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Lewis L, Hauck YL, Crichton C, Barnes C, Poletti C, Overing H, Keyes L, Thomson B. The perceptions and experiences of women who achieved and did not achieve a waterbirth. BMC Pregnancy Childbirth 2018; 18:23. [PMID: 29320998 PMCID: PMC5763519 DOI: 10.1186/s12884-017-1637-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is a gap in knowledge and understanding relating to the experiences of women exposed to the opportunity of waterbirth. Our aim was to explore the perceptions and experiences of women who achieved or did not achieve their planned waterbirth. METHODS An exploratory design using critical incident techniques was conducted between December 2015 and July 2016, in the birth centre of the tertiary public maternity hospital in Western Australia. Women were telephoned 6 weeks post birth. Demographic data included: age; education; parity; and previous birth mode. Women were also asked the following: what made you choose to plan a waterbirth?; what do you think contributed to you having (or not having) a waterbirth?; and which three words would you use to describe your birth experience? Frequency distributions and univariate comparisons were employed for quantitative data. Thematic analysis was undertaken to extract common themes from the interviews. RESULTS A total of 31% (93 of 296) of women achieved a waterbirth and 69% (203 of 296) did not. Multiparous women were more likely to achieve a waterbirth (57% vs 32%; p < 0.001). Women who achieved a waterbirth were less likely to have planned a waterbirth for pain relief (38% vs 52%; p = 0.24). The primary reasons women gave for planning a waterbirth were: pain relief; they liked the idea; it was associated with a natural birth; it provided a relaxing environment; and it was recommended. Two fifths (40%) of women who achieved a waterbirth suggested support was the primary reason they achieved their waterbirth, with the midwife named as the primary support person by 34 of 37 women. Most (66%) women who did not achieve a waterbirth perceived this was because they experienced an obstetric complication. The words women used to describe their birth were coded as: affirming; distressing; enduring; natural; quick; empowering; and long. CONCLUSIONS Immersion in water for birth facilitates a shift of focus from high risk obstetric-led care to low risk midwifery-led care. It also facilitates evidence based, respectful midwifery care which in turn optimises the potential for women to view their birthing experience through a positive lens.
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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, Western Australia 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, Western Australia Australia
| | | | - Courtney Barnes
- King Edward Memorial Hospital, Subiaco, Western Australia Australia
| | - Corrinne Poletti
- King Edward Memorial Hospital, Subiaco, Western Australia Australia
| | - Helen Overing
- King Edward Memorial Hospital, Subiaco, Western Australia Australia
| | - Louise Keyes
- King Edward Memorial Hospital, Subiaco, Western Australia Australia
| | - Brooke Thomson
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102 Australia
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202
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Baloyi OB, Mtshali NG. Clinical reasoning skills in undergraduate midwifery education: A concept analysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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203
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Lori JR, Moyer CA, Dzomeku V, Nakua EK, Agyei-Baffour P, Rominski S. Achieving universal coverage: Understanding barriers to rural placement for final year midwifery students. Midwifery 2017; 58:44-49. [PMID: 29288896 DOI: 10.1016/j.midw.2017.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/18/2017] [Accepted: 12/07/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE the objective of this study is to understand the barriers final year midwifery students face when deciding to practice in a rural, deprived area. DESIGN a cross-sectional study design using a computer based structured survey. SETTING 15 of the 16 publicly funded midwifery colleges across all ten regions in Ghana. PARTICIPANTS a national sample of final-year midwifery students from publically funded midwifery colleges in Ghana. MEASUREMENTS basic frequencies and percentages were calculated for the variables cited as the top three factors motivating participants to study midwifery stratified by student type (post-basic verses diploma) and program location (urban, peri-urban, and rural). Odds ratios were calculated using separate logistic regression models to analyze the relationship between students' experience with rural communities and how it affected their willingness to work in a rural area following graduation. FINDINGS eight hundred and fifty-six midwifery students (N = 856) completed a computerised survey for a response rate of 91.8%. The top motivation to study midwifery was a 'desire to help others'. Over half (55%) of participants reported they will 'definitely work' (11%) or 'were likely to work' (44%) in a deprived area. When examined by student type and location of school, the top reason cited by participants was 'to serve humanity'. Those born in a rural area, currently living in a rural area, or under obligation to return to a rural or peri-urban area had greater odds of being willing to work in a deprived area after graduation. KEY CONCLUSIONS findings from our study are unique in that they examine the distinct motivational factors from a national sample of midwifery students about to join the workforce. Regardless of the type of student or the location of the school, midwifery students in Ghana were highly motivated by altruistic values. Strategies to address the rural shortage of midwifery providers in Ghana is presented. IMPLICATION FOR PRACTICE understanding the factors that motivate midwifery students to work in rural, deprived areas will help develop effective policy interventions affecting practice.
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Affiliation(s)
- Jody R Lori
- University of Michigan, School of Nursing, 400 N. Ingalls Bldg., Suite 3320, Ann Arbor, MI 48109, USA.
| | - Cheryl A Moyer
- University of Michigan, University of Michigan Medical School, 1111 Catherine Street, Ann Arbor, MI 48109, USA
| | - Veronica Dzomeku
- Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi, Ghana
| | | | - Peter Agyei-Baffour
- Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi, Ghana
| | - Sarah Rominski
- University of Michigan, University of Michigan Medical School, 1111 Catherine Street, Ann Arbor, MI 48109, USA
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204
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Fontein-Kuipers Y, Romeijn E. ISeeYou - Evaluation of a woman-centred care pilot project in Bachelor midwifery education and research. Midwifery 2017; 58:1-5. [PMID: 29241146 DOI: 10.1016/j.midw.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 11/18/2022]
Abstract
AIM to evaluate the ISeeYou project that aims to equip first year Bachelor midwifery students to support them in their learning of providing woman-centred care. METHODS the project has an ethnographic design. First year midwifery students buddied up to one woman throughout her continuum of the childbirth process and accompanied her during her antenatal and postnatal care encounters. Participant-observation was utilised by the students to support their learning. The Client Centred Care Questionnaire (CCCQ) was administered to collect data about women's care experiences. The project was evaluated using the SWOT model. MAIN FINDINGS 54 first year students completed the project and observed and evaluated on average eight prenatal visits and two postnatal visits. Students gained insight into women's lived experiences during the childbirth process and of received care throughout this period. Students reported that this was meaningful and supported and enhanced their comprehension of women-centred care. Logistic issues (lectures, travel, time) and being conscious of their role as an 'outsider' sometimes constrained, but never hindered, the students in meeting the requirements of the project. Overall, the project provided students with opportunities to expand competencies and to broaden their outlook on midwifery care. CONCLUSION the project offers students unique and in-depth experiences supporting and augmenting their professional competencies and their personal, professional and academic development.
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Affiliation(s)
- Yvonne Fontein-Kuipers
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands; Institute for Healthcare - School of Midwifery Education, Rotterdam University of Applied Sciences Rochussenstraat 198 3015 EK Rotterdam, Netherlands.
| | - Enja Romeijn
- Institute for Healthcare - School of Midwifery Education, Rotterdam University of Applied Sciences Rochussenstraat 198 3015 EK Rotterdam, Netherlands.
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Vedam S, Stoll K, Rubashkin N, Martin K, Miller-Vedam Z, Hayes-Klein H, Jolicoeur G. The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth. SSM Popul Health 2017; 3:201-210. [PMID: 29349217 PMCID: PMC5768993 DOI: 10.1016/j.ssmph.2017.01.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Abuse of human rights in childbirth are documented in low, middle and high resource countries. A systematic review across 34 countries by the WHO Research Group on the Treatment of Women During Childbirth concluded that there is no consensus at a global level on how disrespectful maternity care is measured. In British Columbia, a community-led participatory action research team developed a survey tool that assesses women's experiences with maternity care, including disrespect and discrimination. METHODS A cross-sectional survey was completed by women of childbearing age from diverse communities across British Columbia. Several items (31/130) assessed characteristics of their communication with care providers. We assessed the psychometric properties of two versions of a scale (7 and 14 items), among women who described experiences with a single maternity provider (n=2514 experiences among 1672 women). We also calculated the proportion and selected characteristics of women who scored in the bottom 10th percentile (those who experienced the least respectful care). RESULTS To demonstrate replicability, we report psychometric results separately for three samples of women (S1 and S2) (n=2271), (S3, n=1613). Analysis of item-to-total correlations and factor loadings indicated a single construct 14-item scale, which we named the Mothers on Respect index (MORi). Items in MORi assess the nature of respectful patient-provider interactions and their impact on a person's sense of comfort, behavior, and perceptions of racism or discrimination. The scale exhibited good internal consistency reliability. MORi- scores among these samples differed by socio-demographic profile, health status, experience with interventions and mode of birth, planned and actual place of birth, and type of provider. CONCLUSION The MOR index is a reliable, patient-informed quality and safety indicator that can be applied across jurisdictions to assess the nature of provider-patient relationships, and access to person-centered maternity care.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Research Lab, Division of Midwifery, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Kathrin Stoll
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Nicholas Rubashkin
- Department of Global Health Sciences, University of California San Francisco, Mission Hall Building, 550 – 16th Street, 3rd Floor, San Francisco, CA 94158, USA
- Department of Obstetrics and Gynecology, University of California San Francisco, Mission Hall Building, 550 – 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Kelsey Martin
- Birth Place Research Lab, Division of Midwifery, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Zoe Miller-Vedam
- Human Rights in Childbirth, 6312 SW Capitol Highway St, 234 Portland, OR 97239, USA
| | - Hermine Hayes-Klein
- Human Rights in Childbirth, 6312 SW Capitol Highway St, 234 Portland, OR 97239, USA
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, 2-175 E. 15th Avenue, Vancouver, BC, Canada V5T 2P6
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Oosthuizen SJ, Bergh AM, Pattinson RC, Grimbeek J. It does matter where you come from: mothers' experiences of childbirth in midwife obstetric units, Tshwane, South Africa. Reprod Health 2017; 14:151. [PMID: 29145897 PMCID: PMC5689145 DOI: 10.1186/s12978-017-0411-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022] Open
Abstract
Background Health professionals are striving to improve respectful care for women, but they fall short in the domains of effective communication, respectful and dignified care and emotional support during labour. This study aimed to determine women’s experiences of childbirth with a view to improving respectful clinical care practices in low-risk, midwife-led obstetric units in the Tshwane District Health District, South Africa. Methods A survey covering all midwife-led units in the district was conducted among 653 new mothers. An anonymous questionnaire was administered to mothers returning for a three-days-to-six-weeks postnatal follow-up visit. Mothers were asked about their experiences regarding communication, labour, clinical care and respectful care during confinement. An ANCOVA was performed to identify the socio-demographic variables that significantly predicted disrespectful care. Six items representing the different areas of experience were used in the analysis. Results Age, language, educational level and length of residence in the district were significantly associated with disrespectful care (p ≤ 0.01). Overall, the following groups of mothers reported more negative care experiences during labour: women between the ages of 17 and 24 years; women with limited formal education; and women from another province or a neighbouring country. Items which attracted fewer positive responses from participants were the following: 46% of mothers had been welcomed by name on arrival; 47% had been asked to give consent to a physical examination; and 39% had been offered food or water during labour. With regard to items related to respectful care, 54% of mothers indicated that all staff members had spoken courteously to them, 48% said they had been treated with a lot of respect, and 55% were completely satisfied with their treatment. Conclusion There is a need to improve respectful care through interventions that are integrated into routine care practices in labour wards. To stop the spiral of abusive obstetric care, the care provided should be culturally sensitive and should address equity for the most vulnerable and underserved groups. All levels of the health care system should employ respectful obstetric care practices, matched with support for midwives and improved clinical governance in maternity facilities. Electronic supplementary material The online version of this article (dio: 10.1186/s12978-017-0411-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarie J Oosthuizen
- Tshwane District Health and Department of Family Medicine, University of Pretoria, Pretoria, South Africa.
