion Consistent scientific and technical training among midwives is required to update their knowledge and skills, particularly those relating to documenting the results of antenatal examinations at different stages of pregnancy and using that information to assess potential risks and identify necessary interventions. This should also be followed by routine monitoring on the quality of collected antenatal data. This can be one of the enabling actions to achieve the 2030 Sustainable Development Goals target in reducing neonatal mortality in Indonesia.
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Affiliation(s)
- Dewi Anggraini
- Study Program of Statistics, Faculty of Mathematics and Natural Sciences, Lambung Mangkurat University, Banjarbaru, South Kalimantan, Indonesia
| | - Mali Abdollahian
- School of Science, College of Science, Engineering, and Health, RMIT University, Melbourne, VIC, Australia
| | - Kaye Marion
- School of Science, College of Science, Engineering, and Health, RMIT University, Melbourne, VIC, Australia
| | - Asmu'i
- Study Program of Public Administration, Faculty of Social and Political Sciences, Lambung Mangkurat University, Banjarmasin, South Kalimantan, Indonesia
| | - Gusti Tasya Meilania
- Study Program of Statistics, Faculty of Mathematics and Natural Sciences, Lambung Mangkurat University, Banjarbaru, South Kalimantan, Indonesia
| | - Auliya Syifa Annisa
- Study Program of Statistics, Faculty of Mathematics and Natural Sciences, Lambung Mangkurat University, Banjarbaru, South Kalimantan, Indonesia
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Distribution of midwives in Mongolia: A secondary data analysis. Midwifery 2020; 86:102704. [PMID: 32208230 DOI: 10.1016/j.midw.2020.102704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Midwives are at the core of strengthening the health system, especially in the crucial period around pregnancy, childbirth, and the early weeks of life. In 2016, the national-level maternal mortality ratio in Mongolia was 48.6 deaths per 100,000 live births, but this was much higher (up to 212.9 deaths/100,000) in some rural provinces of the country. The wide variation in maternal mortality between urban and rural areas of Mongolia might be related to the distribution of midwives and equity of access to maternity care. OBJECTIVES In the present study, we aimed to determine the distribution of midwives in each province of Mongolia and to examine inequality in the distribution of midwives nationwide. DESIGN A secondary data analysis. METHODS Data from the Centre of Health Development and the National Statistical Office of Mongolia were obtained and analysed. First, we assessed the distribution of midwives at provincial and regional levels, along with the association between these distributions and the maternal mortality ratio in 2016. We then calculated the inequality of these distributions using the Gini coefficient and examined trends for the years 2010-2016. We compared results for urban, suburban, and rural provinces. Rural areas are sparsely populated and enormous in size, so it may be difficult access to basic healthcare services. It was considered important, therefore, to assess the number of midwives per 1000 km2 as well as the commonly used indicator of per 10,000 population. RESULTS When the land area in each province was taken into consideration rather than only the population, wider variations between urban, suburban, and rural provinces became apparent. Provinces varied according to the number of midwives per 10,000 population by a factor of three (range 2.0-6.2/midwives); while provinces varied according to the number of midwives per 1000 km2 by a factor of approximately 300 (range 0.2-61.2/midwives). The Gini coefficient for the number of midwives per 10,000 population in 2016, R = 0.201, revealed "relative" equality. This was slightly reduced from R = 0.305 in 2010 and indicated a shift toward equality. However, the Gini coefficient for the number of midwives per 1000 km2 area indicated "severe" inequality of R = 0.524 in 2016. This was increased from R = 0.466 in 2010, indicating that no improvement has been seen over these years. CONCLUSIONS Our study suggests that two different measures of midwifery distribution should be used as indicators: number of midwives "per 10,000 population" and "per 1000 km2 area". In rural areas such as parts of Mongolia, geographical features and population density are important features of the local context. To deliver healthcare services in a timely manner and within a reasonable distance for pregnant women who need care, the indicator of per 1000 km2 area would be more suitable for rural and sparsely populated areas than the indicator of per 10,000 population, which is commonly used for urban and settled areas. Based on our findings, to reduce the wide gap in MMR between rural and urban areas, we recommend at least one midwife per 1000 km2 area in rural regions of Mongolia.
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Mattison CA, Lavis JN, Hutton EK, Dion ML, Wilson MG. Understanding the conditions that influence the roles of midwives in Ontario, Canada's health system: an embedded single-case study. BMC Health Serv Res 2020; 20:197. [PMID: 32164698 PMCID: PMC7068956 DOI: 10.1186/s12913-020-5033-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the significant variability in the role and integration of midwifery across provincial and territorial health systems, there has been limited scholarly inquiry into whether, how and under what conditions midwifery has been assigned roles and integrated into Canada's health systems. METHODS We use Yin's (2014) embedded single-case study design, which allows for an in-depth exploration to qualitatively assess how, since the regulation of midwives in 1994, the Ontario health system has assigned roles to and integrated midwives as a service delivery option. Kingdon's agenda setting and 3i + E theoretical frameworks are used to analyze two recent key policy directions (decision to fund freestanding midwifery-led birth centres and the Patients First primary care reform) that presented opportunities for the integration of midwives into the health system. Data were collected from key informant interviews and documents. RESULTS Nineteen key informant interviews were conducted, and 50 documents were reviewed in addition to field notes taken during the interviews. Our findings suggest that while midwifery was created as a self-regulated profession in 1994, health-system transformation initiatives have restricted the profession's integration into Ontario's health system. The policy legacies of how past decisions influence the decisions possible today have the most explanatory power to understand why midwives have had limited integration into interprofessional maternity care. The most important policy legacies to emerge from the analyses were related to payment mechanisms. In the medical model, payment mechanisms privilege physician-provided and hospital-based services, while payment mechanisms in the midwifery model have imposed unintended restrictions on the profession's ability to practice in interprofessional environments. CONCLUSIONS This is the first study to explain why midwives have not been fully integrated into the Ontario health system, as well as the limitations placed on their roles and scope of practice. The study also builds a theoretical understanding of the integration process of healthcare professions within health systems and how policy legacies shape service delivery options.
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Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
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Attanasio LB, Alarid-Escudero F, Kozhimannil KB. Midwife-led care and obstetrician-led care for low-risk pregnancies: A cost comparison. Birth 2020; 47:57-66. [PMID: 31680337 DOI: 10.1111/birt.12464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/13/2019] [Accepted: 10/03/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Low-risk pregnant women cared for by midwives have similar birth outcomes to women cared for by physicians, although experiencing fewer medical procedures. However, limited research has assessed cost implications in the United States. Using national data, we assessed costs and resource use of midwife-led care vs obstetrician-led care for low-risk pregnancies using a decision-analytic approach. METHODS We developed a decision-analytic model of costs (health plan payments to clinicians) and use of medical procedures during childbirth (epidural analgesia, labor induction, cesarean birth, episiotomy) and outcomes of care (birth at preterm gestation) that may differ with midwife-led vs obstetrician-led care. Model parameters for obstetric procedures were generated using Listening to Mothers III data, a national survey of women who gave birth in US hospitals in 2011-2012 and other published estimates. Cost estimates came from published or publicly available information on health insurance claims payments. RESULTS The costs of childbirth for low-risk women with midwife-led care were, on average, $2262 less than births to low-risk women cared for by obstetricians. These cost differences derive from lower rates of preterm birth and episiotomy among women with midwife-led care, compared with obstetrician-led care. Across the population of US women with low-risk births each year (approximately 2.6 million), the model predicted substantially fewer preterm births (167 259 vs 219 427 for midwife-led vs obstetrician-led care) and fewer episiotomies (170 504 vs 415 686, for midwife-led vs obstetrician-led care). CONCLUSIONS A shift from obstetrician-led care to midwife-led care for low-risk pregnancies could be cost saving.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Katy B Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Hospital accreditation: Driving best outcomes through continuity of midwifery care? A scoping review. Women Birth 2020; 34:113-121. [PMID: 32111556 DOI: 10.1016/j.wombi.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 01/26/2023]
Abstract
PROBLEM Continuity of midwifery care models are the gold standard of maternity care. Despite being recommended by the Australian Health Ministers' Advisory Council, few women in Australia have access to such models. BACKGROUND Extensive research shows that if all women had access to continuity of midwifery care, maternal and neonatal outcomes would improve. Hospital accreditation, the main national safety and quality system in Australia, aims to encourage and enable the translation of healthcare quality and safety standards into practice. AIM This paper explored the realities and possibilities of a health care accreditation system driving health service re-organisation towards the provision of continuity of midwifery care for childbearing women. METHODS A scoping review sought literature at the macro (policy) level. From 3036 records identified, the final number of sources included was 100:73 research articles and eight expert opinion pieces/editorials from journals, 15 government/accreditation documents, three government/accreditation websites, and one thesis. FINDINGS Two narrative themes emerged: (1) Hospital accreditation: 'Here to stay' but no clear evidence and calls for change. (2) Measuring and implementing quality and safety in maternity care. DISCUSSION Regulatory frameworks drive hospitals' priorities, potentially creating conditions for change. The case for reform in the hospital accreditation system is persuasive and, in maternity services, clear. Mechanisms to actualise the required changes in maternity care are less apparent, but clearly possible. CONCLUSIONS Structural changes to Australia's health accreditation system are needed to prioritise, and mandate, continuity of midwifery care.