| | - Anne-Marie Bergh
- South African Medical Research Council Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Robert C Pattinson
- South African Medical Research Council Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa.,Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Jackie Grimbeek
- South African Medical Research Council Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa
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207
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Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D. Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity. Gates Open Res 2017; 1:1. [PMID: 29355215 PMCID: PMC5764229 DOI: 10.12688/gatesopenres.12756.1] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Globally, substantial health inequities exist with regard to maternal, newborn and reproductive health. Lack of access to good quality care-across its many dimensions-is a key factor driving these inequities. Significant global efforts have been made towards improving the quality of care within facilities for maternal and reproductive health. However, one critically overlooked aspect of quality improvement activities is person-centered care. Main body: The objective of this paper is to review existing literature and theories related to person-centered reproductive health care to develop a framework for improving the quality of reproductive health, particularly in low and middle-income countries. This paper proposes the Person-Centered Care Framework for Reproductive Health Equity, which describes three levels of interdependent contexts for women's reproductive health: societal and community determinants of health equity, women's health-seeking behaviors, and the quality of care within the walls of the facility. It lays out eight domains of person-centered care for maternal and reproductive health. Conclusions: Person-centered care has been shown to improve outcomes; yet, there is no consensus on definitions and measures in the area of women's reproductive health care. The proposed Framework reviews essential aspects of person-centered reproductive health care.
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Affiliation(s)
- May Sudhinaraset
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA.,Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Patience Afulani
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA
| | - Nadia Diamond-Smith
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA
| | | | - France Donnay
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Dominic Montagu
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA
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Women’s experiences of routine care during labour and childbirth and the influence of medicalisation: A qualitative study from Iran. Midwifery 2017; 53:63-70. [DOI: 10.1016/j.midw.2017.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 06/30/2017] [Accepted: 07/01/2017] [Indexed: 01/12/2023]
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209
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Yigzaw T, Abebe F, Belay L, Assaye Y, Misganaw E, Kidane A, Ademie D, van Roosmalen J, Stekelenburg J, Kim YM. Quality of Midwife-provided Intrapartum Care in Amhara Regional State, Ethiopia. BMC Pregnancy Childbirth 2017; 17:261. [PMID: 28814285 PMCID: PMC5558781 DOI: 10.1186/s12884-017-1441-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 08/02/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite much progress recently, Ethiopia remains one of the largest contributors to the global burden of maternal and newborn deaths and stillbirths. Ethiopia's plan to meet the sustainable development goals for maternal and child health includes unprecedented emphasis on improving quality of care. The purpose of this study was to assess the quality of midwifery care during labor, delivery and immediate postpartum period. METHODS A cross-sectional study using multiple data collection methods and a 2-stage cluster sampling technique was conducted from January 25 to February 14, 2015 in government health facilities of the Amhara National Regional State of Ethiopia. Direct observation of performance was used to determine competence of midwives in providing care during labor, delivery, and the first 6 h after childbirth. Inventory of drugs, medical equipment, supplies, and infrastructure was conducted to identify availability of resources in health facilities. Structured interview was done to assess availability of resources and performance improvement opportunities. Data analysis involved calculating percentages, means and chi-square tests. RESULTS A total of 150 midwives and 56 health facilities were included in the study. The performance assessment showed 16.5% of midwives were incompetent, 72.4% were competent, and 11.1% were outstanding in providing routine intrapartum care. Forty five midwives were observed while managing 54 obstetric and newborn complications and 41 (91%) of them were rated competent. Inventory of resources found that the proportion of facilities with more than 75% of the items in each category was 32.6% for drugs, 73.1% for equipment, 65.4% for supplies, 47.9% for infection prevention materials, and 43.6% for records and forms. Opportunities for performance improvement were inadequate, with 31.3% reporting emergency obstetric and newborn care training, and 44.7% quarterly or more frequent supportive supervision. Health centers fared worse in provider competence, physical resources, and quality improvement practices except for supportive supervision visits and in-service training. CONCLUSIONS Although our findings indicate most midwives are competent in giving routine and emergency intrapartum care, the major gaps in the enabling environment and the significant proportion of midwives with unsatisfactory performance suggest that the conditions for providing quality intrapartum care are not optimal.
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Affiliation(s)
| | | | | | | | | | | | | | - Jos van Roosmalen
- Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Jelle Stekelenburg
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, Netherlands
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Love B, Sidebotham M, Fenwick J, Harvey S, Fairbrother G. “Unscrambling what’s in your head”: A mixed method evaluation of clinical supervision for midwives. Women Birth 2017; 30:271-281. [DOI: 10.1016/j.wombi.2016.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 11/29/2022]
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Utz B, Assarag B, Essolbi A, Barkat A, Delamou A, De Brouwere V. Knowledge and practice related to gestational diabetes among primary health care providers in Morocco: Potential for a defragmentation of care? Prim Care Diabetes 2017; 11:389-396. [PMID: 28576661 DOI: 10.1016/j.pcd.2017.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The objective of this study was to assess knowledge and practices of general practitioners, nurses and midwives working at primary health care facilities in Morocco regarding screening and management of gestational diabetes (GDM). METHODS Structured interviews with 100 doctors, midwives and nurses at 44 randomly selected public health care centers were conducted in Marrakech and Al Haouz. All data were descriptively analyzed. Ethical approval for the study was granted by the institutional review boards in Belgium and Morocco. RESULTS Public primary health care providers have a basic understanding of gestational diabetes but screening and management practices are not uniform. Although 56.8% of the doctors had some pre-service training on gestational diabetes, most nurses and midwives lack such training. After diagnosing GDM, 88.5% of providers refer patients to specialists, only 11.5% treat them as outpatients. DISCUSSION Updating knowledge and skills of providers through both pre- and in-service-training needs to be supported by uniform national standards enabling first line health care workers to manage women with GDM and thus increase access and provide a continuity in care. Findings of this study will be used to pilot a model of GDM screening and initial management through the primary level of care.
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Affiliation(s)
- Bettina Utz
- Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | - Amina Barkat
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
| | - Alexandre Delamou
- Maferinyah Training and Research Centre, Conakry, Guinea; Institute of Tropical Medicine, Antwerp, Belgium.
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Narchi NZ, de Castro CM, Oliveira CDF, Tambellini F. Report on the midwives' experiences in the Brazilian National Health System: A qualitative research. Midwifery 2017; 53:96-102. [PMID: 28780144 DOI: 10.1016/j.midw.2017.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/04/2017] [Accepted: 07/18/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE to describe the experiences of midwives who graduated from the University of São Paulo's midwifery program and the characteristics of their work within the Brazilian National Health System (SUS). DESIGN a descriptive, qualitative field study. SETTING interviews were scheduled by telephone or e-mail and were held with the midwives outside their work environment. Interviews lasted for up to one hour and were recorded. PARTICIPANTS ten midwives who had graduated from the University of São Paulo's midwifery program and were working or had worked in the SUS at the time of the study. ETHICAL ISSUES the study protocol was approved by the internal review board of the School of Arts, Sciences and Humanities, University of São Paulo. All pertinent ethical principles were followed. MEASURES AND FINDINGS: data were collected at interviews focussing on the participants' work and their experiences while working in the SUS. The dialogues during the interview sessions allowed the participants to build on and extend the proposed topics. After the data had been transcribed and read, the discourses were grouped in accordance with the similarity of their content, resulting in four thematic categories: the inclusion of midwives into the obstetric team; dealing with contradictions: challenges of the profession; working in the SUS: between precariousness and guaranteeing access to health services; and making a difference. The findings provoke reflection on the challenges faced by midwives in their work within the SUS: challenges associated with the difficulties in working in the public healthcare sector, difficulties in their relationships with other healthcare professionals, difficulties related to a general lack of knowledge on this specific occupation in Brazil, the absence of a midwifery model of care, difficulty in dealing with obstetric abuse, and the dilemmas facing the midwives during their daily practice of midwifery. KEY CONCLUSION despite the difficulties encountered, the midwives consider the care they provide to be differentiated. They perceive gradual changes in the care offered to women by the healthcare facilities and by other professionals, and believe that they make a difference in their workplaces. In addition, they want to work in the SUS and are committed to transforming the quality of care provided to women in Brazil. PRACTICAL IMPLICATIONS the experiences related by midwives reflect the midwifery scenario nationwide, highlighting the perspectives for change. The emphasis placed by midwives on their social role and their commitment to changing current midwifery care models and to consolidating the SUS is noteworthy.
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Affiliation(s)
- Nádia Zanon Narchi
- School of Arts, Sciences and Humanities of the University of São Paulo, Av. Arlindo Bettio, 1000 - Ermelino Matarazzo, 03828-000 São Paulo, São Paulo, Brazil.
| | - Cláudia Medeiros de Castro
- School of Arts, Sciences and Humanities of the University of São Paulo, Av. Arlindo Bettio, 1000 - Ermelino Matarazzo, 03828-000 São Paulo, São Paulo, Brazil.
| | - Cintia de Freitas Oliveira
- School of Arts, Sciences and Humanities of the University of Sao Paulo, Rua Francisco Manoel da Silva,17, 09171040 Santo André, São Paulo, Brazil.
| | - Fernanda Tambellini
- School of Arts, Sciences and Humanities of the University of Sao Paulo, Rua Cayowaá, 1366 - ap. 94, 05018-001 São Paulo, São Paulo, Brazil.
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Kermode M, Morgan A, Nyagero J, Nderitu F, Caulfield T, Reeve M, Nduba J. Walking Together: Towards a Collaborative Model for Maternal Health Care in Pastoralist Communities of Laikipia and Samburu, Kenya. Matern Child Health J 2017; 21:1867-1873. [DOI: 10.1007/s10995-017-2337-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Luyben A, Barger M, Avery M, Bharj KK, O’Connell R, Fleming V, Thompson J, Sherratt D. Exploring global recognition of quality midwifery education: Vision or fiction? Women Birth 2017; 30:184-192. [DOI: 10.1016/j.wombi.2017.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/09/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
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Haley CA, Vermund SH, Moyo P, Kipp AM, Madzima B, Kanyowa T, Desta T, Mwinga K, Brault MA. Impact of a critical health workforce shortage on child health in Zimbabwe: a country case study on progress in child survival, 2000-2013. Health Policy Plan 2017; 32:613-624. [PMID: 28064212 PMCID: PMC5406757 DOI: 10.1093/heapol/czw162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 12/15/2022] Open
Abstract
Despite notable progress reducing global under-five mortality rates, insufficient progress in most sub-Saharan African nations has prevented the achievement of Millennium Development Goal four (MDG#4) to reduce under-five mortality by two-thirds between 1990 and 2015. Country-level assessments of factors underlying why some African countries have not been able to achieve MDG#4 have not been published. Zimbabwe was included in a four-country study examining barriers and facilitators of under-five survival between 2000 and 2013 due to its comparatively slow progress towards MDG#4. A review of national health policy and strategy documents and analysis of qualitative data identified Zimbabwe's critical shortage of health workers and diminished opportunities for professional training and education as an overarching challenge. Moreover, this insufficient health workforce severely limited the availability, quality, and utilization of life-saving health services for pregnant women and children during the study period. The impact of these challenges was most evident in Zimbabwe's persistently high neonatal mortality rate, and was likely compounded by policy gaps failing to authorize midwives to deliver life-saving interventions and to ensure health staff make home post-natal care visits soon after birth. Similarly, the lack of a national policy authorizing lower-level cadres of health workers to provide community-based treatment of pneumonia contributed to low coverage of this effective intervention and high child mortality. Zimbabwe has recently begun to address these challenges through comprehensive policies and strategies targeting improved recruitment and retention of experienced senior providers and by shifting responsibility of basic maternal, neonatal and child health services to lower-level cadres and community health workers that require less training, are geographically broadly distributed, and are more cost-effective, however the impact of these interventions could not be assessed within the scope and timeframe of the current study.
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Affiliation(s)
- Connie A Haley
- Vanderbilt Institute for Global Health, Departments of 2Medicine and 3Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Departments of 2Medicine and 3Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Precious Moyo
- University of Zimbabwe-University of California San Francisco Collaborative Research Programme, Harare, Zimbabwe
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Departments of 2Medicine and 3Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bernard Madzima
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Trevor Kanyowa
- World Health Organization/Zimbabwe Country Office, Harare, Zimbabwe
| | - Teshome Desta
- World Health Organization/Inter-country Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Kasonde Mwinga
- World Health Organization/Regional Office for Africa, Brazzaville, Congo
| | - Marie A Brault
- Department of Anthropology, University of Connecticut, Storrs, CT, USA
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216
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Wrammert J, Sapkota S, Baral K, KC A, Målqvist M, Larsson M. Teamwork among midwives during neonatal resuscitation at a maternity hospital in Nepal. Women Birth 2017; 30:262-269. [DOI: 10.1016/j.wombi.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/07/2016] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
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217
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Homer CS, Turkmani S, Rumsey M. The state of midwifery in small island Pacific nations. Women Birth 2017; 30:193-199. [DOI: 10.1016/j.wombi.2017.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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218
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Building midwifery educator capacity using international partnerships: Findings from a qualitative study. Nurse Educ Pract 2017; 25:66-73. [PMID: 28505556 DOI: 10.1016/j.nepr.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/29/2017] [Accepted: 05/07/2017] [Indexed: 11/22/2022]
Abstract
Midwifery educators play a critical role in strengthening the midwifery workforce globally, including in low and lower-middle income countries (LMIC) to ensure that midwives are adequately prepared to deliver quality midwifery care. The most effective approach to building midwifery educator capacity is not always clear. The aim of this study was to determine how one capacity building approach in Papua New Guinea (PNG) used international partnerships to improve teaching and learning. A qualitative exploratory case study design was used to explore the perspectives of 26 midwifery educators working in midwifery education institutions in PNG. Seven themes were identified which provide insights into the factors that enable and constrain midwifery educator capacity building. The study provides insights into strategies which may aid institutions and individuals better plan and implement international midwifery partnerships to strengthen context-specific knowledge and skills in teaching. Further research is necessary to assess how these findings can be transferred to other contexts.
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219
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Guerra Arias M, Nove A, Michel-Schuldt M, de Bernis L. Current and future availability of and need for human resources for sexual, reproductive, maternal and newborn health in 41 countries in Sub-Saharan Africa. Int J Equity Health 2017; 16:69. [PMID: 28468654 PMCID: PMC5415807 DOI: 10.1186/s12939-017-0569-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WHO African region, covering the majority of Sub-Saharan Africa, faces the highest rates of maternal and neonatal mortality in the world. This study uses data from the State of the World's Midwifery 2014 survey to cast a spotlight on the WHO African region, highlight the specific characteristics of its sexual, reproductive, maternal and newborn health (SRMNH) workforce and describe and compare countries' different trajectories in terms of meeting the population need for services. METHODS Using data from 41 African countries, this study used a mathematical model to estimate potential met need for SRMNH services, defined as "the percentage of a universal SRMNH package that could potentially be obtained by women and newborns given the composition, competencies and available working time of the SRMNH workforce." The model defined the 46 key interventions included in this universal SRMNH package and allocated them to the available health worker time and skill set in each country to estimate the potential met need. RESULTS Based on the current and projected potential met need in the future, the countries were grouped into three categories: (1) 'making or maintaining progress' (expected to meet more, or the same level, of the need in the future than currently): 14 countries including Ghana, Senegal and South Africa, (2) 'at risk' (currently performing relatively well but expected to deteriorate due to the health workforce not keeping pace with population growth): 6 countries including Gabon, Rwanda and Zambia, and (3) 'low performing' (not performing well and not expected to improve): 21 countries including Burkina Faso, Eritrea and Sierra Leone. CONCLUSION The three groups face different challenges, and policy solutions to increasing met need should be tailored to the specific context of the country. National health workforce accounts should be strengthened so that workforce planning can be evidence-informed.
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Affiliation(s)
| | - Andrea Nove
- Instituto de Cooperación Social Integrare, Barcelona, Spain
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220
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Homer CS. Models of maternity care: evidence for midwifery continuity of care. Med J Aust 2017; 205:370-374. [PMID: 27736625 DOI: 10.5694/mja16.00844] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/16/2016] [Indexed: 11/17/2022]
Abstract
There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects. Non-randomised studies have shown benefits of midwifery continuity of care for specific groups, such as Aboriginal and Torres Strait Islander women. There are also benefits for midwives, including high levels of job satisfaction and less occupational burnout. Implementing midwifery continuity of care in public and private settings in Australia has been challenging, despite the evidence in its favour and government policy documents that support it. A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.