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Cadée F, Nieuwenhuijze MJ, Lagro-Janssen ALM, de Vries R. Paving the way for successful twinning:: Using grounded theory to understand the contribution of twin pairs in twinning collaborations. Women Birth 2020; 34:14-21. [PMID: 32089457 DOI: 10.1016/j.wombi.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Twinning collaborations, where two groups - from educational institutions, hospitals or towns - work together cross-culturally on joint goals, are increasingly common worldwide. Pairing up individuals, so-called twin pairs, is thought to contribute to successful collaboration in twinning projects, but as yet, there is no empirical evidence or theory that offers insight into the value of the pair relationship for twinning. AIM To explore the contribution of one-to-one relationships between twins to twinning projects, as exemplified in projects between Dutch and Moroccan, and Dutch and Sierra Leone midwives. METHODS We conducted thirteen in-depth interviews with midwives from two twinning collaborations. Interviews were transcribed and analysed using an iterative, grounded theory process, yielding a theoretical understanding of one-to-one twinning relationships for twinning collaborations. FINDINGS Participant comments fell into four substantive categories: 1) Being named a twin, 2) moving beyond culture to the personal level, 3) searching for common ground to engage, 4) going above and beyond the twinning collaboration. Their interplay demonstrates the value of twin pairs in paving the way for successful twinning. DISCUSSION A complex combination of contextual inequities, personality, and cultural differences affect the twin relationship. Trusting relationships promote effective collaboration, however, as 'trust' cannot be mandated, it must be built by coaching twins in personal flexibility and (cultural) communication. CONCLUSION By offering original insights into the ways twinning relationships are built, our research explores how twin pairs can enhance the success of twinning projects.
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Affiliation(s)
- Franka Cadée
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands.
| | - Marianne J Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
| | - A L M Lagro-Janssen
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Raymond de Vries
- Center for Bioethics and Social Sciences in Medicine University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, 419W, Ann Arbor, MI 48109-2800, USA
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Home and Birth Center Birth in the United States: Time for Greater Collaboration Across Models of Care. Obstet Gynecol 2020; 133:1033-1050. [PMID: 31022111 DOI: 10.1097/aog.0000000000003215] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There has been a small, but significant, increase in community births (home and birth-center births) in the United States in recent years. The rate increased by 20% from 2004 to 2008, and another 59% from 2008 to 2012, though the overall rate is still low at less than 2%. Although the United States is not the only country with a large majority of births occurring in the hospital, there are other high-resource countries where home and birth-center birth are far more common and where community midwives (those attending births at home and in birth centers) are far more central to the provision of care. In many such countries, the differences in perinatal outcomes between hospital and community births are small, and there are lower rates of maternal morbidity in the community setting. In the United States, perinatal mortality appears to be higher for community births, though there has yet to be a national study comparing outcomes across settings that controls for planned place of birth. Rates of intervention, including cesarean delivery, are significantly higher in hospital births in the United States. Compared with the United States, countries that have higher rates of community births have better integrated systems with clearer national guidelines governing risk criteria and planned birth location, as well as transfer to higher levels of care. Differences in outcomes, systems, approaches, and client motivations are important to understand, because they are critical to the processes of person-centered care and to risk reduction across all birth settings.
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121
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Sochas L. The predictive power of health system environments: a novel approach for explaining inequalities in access to maternal healthcare. BMJ Glob Health 2020; 4:e002139. [PMID: 32154033 PMCID: PMC7044705 DOI: 10.1136/bmjgh-2019-002139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction The growing use of Geographic Information Systems (GIS) to link population-level data to health facility data is key for the inclusion of health system environments in analyses of health disparities. However, such approaches commonly focus on just a couple of aspects of the health system environment and only report on the average and independent effect of each dimension. Methods Using GIS to link Demographic and Health Survey data on births (2008–13/14) to Service Availability and Readiness Assessment data on health facilities (2010) in Zambia, this paper rigorously measures the multiple dimensions of an accessible health system environment. Using multilevel Bayesian methods (multilevel analysis of individual heterogeneity and discriminatory accuracy), it investigates whether multidimensional health system environments defined with reference to both geographic and social location cut across individual-level and community-level heterogeneity to reliably predict facility delivery. Results Random intercepts representing different health system environments have an intraclass correlation coefficient of 25%, which demonstrates high levels of discriminatory accuracy. Health system environments with four or more access barriers are particularly likely to predict lower than average access to facility delivery. Including barriers related to geographic location in the non-random part of the model results in a proportional change in variance of 74% relative to only 27% for barriers related to social discrimination. Conclusions Health system environments defined as a combination of geographic and social location can effectively distinguish between population groups with high versus low probabilities of access. Barriers related to geographic location appear more important than social discrimination in the context of Zambian maternal healthcare access. Under a progressive universalism approach, resources should be disproportionately invested in the worst health system environments.
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Affiliation(s)
- Laura Sochas
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Homer C. 2020 is the International Year of the Midwife: Announcing a special issue. Women Birth 2020; 33:1-2. [PMID: 31987468 DOI: 10.1016/j.wombi.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Developing of a new guideline for improving birth experiences among Iranian women: a mixed method study protocol. Reprod Health 2020; 17:17. [PMID: 32000775 PMCID: PMC6993433 DOI: 10.1186/s12978-020-0868-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/19/2020] [Indexed: 11/28/2022] Open
Abstract
Background The childbirth experience has significant effects on the life of the mother and family. However, there are no Iranian studies which evaluate and measure women’s childbirth experiences to provide accurate data on this important matter. The aim of this study is to develop a new guideline to improve women’s childbirth experiences by meeting their needs and expectations. Methods/design The present study will use the mixed method with the explanatory sequential approach. Phase one is a cross-sectional survey with random cluster sampling of the health centers in Tabriz. Eight hundred primiparous women will be selected to measure their childbirth experiences and predictors factors. Phase two is a qualitative study to explore women’s perceptions of the aspects and determinants of the childbirth experience. Phase two participants will be selected using purposive sampling from the women who participated in phase one. Phase three involves developing a new guideline to improve women’s childbirth experiences. The new guideline will be developed based on the following elements: a) the results of the qualitative and quantitative data from phase one and two, b) a review of the related literature, and c) expert opinions that have been collected using the Delphi technique. Discussion By exploring women’s childbirth experiences and the influencing factors, a culturally sensitive evidence-based guideline can be developed. The provision of the evidence-based guideline resulting from this study might be effective in improving the quality care of the services for pregnant women. Ethical code IR.TBZMED.REC.1396.786.
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Peters M, Kolip P, Schäfers R. A theory of the aims and objectives of midwifery practice: A theory synthesis. Midwifery 2020; 84:102653. [PMID: 32044538 DOI: 10.1016/j.midw.2020.102653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Every discipline has a dichotomous objective by which it recognizes whether its work has been successful (Vogd, 2011). For midwifery care, no objective has been set in this way so far. This also has implications for measuring quality, because quality of care is only measurable if objectives have been identified. This paper aims to contribute to theory formation in midwifery science by analysing existing concepts and theories and preferences of women to midwifery care to answer the question of the dichotomous objective of midwifery. METHOD AND FINDINGS The method of theory synthesis (Walker and Avant, 2011) was used to analyse existing theories and concepts of midwifery care and literature-based preferences of women to midwifery care and synthesize them with regard to the objectives of midwifery care. The synthesis took place in the form of a means-end chain to extract the dichotomous target of midwifery care. In this way, the objectives of midwifery could be compared and linked from both the scientific and from women's perspective. The resulting means-end chain model of the process of midwifery describes the aims and objectives of midwifery from the point of view of women on three levels. DISCUSSION The hierarchical model of the process of midwifery presented here is a first attempt to illustrate the aims and objectives of midwifery practice in a means-end chain model in order to facilitate discussion on the topic and to make the quality of midwifery care measurable. Measurement is a first step towards improving quality of midwifery care and thereby improving women's reproductive capabilities.
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Affiliation(s)
- Mirjam Peters
- Bielefeld University, Bielefeld School of Public Health, Germany; The Hochschule für Gesundheit, University of Applied Sciences (hsg), Department of Applied Sciences, Germany.
| | - Petra Kolip
- Bielefeld University, Bielefeld School of Public Health, Germany
| | - Rainhild Schäfers
- The Hochschule für Gesundheit, University of Applied Sciences (hsg), Department of Applied Sciences, Germany
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Bly KC, Ellis SA, Ritter RJ, Kantrowitz-Gordon I. A Survey of Midwives' Attitudes Toward Men in Midwifery. J Midwifery Womens Health 2020; 65:199-207. [PMID: 31904186 DOI: 10.1111/jmwh.13060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The midwifery profession in the United States demonstrates a significant lack of diversity. The critical need to address the lack of racial and ethnic diversity in the midwifery workforce is well recognized; little attention, however, has been given to gender diversity. This study focused on gender diversity within midwifery, specifically with regard to men who are midwives. Nearly 99% of midwives in the United States are women. No research has previously explored the attitudes of the predominantly female midwifery workforce toward its male members. METHODS An invitation to an internet survey was sent to the American College of Nurse-Midwives (ACNM) membership. Quantitative and open-ended questions assessed attitudes toward and experiences with male midwives, whether members thought men belong in the profession, whether gender impacts quality of care, if ACNM should facilitate gender diversification, and whether exposure to male midwives impacts attitudes toward gender diversification. Data analysis of qualitative responses used a qualitative description methodology to identify common themes. RESULTS Six thousand, nine hundred sixty-five surveys were distributed, and 864 participants completed the survey. Respondents reported beliefs that men belong in midwifery (71.4%), that gender does not affect quality of care (74%), and that ACNM should support gender diversity (72%). Respondents' perspectives revealed 3 dichotomous themes pertaining to the core nature of midwifery and how men fit within the profession: 1) inclusion versus exclusion, 2) empowerment versus protection, and 3) sharing with versus taking from. Often, the same respondent expressed both aspects of the dichotomy simultaneously. DISCUSSION This study contributes new information about midwives' attitudes and beliefs toward gender diversity in midwifery in the United States. The values of professionalism, tradition, feminism, protection, and diversification inform participant responses. Findings support efforts toward gender diversification and have implications for implementation in education and practice.
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Affiliation(s)
- K C Bly
- Perinatal Department, CommuniCare Health Centers, Davis, California
| | | | | | - Ira Kantrowitz-Gordon
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington.,Providence Medical Group, Everett, Washington
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Lama TP, Munos MK, Katz J, Khatry SK, LeClerq SC, Mullany LC. Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal. BMC Health Serv Res 2020; 20:16. [PMID: 31906938 PMCID: PMC6945781 DOI: 10.1186/s12913-019-4871-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 12/24/2019] [Indexed: 01/08/2023] Open
Abstract
Background Increased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care. Methods Using an audit tool and interviews, respectively, facility readiness and health providers’ knowledge of maternal and immediate newborn care were assessed at all 23 birthing centers (BCs) and the District hospital in the rural southern Nepal district of Sarlahi. Facility readiness to perform specific functions was assessed through descriptive analysis and comparisons by facility type (health post (HP), primary health care center (PHCC), private and District hospital). Knowledge was compared by facility type and by additional skilled birth attendant (SBA) training. Results Infection prevention items were lacking in more than one quarter of facilities, and widespread shortages of iron/folic acid tablets, injectable ampicillin/gentamicin, and magnesium sulfate were a major barrier to facility readiness. While parenteral oxytocin was commonly provided, only the District hospital was prepared to perform all seven basic emergency obstetric and newborn care signal functions. The required number of medical doctors, nurses and midwives were present in only 1 of 5 PHCCs. Private sector SBAs had significantly lower knowledge of active management of third stage of labor and correct diagnosis of severe pre-eclampsia. While half of the health workers had received the mandated additional two-month SBA training, comparison with the non-trained group showed no significant difference in knowledge indicators. Conclusions Facility readiness to provide quality maternal and newborn care is low in this rural area of Nepal. Addressing the gaps by facility type through regular monitoring, improving staffing and supply chains, supervision and refresher trainings is important to improve quality.
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Affiliation(s)
- Tsering P Lama
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W5009C, Baltimore, MD, 21205, USA
| | - Melinda K Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W5009C, Baltimore, MD, 21205, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W5009C, Baltimore, MD, 21205, USA
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W5009C, Baltimore, MD, 21205, USA.,Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W5009C, Baltimore, MD, 21205, USA.
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127
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Mohapatra S, Wiley LF. Feminist Perspectives in Health Law. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:103-115. [PMID: 31955688 DOI: 10.1177/1073110519898047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This essay argues that feminist legal theory offers an important, and underutilized, perspective to examine health law and policy. We use several theoretical frameworks developed by feminist legal theorists including relational autonomy, intersectionality, vulnerability theory, and the feminist critique of the public-private divide to demonstrate the utility of these theories to health law analysis. These frameworks provide insights relevant not only to issues that obviously relate to gender, but also to matters of choice, quality, and access that are less obviously gender-related. We map three key areas of existing scholarship and future inquiry at the intersection of health law and feminist legal theory: (I) patient choice and relational autonomy, (II) patriarchy, power and patient safety, and (III) access to health care and healthy living conditions at the public-private divide. Uniting these areas of inquiry is a nagging question central to the relationship between critical legal scholarship (including feminist scholarship) and pragmatic action to combat injustice: Can we use legal rights to achieve our aims even as we recognize them as tainted tools that have propped up oppressive social structures? A feminist agenda for health law and policy must grapple with this dilemma.