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Affiliation(s)
- Caroline Se Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, NSW
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221
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Mayberry LJ, Avery MD, Budin W, Perry S. Improving maternal and infant outcomes by promoting normal physiologic birth on hospital birthing units. Nurs Outlook 2017; 65:240-241. [PMID: 28363309 DOI: 10.1016/j.outlook.2017.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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222
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Dencker A, Smith V, McCann C, Begley C. Midwife-led maternity care in Ireland - a retrospective cohort study. BMC Pregnancy Childbirth 2017; 17:101. [PMID: 28351386 PMCID: PMC5371234 DOI: 10.1186/s12884-017-1285-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/22/2017] [Indexed: 11/25/2022] Open
Abstract
Background Midwife-led maternity care is shown to be safe for women with low-risk during pregnancy. In Ireland, two midwife-led units (MLUs) were introduced in 2004 when a randomised controlled trial (the MidU study) was performed to compare MLU care with consultant-led care (CLU). Following study completion the two MLUs have remained as a maternity care option in Ireland. The aim of this study was to evaluate maternal and neonatal outcomes and transfer rates during six years in the larger of the MLU sites. Methods MLU data for the six years 2008–2013 were retrospectively analysed, following ethical approval. Rates of transfer, reasons for transfer, mode of birth, and maternal and fetal outcomes were assessed. Linear-by-Linear Association trend analysis was used for categorical data to evaluate trends over the years and one-way ANOVA was used when comparing continuous variables. Results During the study period, 3,884 women were registered at the MLU. The antenatal transfer rate was 37.4% and 2,410 women came to labour in the MLU. Throughout labour and birth, 567 women (14.6%) transferred to the CLU, of which 23 were transferred after birth due to need for suturing or postpartum hemorrhage. The most common reasons for intrapartum transfer were meconium stained liquor/abnormal fetal heart rate (30.3%), delayed labour progress in first or second stage (24.9%) and woman’s wish for epidural analgesia (15.1%). Of the 1,903 babies born in the MLU, 1,878 (98.7%) were spontaneous vaginal births and 25 (1.3%) were instrumental (ventouse/forceps). Only 25 babies (1.3%) were admitted to neonatal intensive care unit. All spontaneous vaginal births from the MLU registered population, occurring in the study period in both the MLU and CLU settings (n = 2,785), were compared. In the MLU more often 1–2 midwives (90.9% vs 69.7%) cared for the women during birth, more women had three vaginal examinations or fewer (93.6% vs 79.9%) and gave birth in an upright position (standing, squatting or kneeling) (52.0% vs 9.4%), fewer women had an amniotomy (5.9% vs 25.9%) or episiotomy (3.4% vs 9.7%) and more women had a physiological management of third stage of labour (50.9% vs 4.6%). Conclusions Midwife-led care is a safe option that could be offered to a large proportion of healthy pregnant women. With strict transfer criteria there are very few complications during labour and birth. Maternity units without the option of MLU care should consider its introduction.
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Affiliation(s)
- Anna Dencker
- Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden. .,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02T283, Ireland
| | | | - Cecily Begley
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02T283, Ireland
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223
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Callister LC, Edwards JE. Sustainable Development Goals and the Ongoing Process of Reducing Maternal Mortality. J Obstet Gynecol Neonatal Nurs 2017; 46:e56-e64. [PMID: 28286075 DOI: 10.1016/j.jogn.2016.10.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2016] [Indexed: 10/20/2022] Open
Abstract
Innovative programs introduced in response to the Millennium Development Goals show promise to reduce the global rate of maternal mortality. The Sustainable Development Goals, introduced in 2015, were designed to build on this progress. In this article, we describe the global factors that contribute to maternal mortality rates, outcomes of the implementation of the Millennium Development Goals, and the new, related Sustainable Development Goals. Implications for clinical practice, health care systems, research, and health policy are provided.
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224
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Vedam S, Stoll K, Martin K, Rubashkin N, Partridge S, Thordarson D, Jolicoeur G. The Mother's Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care. PLoS One 2017; 12:e0171804. [PMID: 28231285 PMCID: PMC5322919 DOI: 10.1371/journal.pone.0171804] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 01/26/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To develop and validate a new instrument that assesses women's autonomy and role in decision making during maternity care. DESIGN Through a community-based participatory research process, service users designed, content validated, and administered a cross-sectional quantitative survey, including 31 items on the experience of decision-making. SETTING AND PARTICIPANTS Pregnancy experiences (n = 2514) were reported by 1672 women who saw a single type of primary maternity care provider in British Columbia. They described care by a midwife, family physician or obstetrician during 1, 2 or 3 maternity care cycles. We conducted psychometric testing in three separate samples. MAIN OUTCOME MEASURES We assessed reliability, item-to-total correlations, and the factor structure of the The Mothers' Autonomy in Decision Making (MADM) scale. We report MADM scores by care provider type, length of prenatal appointments, preferences for role in decision-making, and satisfaction with experience of decision-making. RESULTS The MADM scale measures a single construct: autonomy in decision-making during maternity care. Cronbach alphas for the scale exceeded 0.90 for all samples and all provider groups. All item-to-total correlations were replicable across three samples and exceeded 0.7. Eigenvalue and scree plots exhibited a clear 90-degree angle, and factor analysis generated a one factor scale. MADM median scores were highest among women who were cared for by midwives, and 10 or more points lower for those who saw physicians. Increased time for prenatal appointments was associated with higher scale scores, and there were significant differences between providers with respect to average time spent in prenatal appointments. Midwifery care was associated with higher MADM scores, even during short prenatal appointments (<15 minutes). Among women who preferred to lead decisions around their care (90.8%), and who were dissatisfied with their experience of decision making, MADM scores were very low (median 14). Women with physician carers were consistently more likely to report dissatisfaction with their involvement in decision making. DISCUSSION The Mothers Autonomy in Decision Making (MADM) scale is a reliable instrument for assessment of the experience of decision making during maternity care. This new scale was developed and content validated by community members representing various populations of childbearing women in BC including women from vulnerable populations. MADM measures women's ability to lead decision making, whether they are given enough time to consider their options, and whether their choices are respected. Women who experienced midwifery care reported greater autonomy than women under physician care, when engaging in decision-making around maternity care options. Differences in models of care, professional education, regulatory standards, and compensation for prenatal visits between midwives and physicians likely affect the time available for these discussions and prioritization of a shared decision making process. CONCLUSION The MADM scale reflects person-driven priorities, and reliably assesses interactions with maternity providers related to a person's ability to lead decision-making over the course of maternity care.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
- * E-mail:
| | - Kathrin Stoll
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelsey Martin
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, United States of America
| | - Sarah Partridge
- Residency Program, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dana Thordarson
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, Vancouver, British Columbia, Canada
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225
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von Dadelszen P, Magee LA. Strategies to reduce the global burden of direct maternal deaths. Obstet Med 2017; 10:5-9. [PMID: 28491124 DOI: 10.1177/1753495x16686287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 12/14/2022] Open
Abstract
The leading direct causes of the estimated 196 maternal deaths per 100,000 live births globally are postpartum haemorrhage, the hypertensive disorders of pregnancy, obstructed labour, unsafe abortion and obstetric sepsis. Of the Sustainable Development Goals, one (Sustainable Development Goal 3.1) specifically addresses maternal mortality; by 2030, the goal is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Eleven other Sustainable Development Goals provide opportunities to intervene. Unapologetically, this review focusses the reader's attention on health advocacy and its central role in altering the risks that many of the world's women face from direct obstetric causes of mortality. Hard work to alter social determinants of health and health outcomes remains. That work needs to start today to improve the health and social equality of today's girls who will be the women delivering their babies in 2030.
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Affiliation(s)
- Peter von Dadelszen
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
| | - Laura A Magee
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
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226
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Roberts LR, Anderson BA. Simulation Learning Among Low Literacy Guatemalan Traditional Birth Attendants. INTERNATIONAL JOURNAL OF CHILDBIRTH 2017. [DOI: 10.1891/2156-5287.7.2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Guatemalan maternal and infant mortality rates remain high, particularly among indigenous populations. In remote areas, traditional birth attendants (TBAs), without formal midwifery education, are frequently the only maternal care providers. We conducted a mixed methods study to evaluate knowledge, skills, and attitudes of 26 TBAs in western Guatemala. The purposes of this study were to evaluate the efficacy of a community-based midwifery training program and to determine how the knowledge, skills, and attitudes of TBAs influence the care provided to indigenous mothers and infants. Themes from 5 key informant interviews included survival of mother and baby, facilitating referrals, and community pressure not to refer. We offered a 2-week simulation-based training designed for low resource settings. Participants completed pre- and posttests and demonstrated midwifery skills. Knowledge scores and objectively measured skills improved significantly. Attitude outcomes included increased endorsement regarding importance of pre- and postnatal visits, recognizing risk/complications, and partnering with medical providers. Potential effects discussed include safe TBA practice, training value, and intent to disseminate learnings in their communities.
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227
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McRae DN, Muhajarine N, Stoll K, Mayhew M, Vedam S, Mpofu D, Janssen PA. Is model of care associated with infant birth outcomes among vulnerable women? A scoping review of midwifery-led versus physician-led care. SSM Popul Health 2016; 2:182-193. [PMID: 29349139 PMCID: PMC5757823 DOI: 10.1016/j.ssmph.2016.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/17/2015] [Accepted: 01/11/2016] [Indexed: 11/15/2022] Open
Abstract
This scoping review investigates if, over the last 25 years in high resource countries, midwives' patients of low socioeconomic position (SEP) were at more or less risk of adverse infant birth outcomes compared to physicians' patients. Reviewers identified 917 records in a search of 12 databases, grey literature, and citation lists. Thirty-one full documents were assessed and nine studies met inclusion criteria. Eight studies were assessed as moderate in quality; one study was given a weak rating. Of the moderate quality studies, the majority found no statistical difference in outcomes according to model of care for preterm birth, low or very low birth weight, or NICU admission. No study reported a statistically significant difference for small for gestational age birth (2 studies), or mean or low Apgar score (4 studies). However, one study found a reduced risk of preterm birth (AOR=0.70, p<0.01), and heavier mean infant birth weight (3325 g vs. 3282 g, p<0.01) for midwifery patients. Another study reported lower risk of low (RR=0.59, 95% CI: 0.46, 0.73) and very low birthweight (RR=0.44, 95% CI: 0.23, 0.85) for midwifery care. And, a third study reported a decrease in stays (1-3 days) in NICU (Adjusted Risk Difference=-1.8, 95% CI: -3.9, 0.2) for midwifery patients, though no overall difference in NICU admission of any duration. Other studies reported significant differences favoring midwifery care for mean birth weight (3598 g vs. 3407.3 g, p<0.05; 3233 g vs. 3089 g, p<0.05; 2 studies) and very low birth weight (OR=0.35, 95% CI:0.1, 0.9), for sub-groups within the larger study populations. This scoping review documented heterogeneity in study designs and analytical methods, inconsistent findings, moderate methodological quality, and lack of currency. There is a need for new studies to definitively establish if and how a midwifery-led model of care influences birth outcomes for women of low SEP.