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Affiliation(s)
- Seema Mohapatra
- Seema Mohapatra, J.D., M.P.H., is an Associate Professor of Law and Dean's Fellow at Indiana University Robert H. McKinney School of Law. Lindsay F. Wiley, J.D., M.P.H., is a Professor of Law and Director of the Health Law and Policy Program at American University Washington College of Law
| | - Lindsay F Wiley
- Seema Mohapatra, J.D., M.P.H., is an Associate Professor of Law and Dean's Fellow at Indiana University Robert H. McKinney School of Law. Lindsay F. Wiley, J.D., M.P.H., is a Professor of Law and Director of the Health Law and Policy Program at American University Washington College of Law
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128
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Thompson SM, Nieuwenhuijze MJ, Low LK, De Vries R. “A powerful midwifery vision”: Dutch student midwives’ educational needs as advocates of physiological childbirth. Women Birth 2019; 32:e576-e583. [DOI: 10.1016/j.wombi.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/28/2018] [Accepted: 12/16/2018] [Indexed: 12/01/2022]
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Tuyisenge G, Crooks VA, Berry NS. Facilitating equitable community-level access to maternal health services: exploring the experiences of Rwanda's community health workers. Int J Equity Health 2019; 18:181. [PMID: 31771605 PMCID: PMC6880498 DOI: 10.1186/s12939-019-1065-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Rwanda, community health workers (CHWs) are an integral part of the health system. For maternal health, CHWs are involved in linking members of the communities in which they live to the formal health care system to address preventative, routine, and acute maternal care needs. Drawing on the findings from in-depth interviews with maternal health CHWs and observational insights in ten Rwandan districts, we identify specific strategies CHWs employ to provide equitable maternal care while operating in a low resource setting. METHODS Using case study methodology approach, we conducted interviews with 22 maternal health CHWs to understand the nature of their roles in facilitating equitable access to maternal care in Rwanda at the community level. Interviews were conducted in five Rwandan districts. Participants shared their experiences of and perceptions on promoting equitable access to maternal health service in their communities. RESULTS Four key themes emerged during the analytic process that characterize the contexts and strategic ways in which maternal health CHWs facilitate equitable access to maternal care in an environment of resource scarcity. They are: 1) community building; 2) physical landscapes, which serve as barriers or facilitators both to women's care access and CHWs' equitable service provision; 3) the post-crisis socio-political environment in Rwanda, which highlights resilience and the need to promote maternal health subsequent to the genocide of 1994; and, 4) the strategies used by CHWs to circumvent the constraints of a resource-poor setting and provide equitable maternal health services at the community level. CONCLUSION Rwanda's maternal CHWs are heavily responsible for promoting equitable access to maternal health services. Consequently, they may be required to use their own resources for their practice, which could jeopardize their own socio-economic welfare and capacity to meet the demands of their families. Considering the unpaid and untrained nature of this position, we highlight the factors that threaten the sustainability of CHWs' role to facilitate equitable access to maternal care. These threats introduce turbulence into what is a relatively successful community-level health care initiative.
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Affiliation(s)
- Germaine Tuyisenge
- Department of Geography, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6 Canada
| | - Valorie A. Crooks
- Department of Geography, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6 Canada
| | - Nicole S. Berry
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Bogren M, Erlandsson K, Johansson A, Kalid M, Abdi Igal A, Mohamed J, Said F, Pedersen C, Byrskog U, Osman F. Health workforce perspectives of barriers inhibiting the provision of quality care in Nepal and Somalia - A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 23:100481. [PMID: 31783321 DOI: 10.1016/j.srhc.2019.100481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In this paper settings from Nepal and Somalia are used to focus on the perspectives of healthcare providers within two fragile health systems. The objective of this study was to describe barriers inhibiting quality healthcare in Nepal and Somalia from a health workforce perspective. METHODS Data were collected through 19 semi-structured interviews with healthcare providers working in healthcare facilities. Ten interviews were conducted in Nepal and nine in Somalia. RESULTS Various structural barriers inhibiting the availability, accessibility, and acceptability of the quality care were similar in both countries. Barriers inhibiting the availability of quality care were linked to healthcare providers being overburdened with multiple concurrent jobs. Barriers inhibiting the accessibility to quality healthcare included long distances and the uncertain availability of transportation, and barriers to acceptability of quality healthcare was inhibited by a lack of respect from healthcare providers, characterised by neglect, verbal abuse, and lack of competence. CONCLUSIONS Inequality, poverty, traditional and cultural practices plus the heavy burden placed on healthcare providers are described as the underlying causes of the poor provision of quality care and the consequential shortcomings that emerge from it. In order to improve this situation adequate planning and policies that support the deployment and retention of the healthcare providers and its equitable distribution is required. Another important aspect is provision of training to equip healthcare providers with the ability to provide respectful quality care in order for the population to enjoy good standard of healthcare services.
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Affiliation(s)
- Malin Bogren
- Institute of Health Care and Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | | | | | | | | | - Fatumo Said
- Ministry of Health, Garowe, Puntland, Somalia
| | - Christina Pedersen
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Fatumo Osman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
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131
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Janssens S, Simon R, Barwick S, Clipperton S, Beckmann M, Marshall S. Midwifery leadership in maternity emergencies: a video analysis. J Interprof Care 2019:1-7. [PMID: 31696750 DOI: 10.1080/13561820.2019.1675611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
Maternity emergencies require effective leadership due to their time-critical high stakes nature, and like many emergency teams are recommended to have a singular leader. Midwives possess many of the skills required for leadership, but the extent to which they contribute to leadership in emergencies is unknown. In this video analysis study of 16 interprofessional teams responding to a simulated post-partum hemorrhage, a functional view of leadership was applied to determine midwifery contribution to leadership. The number and type of leadership utterances by team members during an emergency response was assessed, and midwifery and doctor leadership utterances compared. Midwives contributed just over 40% of all leadership utterances, indicating the occurrence of interprofessional shared leadership, despite the recommendation for a singular leadership. While the number of leadership utterances per scenario was similar for midwives and doctors, midwives contributed less to utterances of a clinical nature compared to doctors but a similar amount of non-clinical leadership. Further exploration of the factors which influence midwifery leadership in emergencies and the impact it may have on patient care is warranted.
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Affiliation(s)
- Sarah Janssens
- Mater Misericordiae Brisbane Ltd, Mothers Babies and Womens' Health Services, Brisbane, Australia
- Monash University, Department of Anaesthesia and Perioperative Medicine, Melbourne, Australia
- University of Queensland, School of Medicine, Brisbane, Australia
- Mater Education Ltd. Brisbane, Australia
| | - Robert Simon
- Center for Medical Simulation, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | | | | | - Michael Beckmann
- Mater Misericordiae Brisbane Ltd, Mothers Babies and Womens' Health Services, Brisbane, Australia
- University of Queensland, School of Medicine, Brisbane, Australia
| | - Stuart Marshall
- Monash University, Department of Anaesthesia and Perioperative Medicine, Melbourne, Australia
- University of Melbourne, Department of Medical Education, Melbourne, Australia
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132
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Mortensen B, Diep LM, Lukasse M, Lieng M, Dwekat I, Elias D, Fosse E. Women's satisfaction with midwife-led continuity of care: an observational study in Palestine. BMJ Open 2019; 9:e030324. [PMID: 31685501 PMCID: PMC6858166 DOI: 10.1136/bmjopen-2019-030324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES A midwife-led continuity model of care had been implemented in the Palestinian governmental health system to improve maternal services in several rural areas. This study investigated if the model influenced women's satisfaction with care, during antenatal, intrapartum and postnatal period. DESIGN An observational case-control design was used to compare the midwife-led continuity model of care with regular maternity care. PARTICIPANTS AND SETTING Women with singleton pregnancies, who had registered for antenatal care at a rural governmental clinic in the West Bank, were between 1 to 6 months after birth invited to answer a questionnaire rating satisfaction with care in 7-point Likert scales. PRIMARY OUTCOME The mean sum-score of satisfaction with care through the continuum of antenatal, intrapartum and postnatal period, where mean sum-scores range from 1 (lowest) to 7 (highest). SECONDARY OUTCOME Exclusive breastfeeding. RESULTS Two hundred women answered the questionnaire, 100 who received the midwife-led model and 100 who received regular care. The median time point of interview were 16 weeks postpartum in both groups. The midwife-led model was associated with a statistically significant higher satisfaction with care during antenatal, intrapartum and postnatal period, with a mean sum-score of 5.2 versus 4.8 in the group receiving regular care. The adjusted mean difference between the groups' sum-score of satisfaction with care was 0.6 (95% CI 0.35 to 0.85), p<0.0001. A statistically significant higher proportion of women who received the midwife-led continuity model of care were still exclusively breastfeeding at the time point of interview, 67% versus 46% in the group receiving regular care, an adjusted OR of 2.56 (1.35 to 4.88) p=0.004. CONCLUSIONS There is an association between receiving midwife-led continuity of care and increased satisfaction with care through the continuum of pregnancy, intrapartum and postpartum period, and an increased duration of exclusive breastfeeding. TRIAL REGISTRATION NUMBER NCT03863600.
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Affiliation(s)
- Berit Mortensen
- Oslo University Hospital The Intervention Centre, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lien M Diep
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Mirjam Lukasse
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health and Social Sciences, University of Southeast Norway, Oslo, Norway, Oslo, Norway
| | - Marit Lieng
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Ibtesam Dwekat
- Faculty of Health Professions, Al Quds University, Jerusalem, Palestine
| | - Dalia Elias
- Faculty of Nursing and Health Sciences, Bethlehem University, Bethlehem, Palestine
| | - Erik Fosse
- Oslo University Hospital The Intervention Centre, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Radoff K, Forman R. Lactation Education for Resident Obstetricians: Promoting Breastfeeding Advocates for the Future. J Midwifery Womens Health 2019; 64:754-762. [PMID: 31608544 DOI: 10.1111/jmwh.13037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022]
Abstract
Obstetrics and gynecology residency training programs are historically lacking in breastfeeding education and advocacy. Healthy People 2020 supports interventions that promote breastfeeding as a primary care strategy with significant health benefits to the newborn and woman. Midwives are well poised to engage obstetrics and gynecology residents in lactation education. A few educational interventions have been described in the literature to increase knowledge, confidence, and behavior related to lactation among residents. This article describes a breastfeeding education curriculum developed by midwifery faculty at Boston University School of Medicine. The project included 3 lectures and a simulation center workshop covering topics including lactogenesis, prenatal, intrapartum, and postpartum interventions that promote or limit lactation, hands-on latch assistance, hand expression, use of breast pumps and storage of human milk, and common disorders of lactation. Postintervention evaluations demonstrated improvements in knowledge and confidence. Providing breastfeeding education to resident physicians may be an intervention to promote patient breastfeeding education and support and close the gap of disparities in breastfeeding rates.
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Affiliation(s)
- Kari Radoff
- Boston University School of Medicine, Boston, Massachusetts
| | - Rosha Forman
- Boston University School of Medicine, Boston, Massachusetts
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Bruns DP, Pawloski L, Robinson C. Can Adoption of Cuban Maternity Care Policy Guide the Rural United States to Improve Maternal and Infant Mortality? WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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135
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Goyet S, Broch-Alvarez V, Becker C. Quality improvement in maternal and newborn healthcare: lessons from programmes supported by the German development organisation in Africa and Asia. BMJ Glob Health 2019; 4:e001562. [PMID: 31565404 PMCID: PMC6747907 DOI: 10.1136/bmjgh-2019-001562] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/02/2019] [Accepted: 07/27/2019] [Indexed: 11/25/2022] Open
Abstract
Improving the quality of maternal and child healthcare (MCH) is a mandatory step on the path to reaching the Sustainable Development Goals and Universal Health Coverage. Quality improvement (QI) in MCH is a strong focus of the bilateral development cooperation provided by Germany to help strengthen the health systems of countries with high maternal and child mortality rates and/or with high unmet needs for family planning. In this article, we report on the findings of an analysis commissioned by a community of practice on MCH, of Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ). The objectives were to review the QI interventions implemented through programmes which have received technical assistance from GIZ on behalf of the German Federal Ministry for Economic Cooperation and Development in 14 Asian and African countries, to identify and describe the existing approaches and their results, and finally to draw lessons learnt from their implementation. Our analysis of the information contained in programme documents and reports identified five main methodologies used to improve the quality of care: capacity-building and supervision, governance and regulation, systemic QI at facility level, support to infrastructures, and community support. It is difficult to attribute the observed progresses in maternal and neonatal health to a particular agency, programme or intervention. We acknowledge that systemic implementation research embedded within the programmes would facilitate an understanding of the determinants of successful QI interventions, would better assess their effectiveness, and therefore better guide future bilateral aid programmatic decisions.
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Affiliation(s)
| | - Valerie Broch-Alvarez
- Health and social protection, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Kathmandu, Nepal
| | - Cornelia Becker
- Maternal and Newborn Care, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia
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Renfrew MJ, Ateva E, Dennis-Antwi JA, Davis D, Dixon L, Johnson P, Kennedy HP, Knutsson A, Lincetto O, McConville F, McFadden A, Taniguchi H, Ten Hoope Bender P, Zeck W. Midwifery is a vital solution-What is holding back global progress? Birth 2019; 46:396-399. [PMID: 31270851 DOI: 10.1111/birt.12442] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Mary J Renfrew
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Elena Ateva
- White Ribbon Alliance, Washington, District of Columbia
| | | | - Deborah Davis
- ACT Government Health Directorate and University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | | | | | | | | | | | - Alison McFadden
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Hatsumi Taniguchi
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Towards Resilient Health Systems in Sub-Saharan Africa: A Systematic Review of the English Language Literature on Health Workforce, Surveillance, and Health Governance Issues for Health Systems Strengthening. Ann Glob Health 2019; 85. [PMID: 31418540 PMCID: PMC6696789 DOI: 10.5334/aogh.2514] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Meeting health security capacity in sub-Saharan Africa will require strengthening existing health systems to prevent, detect, and respond to any threats to health. The purpose of this review was to examine the literature on health workforce, surveillance, and health governance issues for health systems strengthening. Methods: We searched PubMed, Science Direct, Cochrane library, CINAHL, Web of Science, EMBASE, EBSCO, Google scholar, and the WHO depository library databases for English-language publications between January 2007 and February 2017. Electronic searches for selected articles were supplemented by manual reference screening. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: Out of 1,548 citations retrieved from the electronic searches, 31 articles were included in the review. Any country health system that trains a cadre of health professionals on the job, reduces health workforce attrition levels, and builds local capacity for health care workers to apply innovative mHealth technologies improves health sector performance. Building novel surveillance systems can improve clinical care and improve health system preparedness for health threats. Effective governance processes build strong partnerships for health and create accountability mechanisms for responding to health emergencies. Conclusions: Overall, policy shifts in African countries’ health systems that prioritize training a cadre of willing and able workforce, invest in robust and cost-effective surveillance capacity, and create financial accountability and good governance are vital in health strengthening efforts.
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Garcia-Lausin L, Perez-Botella M, Duran X, Mamblona-Vicente MF, Gutierrez-Martin MJ, Gómez de Enterria-Cuesta E, Escuriet R. Relation between Length of Exposure to Epidural Analgesia during Labour and Birth Mode. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162928. [PMID: 31443209 PMCID: PMC6720813 DOI: 10.3390/ijerph16162928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/02/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
Objective: To appraise the relationship between the length of exposure to epidural analgesia and the risk of non-spontaneous birth, and to identify additional risk factors. This study is framed within the MidconBirth project. Study design: A multicentre prospective study was conducted between July 2016 and November 2017 in three maternity hospitals in different Spanish regions. The independent variable of the study was the length of exposure to epidural analgesia, and the dependent variable was the type of birth in women with uncomplicated pregnancies. The data was analyzed separately by parity. A multivariate logistic regression was performed. The odds ratios (OR), using 95% confidence intervals (CI) were constructed. Main outcome measures: During the study period, 807 eligible women gave birth. Non-spontaneous births occurred in 29.37% of the sample, and 75.59% received oxytocin for augmentation of labour. The mean exposure length to epidural analgesia when non-spontaneous birth happened was 8.05 for primiparous and 6.32 for multiparous women (5.98 and 3.37 in spontaneous birth, respectively). A logistic regression showed the length of exposure to epidural during labour was the major predictor for non-spontaneous births in primiparous and multiparous women followed by use of oxytocin (multiparous group). Conclusions: The length of exposure to epidural analgesia during labour is associated with non-spontaneous births in our study. It highlights the need for practice change through the development of clinical guidelines, training programs for professionals and the continuity of midwifery care in order to support women to cope with labour pain using less invasive forms of analgesia. Women also need to be provided with evidence-based information.