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Affiliation(s)
- Daphne N. McRae
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
| | - Kathrin Stoll
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Maureen Mayhew
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Saraswathi Vedam
- UBC Midwifery, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Deborah Mpofu
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
- Saskatoon Health Region, 701 Queen St., Saskatoon, Sask., Canada S7K 0M7
| | - Patricia A. Janssen
- UBC Midwifery, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
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228
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Shaping the midwifery profession in Nepal – Uncovering actors' connections using a Complex Adaptive Systems framework. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 10:48-55. [DOI: 10.1016/j.srhc.2016.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/19/2022]
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229
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Soriano-Vidal FJ, Oliver-Roig A, Cabrero-García J, Congost-Maestre N, Dencker A, Richart-Martínez M. The Spanish version of the Childbirth Experience Questionnaire (CEQ-E): reliability and validity assessment. BMC Pregnancy Childbirth 2016; 16:372. [PMID: 27884123 PMCID: PMC5123212 DOI: 10.1186/s12884-016-1100-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Childbirth Experience Questionnaire (CEQ) was originally designed to study women's perceptions of labour and birth. The main objective of our study was to adapt the CEQ to the Spanish context and determine its psychometric properties. This would provide an opportunity to evaluate women's experiences in order to improve evidence in the Spanish context as recommended by national guidelines. METHODS The CEQ was translated into Spanish using a standard forward and back translation method (CEQ-E). A convenience sample of 364 women was recruited from 3 Spanish hospitals; all participants were able to read and write in Spanish. Mothers with high risk pregnancies or preterm deliveries were excluded from the study. A self-administered questionnaire on sociodemographic variables was completed by participants before discharge. Data on childbirth variables were obtained from maternity records. Between 1 and 3 months postpartum a postal CEQ-E questionnaire was sent. The CEQ-E structure was examined by a confirmatory factor analysis of polychoric correlations using a diagonally weighted least squares estimator. Reliability was assessed using Cronbach's alpha. Construct validity was conducted by testing differences in CEQ-E scores between known-groups (to differ on key variables). RESULTS 226 (62.1%) of the recruited participants completed the postal questionnaire. The CEQ-E factor structure was similar to the original one. The Spanish version showed fit statistics in line with standard recommendations: CFI = 0.97; NNFI = 0.97; RMSEA = 0.066; SRMS = 0.077. The internal consistency reliability of the CEQ-E was good for the overall scale (0.88) and for all subscales (0.80, 0.90, 0.76, 0.68 for "own capacity", "professional support", "perceived safety" and "participation", respectively) and similar to the original version. Women with a labour duration ≤ 12 h, women with a labour not induced, women with a normal birth and multiparous women showed higher overall CEQ-E scores and "perceived safety" subscale scores. Women with a labour duration ≤ 12 h and those with previous experience of labour obtained higher scores for the "own capacity" and "participation" subscales. CONCLUSIONS The results of this study indicate that the CEQ-E can be considered a valid and reliable measure of women's perceptions of labour and birth in Spain.
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Affiliation(s)
- F. J. Soriano-Vidal
- Department of Nursing, University of Alicante, Cta. San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig, Alicante Spain
- Department of Nursing, Universidad Católica de Valencia “San Vicente Mártir”, Valencia, Spain
- Obstetrics and Gynaecology, Xàtiva-Oninyent Health Department, Xativa, Valencia Spain
| | - A. Oliver-Roig
- Department of Nursing, University of Alicante, Cta. San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig, Alicante Spain
| | - J. Cabrero-García
- Department of Nursing, University of Alicante, Cta. San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig, Alicante Spain
| | - N. Congost-Maestre
- Department of English Studies, University of Alicante, San Vicente del Raspeig, Alicante Spain
| | - A. Dencker
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M. Richart-Martínez
- Department of Nursing, University of Alicante, Cta. San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig, Alicante Spain
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Phillippi JC, Holley SL, Schorn MN, Lauderdale J, Roumie CL, Bennett K. On the same page: a novel interprofessional model of patient-centered perinatal consultation visits. J Perinatol 2016; 36:932-938. [PMID: 27537857 PMCID: PMC5079800 DOI: 10.1038/jp.2016.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To plan and implement an interprofessional collaborative care clinic for women in midwifery care needing a consultation with a maternal-fetal medicine specialist. STUDY DESIGN A community-engaged design was used to develop a new model of collaborative perinatal consultation, which was tested with 50 women. Participant perinatal outcomes and semistructured interviews with 15 women (analyzed using qualitative descriptive analysis) and clinic providers were used to evaluate the model. RESULTS Participant perinatal outcomes following a simultaneous consultation visit involving a nurse-midwife and maternal-fetal medicine specialist were similar to practice and hospital averages. Women's comments on their experience were positive and had the theme 'on the same page' with six subcategories: clarity, communication, collaboration, planning, validation and 'above and beyond'. Providers also were pleased with the model. CONCLUSION A simultaneous consultation involving the woman, a nurse-midwife and a maternal-fetal medicine specialist improved communication and satisfaction among women and providers.
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Affiliation(s)
- Julia C. Phillippi
- Vanderbilt University School of Nursing, 461 21 Avenue S, Nashville TN 37240
| | - Sharon L. Holley
- Vanderbilt University School of Nursing, 461 21 Avenue S, Nashville TN 37240
| | - Mavis N. Schorn
- Vanderbilt University School of Nursing, 461 21 Avenue S, Nashville TN 37240
| | - Jana Lauderdale
- Vanderbilt University School of Nursing, 461 21 Avenue S, Nashville TN 37240
| | - Christianne L. Roumie
- Veteran Health Administration, Tennessee Valley Healthcare System, Tennessee Valley Geriatric Research Education Clinical Center (GRECC), 1310 24th Ave. S, Nashville, TN 37212-2637
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212
| | - Kelly Bennett
- Division of Maternal Fetal Medicine, Vanderbilt Medical Center, B-1100 Medical Center North, 1161 21 Ave S #R-1217, Nashville TN, 37232
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Thompson SM, Nieuwenhuijze MJ, Low LK, de Vries R. Exploring Dutch midwives' attitudes to promoting physiological childbirth: A qualitative study. Midwifery 2016; 42:67-73. [DOI: 10.1016/j.midw.2016.09.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 09/14/2016] [Accepted: 09/26/2016] [Indexed: 11/24/2022]
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Campbell OMR, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, Donnay F, Macleod D, Gabrysch S, Rong L, Ronsmans C, Sadruddin S, Koblinsky M, Bailey P. The scale, scope, coverage, and capability of childbirth care. Lancet 2016; 388:2193-2208. [PMID: 27642023 DOI: 10.1016/s0140-6736(16)31528-8] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/23/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022]
Abstract
All women should have access to high quality maternity services-but what do we know about the health care available to and used by women? With a focus on low-income and middle-income countries, we present data that policy makers and planners can use to evaluate whether maternal health services are functioning to meet needs of women nationally, and potentially subnationally. We describe configurations of intrapartum care systems, and focus in particular on where, and with whom, deliveries take place. The necessity of ascertaining actual facility capability and providers' skills is highlighted, as is the paucity of information on maternity waiting homes and transport as mechanisms to link women to care. Furthermore, we stress the importance of assessment of routine provision of care (not just emergency care), and contextualise this importance within geographic circumstances (eg, in sparsely-populated regions vs dense urban areas). Although no single model-of-care fits all contexts, we discuss implications of the models we observe, and consider changes that might improve services and accelerate response to future challenges. Areas that need attention include minimisation of overintervention while responding to the changing disease burden. Conceptualisation, systematic measurement, and effective tackling of coverage and configuration challenges to implement high quality, respectful maternal health-care services are key to ensure that every woman can give birth without risk to her life, or that of her baby.
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Affiliation(s)
| | - Clara Calvert
- London School of Hygiene & Tropical Medicine, London, UK
| | - Adrienne Testa
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lenka Benova
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - France Donnay
- Tulane University School of Public Health, New Orleans, LA, USA
| | - David Macleod
- London School of Hygiene & Tropical Medicine, London, UK
| | - Sabine Gabrysch
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Luo Rong
- National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
| | - Carine Ronsmans
- London School of Hygiene & Tropical Medicine, London, UK; West China School of Public Health, Sichuan University, Chengdu, China
| | | | - Marge Koblinsky
- USAID, Office of Health, Infectious Diseases and Nutrition, Maternal and Child Health, Washington, DC, USA
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233
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Kinney MV, Boldosser-Boesch A, McCallon B. Quality, equity, and dignity for women and babies. Lancet 2016; 388:2066-2068. [PMID: 27642024 DOI: 10.1016/s0140-6736(16)31525-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Mary V Kinney
- Save the Children, Saving Newborn Lives, Edgemead 7441, South Africa.