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Affiliation(s)
- Laura Garcia-Lausin
- Department of Experimental and Health Science, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain.
- Parc de Salut Mar, 08003 Barcelona, Spain.
| | - Mercedes Perez-Botella
- Department of Experimental and Health Science, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Research in Childbirth and Health Unit (ReaRH), University of Central Lancashire, 100, Picketlaw Road, G76 0BF Glasgow, UK
| | - Xavier Duran
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | | | | | | | - Ramon Escuriet
- Centre for Research in Health and Economics, University Pompeu Fabra, 08005 Barcelona, Spain
- Catalan Health Service, Government of Catalonia, 08028 Barcelona, Spain
- Faculty of Health Sciences, University Ramon Llull-Blanquerna, 08025 Barcelona, Spain
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Wahlström S, Björklund M, Munck B. The professional role of skilled birth attendants' in Nepal - A phenomenographic study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 21:60-66. [PMID: 31395235 DOI: 10.1016/j.srhc.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to describe the Nepali Skilled Birth Attendants' (SBAs) perceptions of their professional role. METHODS Fifteen Nepalese SBAs were interviewed using a semi-structured interview guide. A phenomenographic approach was chosen to describe their qualitatively different and unreflective conceptions of the professional role. Data was analysed in a seven-step process and three description categories and six conceptions emerged. RESULTS The SBAs described the role as provider, the role as counsellor and the role as educator. As provider, the SBA maintained midwifery nursing and prevented maternal deaths. As counsellor, the SBA advocated and empowered women and facilitated family planning. As educator, the SBA promoted health of families and health in the society. She also tutored students and colleagues about skills and human rights. CONCLUSION The SBAs' vulnerability emerged especially in rural areas while preventing complications and newborn and maternal death in rural areas where she often worked alone with lack of proper equipment and access to other medical professionals. The SBAs perceived that their professional roles required knowledge and experiences, were safety was closely linked to health education. Ethical dilemma could arose when they had to relate to the families' cultural decisions. Education was a key factor connected to close life-saving procedures and to retain good quality and safety in newborn and maternal healthcare. The SBAs switched between their three roles, always striving to be aware of compliance with the Sustainable Development Goals policy.
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Affiliation(s)
- Solveig Wahlström
- Department of Nursing, School of Health and Welfare, Jönköping University, P.O. Box 1026, SE-551 11 Jönköping, Sweden; ADULT Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Margereth Björklund
- Department of Nursing, School of Health and Welfare, Jönköping University, P.O. Box 1026, SE-551 11 Jönköping, Sweden; ADULT Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Berit Munck
- Department of Nursing, School of Health and Welfare, Jönköping University, P.O. Box 1026, SE-551 11 Jönköping, Sweden; ADULT Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Pre-service and in-service education and training for maternal and newborn care providers in low- and middle-income countries: An evidence review and gap analysis. Midwifery 2019; 78:104-113. [PMID: 31419781 DOI: 10.1016/j.midw.2019.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Good quality midwifery care has the potential to reduce both maternal and newborn mortality and morbidity in high, low, and lower-middle income countries (LMIC) and needs to be underpinned by effective education. There is considerable variation in the quality of midwifery education provided globally. OBJECTIVE To determine what are the most efficient and effective ways for LMICs to conduct pre-service and in-service education and training in order to adequately equip care providers to provide quality maternal and newborn care. DESIGN Rapid Systematic Evidence Review METHODS: A systematic search of the following databases was conducted: Medline, CINAHL, LILACs, PsycInfo, ERIC, and MIDIRs. Studies that evaluated the effects of pre-service and in-service education that were specifically designed to train, educate or upskill care providers in order to provide quality maternal and newborn care were included. Data was extracted and presented narratively. FINDINGS Nineteen studies were included in the review. Of these seven were evaluations of pre-service education programmes and 12 were evaluations of in-service education programmes. Whilst studies demonstrated positive effects on knowledge and skills, there was a lack of information on whether this translated into behaviour change and positive effects for women and babies. Moreover, the level of the evidence was low and studies often lacked an educational framework and theoretical basis. Mapping the skills taught in each of the programmes to the Quality Maternal and Newborn Care framework (Renfrew et al., 2014) identified that interventions focused on very specific or individual clinical skills and not on the broader scope of midwifery. KEY CONCLUSIONS There is a very limited quantity and quality of peer reviewed published studies of the effectiveness of pre service and in service midwifery education in LMICs; this is at odds with the importance of the topic to survival, health and well-being. There is a preponderance of studies which focus on training for specific emergencies during labour and birth. None of the in-service programmes considered the education of midwives to international standards with the full scope of competencies needed. There is an urgent need for the development of theoretically informed pre-service and in-service midwifery education programmes, and well-conducted evaluations of such programmes. Upscaling quality midwifery care for all women and newborn infants is of critical importance to accelerate progress towards Sustainable Development Goal 3. Quality midwifery education is an essential pre-requisite for quality care. To deliver SDG 3, the startling underinvestment in midwifery education identified in this review must be reversed.
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Leone T, Alburez-Gutierrez D, Ghandour R, Coast E, Giacaman R. Maternal and child access to care and intensity of conflict in the occupied Palestinian territory: a pseudo longitudinal analysis (2000-2014). Confl Health 2019; 13:36. [PMID: 31406504 PMCID: PMC6686248 DOI: 10.1186/s13031-019-0220-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/30/2019] [Indexed: 12/03/2022] Open
Abstract
Background In the occupied Palestinian territory (oPt), access to maternal and child healthcare (MCH) services are constrained due to the prolonged Israeli military occupation, the Separation Wall, army checkpoints, and restrictions on the movement of people and goods. This study assesses the relationship between conflict intensity and access to Maternal and Child Health care in occupied Palestinian territory (oPt). To the best of our knowledge, the impact of conflict on access to health care has not been measured due to the lack of data. Methods We analyse pooled data from household surveys covering a fifteen-year period (2000–2014) of children (n = 16,793) and women (n = 8477) in five regions of the oPt. Conflict intensity was used as a continuous variable defined as the square root of non-combatant conflict mortality taken from monthly death rates of non-combatants by region. We use multilevel logistic models to explain four outputs: child vaccination schedules, antenatal care, caesarean sections, and complications during pregnancy. Results Locality is important with results showing the negative impact of conflict intensity on access to care, especially in the South West Bank for maternal health services and Central West Bank for vaccination (B − 0.161 p = 0.000 for DPT). Wealth is only significant for DPT vaccinations with poorest (B − 0.098 p = 0.005) and poor (B − 0.148 p = 0.002) individuals less likely to access services. Otherwise conflict does not show a differential effect across socio-economic conditions. Conclusions This study shows how locality is the strongest factor when looking at the impact of conflict in the oPt. Preventative services (ANC and vaccinations) are the most affected by conflict. We recommend a greater use of community health care to improve access to maternal and child care when barriers impede access to health facilities during times of conflict.