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234
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Graham W, Woodd S, Byass P, Filippi V, Gon G, Virgo S, Chou D, Hounton S, Lozano R, Pattinson R, Singh S. Diversity and divergence: the dynamic burden of poor maternal health. Lancet 2016; 388:2164-2175. [PMID: 27642022 DOI: 10.1016/s0140-6736(16)31533-1] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/20/2016] [Accepted: 06/17/2016] [Indexed: 02/07/2023]
Abstract
Maternal health is a big issue and is central to sustainable development. Each year, about 210 million women become pregnant and about 140 million newborn babies are delivered-the sheer scale of maternal health alone makes maternal well being and survival vital concerns. In this Series paper, we adopt primarily a numerical lens to illuminate patterns and trends in outcomes, but recognise that understanding of poor maternal health also warrants other perspectives, such as human rights. Our use of the best available evidence highlights the dynamic burden of maternal health problems. Increased diversity in the magnitude and causes of maternal mortality and morbidity between and within populations presents a major challenge to policies and programmes aiming to match varying needs with diverse types of care across different settings. This diversity, in turn, contributes to a widening gap or differences in levels of maternal mortality, seen most acutely in vulnerable populations, predominantly in sub-Saharan Africa. Strong political and technical commitment to improve equity-sensitive information systems is required to monitor the gap in maternal mortality, and robust research is needed to elucidate major interactions between the broad range of health problems. Diversity and divergence are defining characteristics of poor maternal health in the 21st century. Progress on this issue will be an ultimate judge of sustainable development.
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Affiliation(s)
- Wendy Graham
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK.
| | - Susannah Woodd
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Byass
- Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Giorgia Gon
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Virgo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sennen Hounton
- Reproductive Health Commodity Security Branch, United Nations Population Fund, New York, NY, USA
| | - Rafael Lozano
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert Pattinson
- South African Medical Research Council Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
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von Dadelszen P, Magee LA. Preventing deaths due to the hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 36:83-102. [PMID: 27531686 PMCID: PMC5096310 DOI: 10.1016/j.bpobgyn.2016.05.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/25/2016] [Accepted: 05/29/2016] [Indexed: 02/08/2023]
Abstract
In this chapter, taking a life cycle and both civil society and medically oriented approach, we will discuss the contribution of the hypertensive disorders of pregnancy (HDPs) to maternal, perinatal and newborn mortality and morbidity. Here we review various interventions and approaches to preventing deaths due to HDPs and discuss effectiveness, resource needs and long-term sustainability of the different approaches. Societal approaches, addressing sustainable development goals (SDGs) 2.2 (malnutrition), 3.7 (access to sexual and reproductive care), 3.8 (universal health coverage) and 3c (health workforce strengthening), are required to achieve SDGs 3.1 (maternal survival), 3.2 (perinatal survival) and 3.4 (reduced impact of non-communicable diseases (NCDs)). Medical solutions require greater clarity around the classification of the HDPs, increased frequency of effective antenatal visits, mandatory responses to the HDPs when encountered, prompt provision of life-saving interventions and sustained surveillance for NCD risk for women with a history of the HDPs.
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Affiliation(s)
- Peter von Dadelszen
- Institute of Cardiovascular and Cell Sciences, St George's University of London, UK; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Laura A Magee
- Institute of Cardiovascular and Cell Sciences, St George's University of London, UK; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
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Improving Global Child Health in the Light of the (Old) Millennium Development Goals and the (New) Sustainable Development Goals. Pediatr Infect Dis J 2016; 35:918-9. [PMID: 27213262 DOI: 10.1097/inf.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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237
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Miyake S, Speakman EM, Currie S, Howard N. Community midwifery initiatives in fragile and conflict-affected countries: a scoping review of approaches from recruitment to retention. Health Policy Plan 2016; 32:21-33. [PMID: 27470905 DOI: 10.1093/heapol/czw093] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Birth assisted by skilled health workers is one of the most effective interventions for reducing maternal and neonatal mortality. Fragile and conflict-affected states and situations (FCAS), with one-third of global maternal deaths, face significant challenges in achieving skilled care at birth, particularly in health workforce development. The importance of community-level midwifery services to improve skilled care is internationally recognized, but the literature on FCAS is limited. This review aimed to examine community midwifery (CMW) approaches, from recruitment to retention, in FCAS. METHODS This scoping review design adapted Arksey and O'Malley's six-stage framework. Data collection included systematic searching of seven databases, purposive hand-searching of reference lists and web sites, and stakeholder engagement for additional information. Potential sources were screened against inclusion and exclusion criteria. Included sources were appraised for methodological quality using the McGill University Mixed Methods Appraisal Tool. Data were analysed thematically, using deductive (i.e. cadre definition, recruitment, education, deployment and retention) and inductive coding (i.e. capacity, gender and insecurity). RESULTS Twenty-three sources were included, of 2729 identified, discussing community midwifery programmes in six FCAS (i.e. eight for Sudan, six for Afghanistan, three each for Mali and Yemen, two for South Sudan and one for Somalia). Source quality was relatively poor, and cadre definitions were context dependent. Major enablers for effective CMW programmes were community linkages and acceptance, while barriers included inappropriate recruitment, non-standardized education, weak supportive environment, political insecurity and violence. CONCLUSIONS While community engagement and acceptance were crucial, CMW programmes were weakened by inappropriate recruitment and training, lack of support and general insecurity. Further research and implementation evidence is needed to aid policy-makers, donors and implementing agencies in developing and implementing effective CMW programmes in FCAS.
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Affiliation(s)
- Sachiko Miyake
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Elizabeth M Speakman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Sheena Currie
- Jhpiego, Technical Leadership Office, Baltimore, Jhpiego, Baltimore, MD, USA
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
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Symon A, Pringle J, Cheyne H, Downe S, Hundley V, Lee E, Lynn F, McFadden A, McNeill J, Renfrew MJ, Ross-Davie M, van Teijlingen E, Whitford H, Alderdice F. Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care. BMC Pregnancy Childbirth 2016; 16:168. [PMID: 27430506 PMCID: PMC4949880 DOI: 10.1186/s12884-016-0944-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care. METHODS A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria. RESULTS From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported. CONCLUSIONS The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.
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Affiliation(s)
- Andrew Symon
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Jan Pringle
- />School of Nursing & Health Sciences, University of Dundee, Dundee, DD1 4HJ UK
| | - Helen Cheyne
- />NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Soo Downe
- />School of Health, Brook Building, University of Central Lancashire, Preston, PR1 2HE UK
| | - Vanora Hundley
- />Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BU1 3LH UK
| | - Elaine Lee
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Fiona Lynn
- />School of Nursing and Midwifery, Queens University Belfast, Belfast, BT9 7BL UK
| | - Alison McFadden
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Jenny McNeill
- />School of Nursing and Midwifery, Queens University Belfast, Belfast, BT9 7BL UK
| | - Mary J Renfrew
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Mary Ross-Davie
- />Maternal and Child Health, NHS Education for Scotland, Edinburgh, EH3 9DN UK
| | - Edwin van Teijlingen
- />Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BU1 3LH UK
| | - Heather Whitford
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Fiona Alderdice
- />School of Nursing and Midwifery, Queens University Belfast, Belfast, BT9 7BL UK
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Women's preferences and knowledge about the legal competences of midwives in Brussels, Belgium. A descriptive observational study. Midwifery 2016; 40:177-86. [PMID: 27450589 DOI: 10.1016/j.midw.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/17/2016] [Accepted: 07/03/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to explore women's preferences with regard to their preferred health professional during labour and childbirth in case of an uncomplicated pregnancy, and to gain insight into women's knowledge of the legal competences of midwives. DESIGN a descriptive observational study. SETTING Brussels metropolitan region, Belgium. PARTICIPANTS women in their reproductive age, living in the Brussels metropolitan region, with Dutch or French as their first language (n=830). MEASUREMENTS a ten-item standardized questionnaire'Midwife Profiling Questionnaire' (MidProQ) was developed to determine which health professional respondents would prefer to assist them during labour and childbirth if there were no complications and to assess their knowledge about midwives' legal competences during pregnancy, labour and childbirth. Descriptive statistics were used to report the findings. To identify relationships between the socio-demographic variables of the women and her preferences, knowledge and opinion Chi² analysis were used. FINDINGS For 68.0% of the participants in an uncomplicated labour (n=564) and 66.3% of the participants with an uncomplicated childbirth (n=550), a midwife is the preferred health professional. Brussels women prefer an obstetrician in an uncomplicated labour (n=730, 88%) and for uncomplicated childbirth (n=756, 91.1%). Only 20.2% of the respondents (n=168) consider midwives to play a central role in an uncomplicated pregnancy. The knowledge of Brussels women about midwives' legal competences during pregnancy, labour and childbirth is rather poor, especially in youngsters and women who have never given birth. KEY CONCLUSIONS In general, for Brussels women, midwives are not the first preferred health professional for an uncomplicated labour or for childbirth, and they do not consider midwives to play a central role in an uncomplicated pregnancy. The legal competences of midwives are not known very well, especially by youngsters and women who have never given birth. The Belgian medical model of maternity care and women's experiences affect their preferences and knowledge about the legal competences of midwives and their opinion about the central health professional in an uncomplicated pregnancy. IMPLICATIONS FOR PRACTICE To enhance more women-centred care and initiate change in the current maternity care culture in Belgium, public education, structural changes in maternity services and strategies to inspire public opinion to initiate cultural change are suggested. Involvement of midwifery organisations, other health professionals in maternity services and policy-makers with women's groups and potential service users is key.
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Moores A, Puawe P, Buasi N, West F, Samor MK, Joseph N, Rumsey M, Dawson A, Homer CSE. Education, employment and practice: Midwifery graduates in Papua New Guinea. Midwifery 2016; 41:22-29. [PMID: 27498185 DOI: 10.1016/j.midw.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/20/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Papua New Guinea has a very high maternal mortality rate (773/100,000), low rates of supervised births and a critical shortage of skilled midwives. A midwifery education initiative commenced in 2012, funded by the Australian Government and led by the National Department of Health. One specific objective of the initiative was to improve the standard of clinical teaching and practice in four schools of midwifery. There were 394 midwives educated over the 4 year period (2012-2015) representing half of all midwives in Papua New Guinea. A study was undertaken to describe the educational programme, employment, practices and experiences of graduates who studied midwifery in 2012 and 2013 as part of the initiative. OBJECTIVE the aim of this paper is to explore the education, employment and practice of newly graduated midwives in Papua New Guinea. DESIGN a mixed methods descriptive study design was used. Surveys and focus groups were used to gather data. Ethical approval was granted by the relevant Human Research Ethics Committees. SETTING AND PARTICIPANTS all midwifery graduates in 2012 and 2013 from the four midwifery schools in Papua New Guinea were included in the study and almost 80% were contacted. FINDINGS nearly 90% of graduates were working as midwives, with an additional 3% working as midwifery or nursing educators. This study discovered that graduates exhibited increased skills acquisition and confidence, leadership in maternal and newborn care services and a marked improvement in the provision of respectful care to women. The graduates faced challenges to implement evidence based care with barriers including the lack of appropriate resources and differences of opinion with senior staff. CONCLUSIONS factors affecting the quality of midwifery education will need to be addressed if Papua New Guinea is to continue to improve the status of maternal and newborn health. Specifically, the length of the midwifery education, the quality of clinical practice and the exposure to rural and remote area practice need addressing in many contexts like Papua New Guinea.