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Affiliation(s)
- Tiziana Leone
- 1Department of International Development, London School of Economics and Political Science, London, UK
| | - Diego Alburez-Gutierrez
- 2Department of Social Policy, London School of Economics and Political Science, London, UK.,4Present Address: Max Plank Institute for Demographic Research, Rostock, Germany
| | - Rula Ghandour
- 3Institute of Community and Public Health University of Birzeit, Birzeit, State of Palestine
| | - Ernestina Coast
- 1Department of International Development, London School of Economics and Political Science, London, UK
| | - Rita Giacaman
- 3Institute of Community and Public Health University of Birzeit, Birzeit, State of Palestine
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Matlala MS, Lumadi TG. Perceptions of midwives on shortage and retention of staff at a public hospital in Tshwane District. Curationis 2019; 42:e1-e10. [PMID: 31368315 PMCID: PMC6676782 DOI: 10.4102/curationis.v42i1.1952] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Midwifery is the backbone of women and child healthcare. The shortage of staff in maternity units is a crisis faced by many countries worldwide, including South Africa. OBJECTIVES This study aims to explore the perceptions of midwives on the shortage and retention of staff at a public institution. METHOD The study was conducted at one of the tertiary hospitals in Tshwane District, Gauteng Province. A total of 11 midwives were interviewed through face-to-face and focus group interviews. An explorative, descriptive generic qualitative design method was followed, and a non-probability, purposive sampling technique was used. Thematic coding analysis was followed for analysing data. RESULTS The impact of shortage of midwives was reported to be directly related to poor provision of quality care as a result of increased workload, leading to low morale and burnout. The compromised autonomy of midwives in the high obstetrics dependency units devalues the status of midwives. CONCLUSION Midwives are passionate about their job, despite the hurdles related to their day-to-day work environment. They are demoralised by chronic shortage of staff and feel overworked. Staff involvement in decision-making processes is a motivational factor for midwives to stay in the profession. The midwives need to be in the centre of the decision-making processes related to their profession. The revision of the scope of practice and classification of midwifery profession away from general nursing complex by the South African Nursing Council (SANC) could place midwifery in its rightful status.
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Affiliation(s)
- Mosehle S Matlala
- Department of Health Studies, School of Social Sciences, University of South Africa, Pretoria.
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143
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Sheffel A, Heidkamp R, Mpembeni R, Bujari P, Gupta J, Niyeha D, Aung T, Bakengesa V, Msuya J, Munos M, Kennedy C. Understanding client and provider perspectives of antenatal care service quality: a qualitative multi-method study from Tanzania. J Glob Health 2019; 9:011101. [PMID: 31275570 PMCID: PMC6596286 DOI: 10.7189/jogh.09.01101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Measures of quality of care in low- and middle-income countries (LMICs) rarely include experience of care. This gap in service quality metrics may be driven by a lack of understanding of client and provider perspectives. Understanding these perspectives is a critical first step in not only improving metrics, but also in improving service delivery. This study identifies the items antenatal care (ANC) clients and health care providers in Tanzania associate with a quality ANC service and explores the experience of care domain from both client and provider perspectives. Methods We conducted semi-structured interviews with15 providers and 35 clients in Tanzania that included a free-listing activity to elicit items clients and providers associate with quality ANC services. We analyzed the free-listing for rank order and frequency to identify the most salient items, which were included in the second phase of data collection. We then conducted semi-structured interviews with a pile sort activity with the same 15 providers and 32 new clients to understand the importance of the items identified in the free-listing. We used a thematic analysis driven by the framework approach to analyze interview data. Results Both clients and providers perceived quality of ANC as being comprised of items related to experience of care, provision of care, and cross-cutting essential physical and human resources. The free-listing findings illuminated that the experience of care was equally important to clients and providers as the availability of physical and human resources and the content of the care delivered. In addition, clients and providers perceived that a positive patient care experience – marked by good communication, active listening, keeping confidentiality, and being spoken to politely – increased utilization of health services and improved health outcomes. Conclusions The experience of care in LMICs is an overlooked, yet critically important topic. Understanding the experience of care from those who receive and deliver services is key to measuring and improving the quality of ANC. Our research highlights the importance of incorporating experience of care into future quality improvement activities and quality measures. By doing so, we identify barriers and facilitating factors of practical use to policy-makers and governments in LMICs.
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Affiliation(s)
- Ashley Sheffel
- Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA
| | - Rebecca Heidkamp
- Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA
| | - Rose Mpembeni
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Peter Bujari
- Health Promotion Tanzania. Dar es Salaam, United Republic of Tanzania
| | - Jaya Gupta
- Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA
| | - Debora Niyeha
- Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA
| | - Tricia Aung
- Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA
| | - Victor Bakengesa
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, United Republic of Tanzania
| | - John Msuya
- Sokoine University of Agriculture, Morogoro, United Republic of Tanzania
| | - Melinda Munos
- Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA
| | - Caitlin Kennedy
- Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA
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Tobiasson M, Lyberg A. Fear of childbirth from the perspective of midwives working in hospitals in Norway: A qualitative study. Nurs Open 2019; 6:1180-1188. [PMID: 31367444 PMCID: PMC6650651 DOI: 10.1002/nop2.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/10/2019] [Accepted: 05/10/2019] [Indexed: 11/11/2022] Open
Abstract
AIM To illuminate the perceptions of hospital-based midwives who support women suffering from moderate to severe fear of childbirth during an expected vaginal birth. DESIGN A qualitative descriptive and explorative study. METHODS Focus group interviews were conducted with 18 midwives representing four different hospitals in Norway. RESULTS Encountering fear of childbirth evoked the desire to protect and help, although the ability to provide optimal support was dependent on several circumstances, several of which were beyond the midwives̕ control. The main theme "Midwives finding their own strength when encountering the vulnerability of women with fear of childbirth" consisted of two themes: "Being present" and "Being alone." The midwives described being present as a prerequisite for continuity of care and affirmation. The emphasis on continuity of care could give rise to a sense of loneliness and guilt during and after demanding situations in the birthing room.
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Affiliation(s)
- Marthe Tobiasson
- Centre for Women̕ s, Family and Child Health, Department of Nursing and Health Sciences, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
| | - Anne Lyberg
- Centre for Women̕ s, Family and Child Health, Department of Nursing and Health Sciences, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
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Thompson SM, Nieuwenhuijze MJ, Low LK, De Vries R. Creating Guardians of Physiologic Birth: The Development of an Educational Initiative for Student Midwives in the Netherlands. J Midwifery Womens Health 2019; 64:641-648. [DOI: 10.1111/jmwh.12999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/26/2019] [Accepted: 05/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Suzanne M. Thompson
- CAPHRI School for Public Health and Primary CareUniversity of Maastricht Maastricht The Netherlands
- Research Center for Midwifery ScienceZuyd University of Applied Sciences Maastricht The Netherlands
| | | | - Lisa Kane Low
- School of NursingUniversity of Michigan Ann Arbor Michigan
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in MedicineUniversity of Michigan Ann Arbor Michigan
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146
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Midwives' perceptions of women's mobile phone use and impact on care in birth suite. Midwifery 2019; 76:142-147. [PMID: 31207448 DOI: 10.1016/j.midw.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/23/2019] [Accepted: 06/02/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women's use of mobile phones while in birth suite has been recognised as a common occurrence. However, no evidence has been reported around midwives' perceptions of how women's mobile phone use impacts midwifery care in birth suite. OBJECTIVE To explore midwives' perceptions of women's mobile phone use and impact on care in the labour and birth environment. METHODS A qualitative descriptive study was undertaken. Transcriptions from focus groups were subjected to thematic analysis. FINDINGS Ten focus groups involving 63 Australian midwives were conducted. Four key themes and corresponding subthemes were identified: 'considering consent' which encompassed the subthemes 'establishing boundaries' and 'taken by surprise'; 'competing with the phone' encompassing 'missing the experience' and 'delaying care'; 'being with woman' encompassing 'affecting relationships' and 'not my right to deny'; and finally 'bringing others into the room' with subthemes of 'keeping in touch' and 'seeking a second opinion'. CONCLUSIONS This is the first study to explore midwives perceptions of women's mobile phone use and the impact on a midwife's ability to provide care in birth suite. Findings suggest that women's mobile phone use can influence the relationship between the midwife and the woman and contributes to delays in providing care. Midwives shared how they experienced tensions around their right to grant permission for their image to be recorded. Finally, mobile phones have allowed others not present in the birth suite to access women and influence their decision making. IMPLICATIONS FOR PRACTICE It is widely recognised women are bringing their mobile phones into the labour and birth environment. Therefore, it is important we explore midwives perceptions around the tensions and concerns that exist, so they can be addressed.