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Affiliation(s)
- Alison Moores
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia.
| | - Paula Puawe
- Faculty of Health and Behavioural Sciences, University of Goroka, Goroka, EHP, Papua New Guinea
| | - Nancy Buasi
- Division of Nursing, School of Medical and Health Sciences, University of Papua New Guinea, NCD, Papua New Guinea
| | - Florence West
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia
| | - Mary K Samor
- National Department of Health, Port Moresby, NCD, Papua New Guinea
| | - Nina Joseph
- Papua New Guinea Nursing Council, Port Moresby, NCD, Papua New Guinea
| | - Michele Rumsey
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia
| | - Angela Dawson
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia
| | - Caroline S E Homer
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia
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Abstract
Healthcare delivered by teams is becoming more common, and an estimated 50% of obstetricians in the United States (US) work with or employ nurse practitioners or nurse-midwives. The number of midwife-attended births in the United States is also growing. Interprofessional collaboration between midwives and physicians can increase access to safe, quality maternity care for women in the United States. A review of the literature indicates that successful collaborative practice includes effective communication, trust, and respect between providers. A review of concepts and theoretical frameworks offers a foundation for scholarly inquiry, suggests a research agenda for future study, and provides suggestions for organizational leaders to translate current knowledge into the clinical setting. Midwifery, through increasing collaborative practices, has the potential to change care delivery in the years to come.
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Guerra-Reyes L, Hamilton LJ. Racial disparities in birth care: Exploring the perceived role of African-American women providing midwifery care and birth support in the United States. Women Birth 2016; 30:e9-e16. [PMID: 27364419 DOI: 10.1016/j.wombi.2016.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/08/2016] [Accepted: 06/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Midwifery care has been linked to positive birth outcomes. Despite the broad racial disparities in maternal and infant outcomes in the United States (US), little is known about the role of minority women in either providing or receiving this type of care. A vibrant community of minority women, who self-identify as providing these services, exists online. In this exploratory study we ask how they describe their role; view their practice; and position themselves in the broader discussions of racial health disparities in the US. METHODS Using an internet mediated qualitative design we analyse online narratives from self-described African-American nurse-midwives, lay midwives and birth assistants; we found 28 unique websites. We collected and analysed narrative material from each site. We used a thematic analysis approach to identify recurrent and emergent themes in relation to the study question. RESULTS Narratives identified a strong link to the past, as providers viewed their practice in a historical perspective linking African roots, to the diaspora, and to current African-American struggles. Providers engaged both in direct clinical work, and in activist roles. Advocacy efforts sought to expand numbers of minority birth care workers and to extend the benefits of woman-centred birth care to underserved communities. CONCLUSION Results demonstrate the continued existence and important role of diverse types of African-American birth care providers in minority communities in the US. Recognition, support, and increasing the number of midwives of colour is important in tackling racial inequalities in health. Further research should explore minority access to woman-centred care.
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Affiliation(s)
- Lucia Guerra-Reyes
- Department of Applied Health Science, School of Public Health - Indiana University Bloomington, 1025 East 7th Street, Suite 116, Bloomington 47405, USA.
| | - Lydia J Hamilton
- Department of Applied Health Science, School of Public Health - Indiana University Bloomington, 1025 East 7th Street, Suite 116, Bloomington 47405, USA
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Adolphson K, Axemo P, Högberg U. Midwives' experiences of working conditions, perceptions of professional role and attitudes towards mothers in Mozambique. Midwifery 2016; 40:95-101. [PMID: 27428104 DOI: 10.1016/j.midw.2016.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/04/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND low- and middle-income countries still have a long way to go to reach the fifth Millennium Development Goal of reducing maternal mortality. Mozambique has accomplished a reduction of maternal mortality since the 1990s, but still has among the highest in the world. A key strategy in reducing maternal mortality is to invest in midwifery. AIM the objective was to explore midwives' perspectives of their working conditions, their professional role, and perceptions of attitudes towards mothers in a low-resource setting. SETTING midwives in urban, suburban, village and remote areas; working in central, general and rural hospitals as well as health centres and health posts were interviewed in Maputo City, Maputo Province and Gaza Province in Mozambique. METHOD the study had a qualitative research design. Nine semi-structured interviews and one follow-up interview were conducted and analysed with qualitative content analysis. RESULTS two main themes were found; commitment/devotion and lack of resources. All informants described empathic care-giving, with deep engagement with the mothers and highly valued working in teams. Lack of resources prevented the midwives from providing care and created frustration and feelings of insufficiency. CONCLUSIONS the midwives perceptions were that they tried to provide empathic, responsive care on their own within a weak health system which created many difficulties. The great potential the midwives possess of providing quality care must be valued and nurtured for their competency to be used more effectively.
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Affiliation(s)
- Katja Adolphson
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Pia Axemo
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
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Lohela TJ, Nesbitt RC, Manu A, Vesel L, Okyere E, Kirkwood B, Gabrysch S. Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana. BMJ Open 2016; 6:e010963. [PMID: 27297010 PMCID: PMC4916610 DOI: 10.1136/bmjopen-2015-010963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess health worker competence in emergency obstetric care using clinical vignettes, to link competence to availability of infrastructure in facilities, and to average annual delivery workload in facilities. DESIGN Cross-sectional Health Facility Assessment linked to population-based surveillance data. SETTING 7 districts in Brong Ahafo region, Ghana. PARTICIPANTS Most experienced delivery care providers in all 64 delivery facilities in the 7 districts. PRIMARY OUTCOME MEASURES Health worker competence in clinical vignette actions by cadre of delivery care provider and by type of facility. Competence was also compared with availability of relevant drugs and equipment, and to average annual workload per skilled birth attendant. RESULTS Vignette scores were moderate overall, and differed significantly by respondent cadre ranging from a median of 70% correct among doctors, via 55% among midwives, to 25% among other cadres such as health assistants and health extension workers (p<0.001). Competence varied significantly by facility type: hospital respondents, who were mainly doctors and midwives, achieved highest scores (70% correct) and clinic respondents scored lowest (45% correct). There was a lack of inexpensive key drugs and equipment to carry out vignette actions, and more often, lack of competence to use available items in clinical situations. The average annual workload was very unevenly distributed among facilities, ranging from 0 to 184 deliveries per skilled birth attendant, with higher workload associated with higher vignette scores. CONCLUSIONS Lack of competence might limit clinical practice even more than lack of relevant drugs and equipment. Cadres other than midwives and doctors might not be able to diagnose and manage delivery complications. Checking clinical competence through vignettes in addition to checklist items could contribute to a more comprehensive approach to evaluate quality of care. TRIAL REGISTRATION NUMBER NCT00623337.
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Affiliation(s)
- Terhi Johanna Lohela
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | | | - Alexander Manu
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Linda Vesel
- Innovations for Maternal, Newborn and Child Health, Concern Worldwide US, New York, New York, USA
- Health Section, Programme Division, UNICEF Headquarters, New York, New York, USA
| | - Eunice Okyere
- Department of Public Health, Flinders University, Adelaide, South Australia, Australia
- Ghana Health Service, Kintampo Health Research Centre, Kintampo, Ghana
| | - Betty Kirkwood
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sabine Gabrysch
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
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Castro Lopes S, Nove A, Ten Hoope-Bender P, de Bernis L, Bokosi M, Moyo NT, Homer CSE. A descriptive analysis of midwifery education, regulation and association in 73 countries: the baseline for a post-2015 pathway. HUMAN RESOURCES FOR HEALTH 2016; 14:37. [PMID: 27278786 PMCID: PMC4898359 DOI: 10.1186/s12960-016-0134-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 05/31/2016] [Indexed: 05/31/2023]
Abstract
BACKGROUND Education, regulation and association (ERA) are the supporting pillars of an enabling environment for midwives to provide quality care. This study explores these three pillars in the 73 low- and middle-income countries who participated in the State of the World's Midwifery (SoWMy) 2014 report. It also examines the progress made since the previous report in 2011. METHODS A self-completion questionnaire collected quantitative and qualitative data on ERA characteristics and organisation in the 73 countries. The countries were grouped according to World Health Organization (WHO) regions. A descriptive analysis was conducted. RESULTS In 82% of the participating countries, the minimum education level requirement to start midwifery training was grade 12 or above. The average length of training was higher for direct-entry programmes at 3.1 years than for post-nursing/healthcare provider programmes at 1.9 years. The median number of supervised births that must be conducted before graduation was 33 (range 0 to 240). Fewer than half of the countries had legislation recognising midwifery as an independent profession. This legislation was particularly lacking in the Western Pacific and South-East Asia regions. In most (90%) of the participating countries, governments were reported to have a regulatory role, but some reported challenges to the role being performed effectively. Professional associations were widely available to midwives in all regions although not all were exclusive to midwives. CONCLUSIONS Compared with the 2011 SoWMy report, there is evidence of increasing effort in low- and middle-income countries to improve midwifery education, to strengthen the profession and to follow international ERA standards and guidelines. However, not all elements are being implemented equally; some variability persists between and within regions. The education pillar showed more systematic improvement in the type of programme and length of training. The reinforcement of regulation through the development of legislation for midwifery, a recognised definition and the strengthening of midwives' associations would benefit the development of other ERA elements and the profession generally.
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Affiliation(s)
| | - Andrea Nove
- ICS Integrare, calle Balmes, 30,3-1, 08007, Barcelona, Spain.
| | | | - Luc de Bernis
- UNFPA, 11-13 Chemin des Anémones, 1219, Chatelaine, Switzerland
| | - Martha Bokosi
- ICM, Laan van Meerdervoort 70, 2517 AN, The Hague, The Netherlands
| | - Nester T Moyo
- ICM, Laan van Meerdervoort 70, 2517 AN, The Hague, The Netherlands
| | - Caroline S E Homer
- University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Hildingsson I, Gamble J, Sidebotham M, Creedy DK, Guilliland K, Dixon L, Pallant J, Fenwick J. Midwifery empowerment: National surveys of midwives from Australia, New Zealand and Sweden. Midwifery 2016; 40:62-9. [PMID: 27428100 DOI: 10.1016/j.midw.2016.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/17/2016] [Accepted: 06/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND the predicted midwifery workforce shortages in several countries have serious implications for the care of women during pregnancy, birth and post partum. There are a number of factors known to contribute to midwifery shortages and work attrition. However, midwives assessment of their own professional identity and role (sense of empowerment) are perhaps among the most important. There are few international workforce comparisons. AIM to compare midwives' sense of empowerment across Australia, New Zealand and Sweden using the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). METHOD a self-administered survey package was distributed to midwives through professional colleges and networks in each country. The surveys asked about personal, professional and employment details and included the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Descriptive statistics for the sample and PEMS were generated separately for the three countries. A series of analysis of variance with posthoc tests (Tukey's HSD) were conducted to compare scale scores across countries. Effect size statistics (partial eta squared) were also calculated. RESULTS completed surveys were received from 2585 midwives (Australia 1037; New Zealand 1073 and Sweden 475). Respondents were predominantly female (98%), aged 50-59 years and had significant work experience as a midwife (+20 years). Statistically significant differences were recorded comparing scores on all four PEMS subscales across countries. Moderate effects were found on Professional Recognition, Skills and Resources and Autonomy/Empowerment comparisons. All pairwise comparisons between countries reached statistical significance (p<.001) except between Australia and New Zealand on the Manager Support subscale. Sweden recorded the highest score on three subscales except Skills and Resources which was the lowest score of the three countries. New Zealand midwives scored significantly better than both their Swedish and Australian counterparts in terms of these essential criteria. DISCUSSION/CONCLUSIONS midwives in New Zealand and Sweden had a strong professional identity or sense of empowerment compared to their Australian counterparts. This is likely the result of working in more autonomous ways within a health system that is primary health care focused and a culture that constructs childbirth as a normal but significant life event. If midwifery is to reach its full potential globally then developing midwives sense of autonomy and subsequently their empowerment must be seen as a critical element to recruitment and retention that requires attention and strengthening.
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Affiliation(s)
- Ingegerd Hildingsson
- Mid Sweden University, Department of Nursing, Sundsvall, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
| | - Jenny Gamble
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - Mary Sidebotham
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - Debra K Creedy
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | | | - Lesley Dixon
- Research Development, New Zealand College of Midwives, New Zealand.
| | - Julie Pallant
- Menzies Health Institute Queensland, Griffith University, Australia.
| | - Jennifer Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia; Gold Coast University Hospital, Australia.
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Yigzaw T, Carr C, Stekelenburg J, van Roosmalen J, Gibson H, Gelagay M, Admassu A. Using task analysis to generate evidence for strengthening midwifery education, practice, and regulation in Ethiopia. Int J Womens Health 2016; 8:181-90. [PMID: 27313478 PMCID: PMC4890695 DOI: 10.2147/ijwh.s105046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Realizing aspirations for meeting the global reproductive, maternal, newborn, and child health goals depends not only on increasing the numbers but also on improving the capability of midwifery workforce. We conducted a task analysis study to identify the needs for strengthening the midwifery workforce in Ethiopia. METHODS We conducted a cross-sectional study of recently qualified midwives in Ethiopia. Purposively selected participants from representative geographic and practice settings completed a self-administered questionnaire, making judgments about the frequency of performance, criticality, competence, and location of training for a list of validated midwifery tasks. Using Statistical Package for the Social Sciences, Version 20, we computed the percentages and averages to describe participant and practice characteristics. We identified priority preservice education gaps by considering the tasks least frequently learned in preservice, most frequently mentioned for not being trained, and had the highest not capable response. Identification of top priorities for in-service training considered tasks with highest "not capable" and "never" done responses. We determined the licensing exam blueprint by weighing the composite mean scores for frequency and criticality variables and expert rating across practice categories. RESULTS One hundred and thirty-eight midwives participated in the study. The majority of respondents recognized the importance of midwifery tasks (89%), felt they were capable (91.8%), reported doing them frequently (63.9%), and learned them during preservice education (56.3%). We identified competence gaps in tasks related to obstetric complications, gynecology, public health, professional duties, and prevention of mother to child transmission of HIV. Moreover, our study helped to determine composition of the licensing exam for university graduates. CONCLUSION The task analysis indicates that midwives provide critical reproductive, maternal, newborn, and child health care services and supports continuing investment in this cadre. However, there were substantial competence gaps that limit their ability to accelerate progress toward health development goals. Moreover, basing the licensure exam on task analysis helped to ground it in national practice priorities.
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Affiliation(s)
| | | | - Jelle Stekelenburg
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Jos van Roosmalen
- Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | | | | | - Azeb Admassu
- Federal Ministry of Health, Addis Ababa, Ethiopia
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Nosraty S, Rahimi M, Kohan S, Beigei M. Effective strategies for reducing maternal mortality in Isfahan University of Medical Sciences, 2014. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:310-6. [PMID: 27186210 PMCID: PMC4857667 DOI: 10.4103/1735-9066.180391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Maternal mortality rate is among the most important health indicators. This indicator is a function of factors that are related to pregnant women; these factors include economic status, social and family life of the pregnant woman, human resources, structure of the hospitals and health centers, and management factors. Strategic planning, with a comprehensive analysis and coverage of all causes of maternal mortality, can be helpful in improving this indicator. Materials and Methods: This research is a descriptive exploratory study. After needs assessment and review of the current situation through eight expert panel meetings and evaluating the organization's internal and external environment, the strengths, weaknesses, threats, and opportunities of maternal mortality reduction were determined. Then, through mutual comparison of strengths/opportunities, strengths/threats, weaknesses/opportunities, and weaknesses/threats, WT, WO, ST, and SO strategies and suggested activities of the researchers for reducing maternal mortality were developed and dedicated to the areas of education, research, treatment, and health, as well as food and drug administration to be implemented. Results: In the expert panel meetings, seven opportunity and strength strategies, eight strength and threat strategies, five weakness and threat strategies, and seven weakness and opportunity strategies were determined and a strategic plan was developed. Conclusions: Dedication of the developed strategies to the areas of education, research, treatment, and health, as well as food and drug administration has coordinated these areas to develop Ministry of Health indicators. In particular, it emphasizes the key role of university management in improving the processes related to maternal health.
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Affiliation(s)
- Somaye Nosraty
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Rahimi
- Department of Anesthesiology and Assistant Treatment and Hospitals of Medicine, Faculty in Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Kohan
- Phd in Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Margan Beigei
- Phd in Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Midwives' attitudes towards supporting normal labour and birth - A cross-sectional study in South Germany. Midwifery 2016; 39:98-102. [PMID: 27321726 DOI: 10.1016/j.midw.2016.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE supporting healthy and normal physiological birth is part of the global maternity care agenda. Rising rates of interventions have been attributed to several factors, including characteristics, attitudes and preferences of childbearing women and their care providers. In this paper, the application of a scale that measures midwives' attitudes towards supporting normal labour and birth is described as well as factors that are associated with favourable attitudes, such as general self-efficacy, years in midwifery practice, and primary practice setting. DESIGN in this cross-sectional study an online questionnaire was sent out via e-mail to midwives in two regions of South Germany. The questionnaire contained a validated general self-efficacy scale, a 38-item instrument that measures attitudes towards supporting normal birth among German midwives and questions about midwives' practice experiences and educational preparation. FINDINGS on average, participants (n=188) were 39 years old (SD=10.3), and had 12 years of experience caring for women during labour and birth (SD=9.6). Multivariate modelling revealed that higher general self-efficacy, working primarily in out-of-hospital settings and having provided intrapartum care for fewer years were significantly associated with midwives' favourable attitudes towards supporting physiological birth (variance explained R(2)=29.0%, n=184). General self-efficacy (1.4%) and years of work experience (3.3%) contributed less of the variance in the outcome than work setting (24.5%). Sources of knowledge about normal birth were not significantly associated with the outcome and reduced the overall variance explained by 0.2%. CONCLUSIONS the study has shown that, compared to work setting, the general self-efficacy of German midwives, years providing intrapartum care and sources of knowledge about normal birth had comparatively little impact on their attitude towards supporting normal physiologic birth. Increasing exposure to out-of-hospital birth among German midwives throughout education and practice and fostering the skills and confidence necessary to support normal birth in hospital settings are important strategies to decrease unnecessary obstetric interventions.
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250
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Renfrew MJ. Optimising the contribution of midwifery to preventing stillbirths and improving the overall quality of care: Co-ordinated global action needed. Midwifery 2016; 36:99-101. [PMID: 27106950 DOI: 10.1016/j.midw.2016.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mary J Renfrew
- Mother and Infant Research Unit, University of Dundee, UK and; Scottish Improvement Science Collaborating Centre.
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