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147
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Sudhinaraset M, Giessler K, Golub G, Afulani P. Providers and women's perspectives on person-centered maternity care: a mixed methods study in Kenya. Int J Equity Health 2019; 18:83. [PMID: 31182105 PMCID: PMC6558853 DOI: 10.1186/s12939-019-0980-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background Globally, there has been increasing attention to women’s experiences of care and calls for a person-centered care approach. At the heart of this approach is the patient-provider relationship. It is necessary to examine the extent to which providers and women agree on the care that is provided and received. Studies have found that incongruence between women’s and providers’ perceptions may negatively impact women’s compliance, satisfaction, and future use of health facilities. However, there are no studies that examine patient and provider perspectives on person-centered care. Methods To fill this gap in the literature, we use cross-sectional data of 531 women and 33 providers in seven government health facilities in Kenya to assess concordance and discordance in person-centered care measures. Additionally, we analyze 41 in-depth interviews with providers from three of these facilities to examine why differences in reporting may occur. Descriptive statistical methods were used to measure the magnitude of differences between reports of women and reports of providers. Thematic analyses were conducted for provider surveys. Results Our findings suggest high discordance between women and providers’ perspectives in regard to person-centered care experiences. On average, women reported lower levels of person-centered care compared to providers, including low respectful and dignified care, communication and autonomy, and supportive care. Providers were more likely to report higher rates of poor health facility environment such as having sufficient staff. We summarize the overarching reasons for the divergence in women and provider reports as: 1) different understanding or interpretation of person-centered care behaviors, and 2) different expectations, norms or values of provider behaviors. Providers rationalized abuse towards women, did not allow a companion of choice, and blamed women for poor patient-provider communication. Women lacked assurance in privacy and confidentiality, and faced challenges related to the health facility environment. Providers attributed poor person-centered care to both individual and facility/systemic factors. Conclusions Implications of this study suggests that providers should be trained on person-centered care approaches and women should be counseled on understanding patient rights and how to communicate with health professionals.
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Affiliation(s)
- May Sudhinaraset
- University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, USA. .,School of Medicine, University of California, San Francisco, USA.
| | - Katie Giessler
- School of Medicine, University of California, San Francisco, USA
| | | | - Patience Afulani
- School of Medicine, University of California, San Francisco, USA
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Sheffel A, Heidkamp R, Mpembeni R, Bujari P, Gupta J, Niyeha D, Aung T, Bakengesa V, Msuya J, Munos M, Kennedy C. Understanding client and provider perspectives of antenatal care service quality: a qualitative multi-method study from Tanzania. J Glob Health 2019. [DOI: 10.7189/jogh.09.011101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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149
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Nagle C, McDonald S, Morrow J, Kruger G, Cramer R, Couch S, Hartney N, Bryce J, Birks M, Heartfield M. Informing the development midwifery standards for practice: A literature review for policy development. Midwifery 2019; 76:8-20. [PMID: 31150936 DOI: 10.1016/j.midw.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 05/17/2019] [Accepted: 05/19/2019] [Indexed: 11/16/2022]
Abstract
AIM To critically appraise and synthesise the literature regarding the role and scope of midwifery practice, specifically to inform the evidence based development of standards for practice for all midwives in Australia. DESIGN A structured scoping review of the literature DATA SOURCES: CINAHL Complete, MEDLINE Complete and Cochrane Libraries databases, online and grey literature databases REVIEW METHODS: Comprehensive searches of databases used key words and controlled vocabulary for each database to search for publications 2006-2016. Studies were not restricted by research method. FINDINGS There is no substantive body of literature on midwifery competency standards or standards for practice. From 1648 papers screened, twenty-eight papers were identified to inform this review. Eight studies including systematic reviews were annotated with three research papers further assessed as having direct application to this review. To inform the development of Midwife standards for practice, the comprehensive role of the midwife across multiple settings was seen to include: woman centred and primary health care; safe supportive and collaborative practice; clinical knowledge and skills with interpersonal and cultural competence. KEY CONCLUSIONS Midwifery practice is not restricted to the provision of direct clinical care and extends to any role where the midwife uses midwifery skills and knowledge. This practice includes working in clinical and non-clinical relationships with the woman and other clients as well as working in management, administration, education, research, advisory, regulatory, and policy development roles. IMPLICATIONS FOR PRACTICE This review articulates the definition, role and scope of midwifery practice to inform the development of contemporary standards for practice for the Australian midwife.
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Affiliation(s)
- Cate Nagle
- James Cook University, Centre for Nursing and Midwifery Research, 1 James Cook Drive, Townsville, Queensland 4814 Australia; Townsville Hospital and Health Service, 100 Angus Smith Drive, Douglas QLD 4814 Australia.
| | - Susan McDonald
- La Trobe University, School of Nursing and Midwifery, Kingsbury Dr Bundoora, Victoria 3086, Australia; Mercy Health, Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Jane Morrow
- Australian Catholic University, School of Nursing, Midwifery and Paramedicine, 115 Victoria Parade, Fitzroy, 3065 Victoria, Australia
| | - Gina Kruger
- St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia
| | - Rhian Cramer
- Federation University, School of Nursing Midwifery and Healthcare, Mt Helen Campus, Ballarat, Victoria 3353 Australia
| | - Sara Couch
- Australian Nursing and Midwifery Accreditation Council, Level 1, 15 Lancaster Place, Majura Park, Canberra Airport, 2609 ACT, Australia
| | - Nicole Hartney
- Deakin University, School of Nursing and Midwifery, 1 Gheringhap St, Geelong 3220, Victoria, Australia
| | - Julianne Bryce
- Australian Nursing and Midwifery Federation, Level 1, 365 Queen Street Melbourne 3000, Victoria, Australia
| | - Melanie Birks
- James Cook University, Centre for Nursing and Midwifery Research, 1 James Cook Drive, Townsville, Queensland 4814 Australia
| | - Marie Heartfield
- Deakin University, School of Nursing and Midwifery, 1 Gheringhap St, Geelong 3220, Victoria, Australia
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Haruna U, Kansanga MM, Bagah DA. Repositioning traditional birth attendants to provide improved maternal healthcare services in rural Ghana. Int J Health Plann Manage 2019; 34:e987-e994. [PMID: 30945362 DOI: 10.1002/hpm.2779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
Following the World Health Organization's recommendation for developing countries to discontinue the use of Traditional Birth Attendants (TBAs) in rural areas, the government of Ghana banned TBAs from offering maternal health care services. Since this ban, community-level conflicts have intensified between TBAs, (who still see themselves as legitimate culturally mandated traditional midwives) and nurses. In this articles, we propose a partnership model for a sustainable resolution of these conflicts. This article emanates from the apparent ideological discontent between people from mainstream medical practice who advocate for the complete elimination of TBAs in the maternal health service space and individuals who argue for the inclusion of TBAs in the health sector given the shortage of skilled birth attendants and continued patronage of their services by rural women even in context where nurses are available. In the context of the longstanding manpower deficit in the health sector in Ghana, improving maternal healthcare in rural communities will require harnessing all locally available human resources. This cannot be achieved by "throwing out" a critical group of actors who have been involved in health-care provision for many decades. We propose a win-win approach that involve retraining of TBAs, partnership with health practitioners, and task shifting.
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Affiliation(s)
- Umar Haruna
- Department of Social, Political and Historical Studies, Faculty of Integrated Development Studies, University for Development Studies, Wa, Ghana
| | - Moses M Kansanga
- Department of Geography, University of Western Ontario, London, Canada
| | - Daniel A Bagah
- Department of Social, Political and Historical Studies, Faculty of Integrated Development Studies, University for Development Studies, Wa, Ghana
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