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Becker J, Becker C, Abeysekera R, Moir J, Gray M, Shimwela M, Oprescu F. Silent Tears of Midwives: 'I Want Every Mother Who Gives Birth to Have Her Baby Alive'-A Narrative Inquiry of Midwives Experiences of Very Early Neonatal Death from Tanzania. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040705. [PMID: 37189954 DOI: 10.3390/children10040705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Midwives working in settings with limited clinical resources experience high rates of very early neonatal deaths. Midwives manage the impact of this grief and trauma almost daily, which may affect patient care and their own well-being. RESEARCH AIMS To explore how midwives are impacted by and cope with high rates of very early neonatal deaths. To document midwives' insights and local solutions that may reduce very early neonatal deaths in limited resource settings. To document the stories of midwives in order to create awareness and garner support for midwives and their critical work in low resource settings. METHODS Narrative inquiry utilizing semi structured interviews. Twenty-one midwives with at least six months experience who had experienced or witnessed very early neonatal death were interviewed. Data were audio recorded and transcribed, and reflexive thematic analysis of transcripts was conducted. RESULTS AND DISCUSSION Three themes were identified: (1) deep sadness resulting from very early neonatal deaths leading to internal struggles; (2) use of spirituality, including prayer and occasional beliefs that unexplainable deaths were 'God's plan'; and (3) development of resilience by seeking solutions, educating themselves, taking accountability and guiding mothers. Participating midwives noted that inadequate staff and high caseloads with limited basic supplies hindered their clinical practice. Participants articulated that they concentrated on active solutions to save babies during labour, such as vigilant foetal rate heart monitoring and partogram. Further, reduction and prevention of very early neonatal death is a complex problem requiring multidisciplinary teams and woman-centred care approaches to address issues contributing to the health of mothers and their new-borns. CONCLUSIONS Midwives' narratives highlighted ways of coping with grief and deep sadness, through prayer, and further education of both mothers and fellow colleagues to achieve better antenatal and intrapartum care and outcomes. This study gave midwives an opportunity for their voices to be heard and to generate solutions or insights that can be shared with colleagues in similar low-resource settings.
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Affiliation(s)
- Jan Becker
- Midwife Vision Global, Uhuru Street, Dar es Salaam 12101, Tanzania
| | - Chase Becker
- Midwife Vision Global, Uhuru Street, Dar es Salaam 12101, Tanzania
| | - Rachel Abeysekera
- Medical School, University of Nicosia in Partnership with St George's University of London, Makedonitissis 46, Nicosia 2417, Cyprus
| | - James Moir
- Midwife Vision Global, Uhuru Street, Dar es Salaam 12101, Tanzania
| | - Marion Gray
- Centre for Health Research, School of Health and Wellbeing, Faculty of Health, Engineering and Sciences, University of the Southern Queensland, Toowoomba, QLD 4300, Australia
| | - Meshack Shimwela
- Temeke Regional Referral Hospital, Dar es Salaam 15101, Tanzania
| | - Florin Oprescu
- Public Health, University of Sunshine Coast, Sippy Downs, QLD 4556, Australia
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Rosa RD, Gomes IEM, Costa R, Alves IFBDO, Aires LCDP. Experiências e condutas do profissional de saúde frente ao óbito neonatal. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.41101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Objetivo: identificar as experiências e condutas do profissional de saúde frente ao óbito neonatal disponíveis na literatura. Método: estudo bibliográfico descritivo, do tipo revisão integrativa, com delimitação temporal de 2009 a 2020, realizado nas bases de dados LILACS, BDENF, MEDLINE, Scopus, Web of Science, CINAHL e biblioteca virtual SciELO, por duas pesquisadoras de forma independente em junho de 2021. Foram selecionados 511 artigos, porém somente 21 compuseram o corpus final do estudo após aplicação dos critérios de inclusão/exclusão. Resultados: os estudos evidenciaram que as experiências dos profissionais diante do óbito são permeadas por sentimentos ambivalentes que influenciam na escolha de suas estratégias de enfrentamento. Dentre as condutas adotadas pelos profissionais, destacam-se: a comunicação clara e sensível; o acolhimento ao luto dos familiares; o respeito à decisão dos pais em relação aos cuidados com o recém-nascido; e a entrega de lembranças, foram consideradas atitudes positivas para a superação do óbito neonatal. Considerações finais: os resultados mostram o despreparo dos profissionais para lidar com o processo de morte do recém-nascido e da necessidade de haver estratégias de educação permanente voltada ao óbito neonatal.
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Roche N, Darzins S, Oakman J, Stuckey R. Worker Experiences of the Work Health and Safety Impacts of Exposure to Dying and Death in Clinical Settings: A Qualitative Scoping Review. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221117902. [PMID: 36476137 DOI: 10.1177/00302228221117902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually.
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Affiliation(s)
- Natalie Roche
- Centre for Ergonomics and Human Factors, School of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Susan Darzins
- School of Allied Health, Australian Catholic University, Melbourne, VIC, Australia
| | - Jodi Oakman
- Centre for Ergonomics and Human Factors, School of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Rwth Stuckey
- Centre for Ergonomics and Human Factors, School of Public Health, La Trobe University, Melbourne, VIC, Australia
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McNamara K, Smith A, Shine B, Cregan M, Prihodova L, O’Shaughnessy A, Martin A, Macdonald J, Kingston P, Fitzpatrick C, Hennessy M, O’Donoghue K. Addressing obstetricians' awareness of compassion, communication, and self-care when caring for families experiencing stillbirth: Evaluation of a novel educational workshop using applied drama techniques. PLoS One 2022; 17:e0277496. [PMID: 36395201 PMCID: PMC9671339 DOI: 10.1371/journal.pone.0277496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Obstetricians describe feeling shocked and isolated following stillbirth. Few receive adequate training in how to care for bereaved parents or themselves. We developed a novel workshop for trainee obstetricians using applied drama techniques-in collaboration with the National Theatre of Ireland, the national training body for obstetricians and gynaecologists, and patient support groups-to teach obstetricians skills in communication and self-care around the time of stillbirth. MATERIALS AND METHODS Five workshops, delivered January-May 2018, are the focus of this evaluation. Senior trainees in Obstetrics attended and completed a post-workshop evaluation questionnaire. Five-point Likert scales were used to assess participants' communication and support skills pre- and post- the workshop, and their views on pre-specified attributes needed when caring for families experiencing stillbirth and aspects of the workshop. Quantitative and qualitative data were analysed using descriptive statistics and content analysis, respectively. RESULTS 39/59 (66%) workshop participants completed the questionnaires. Most had received no prior training in caring for families experiencing antenatal (31/39, 80%) or intrapartum (34/39, 87%) stillbirth. Following the workshop there was a significant improvement in trainee's level of confidence in breaking bad news, communicating clearly with the family when breaking bad news, recognising the emotional needs of the family, recognising their own emotional responses, and supporting their colleagues. Trainees were positive about the workshop content and delivery; 90% stated they would recommend it to a colleague. DISCUSSION Adequate, appropriate, and stimulating education and training in stillbirth care and self-care is clearly needed to improve patient care. Our findings demonstrate that this novel educational workshop using applied drama techniques-developed in collaboration with diverse stakeholders and underpinned by the views of parents and obstetricians who had experience of stillbirth-is an acceptable and appropriate way of training obstetricians in how to care for bereaved parents and/or to engage in self-care.
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Affiliation(s)
- Karen McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Aisling Smith
- Royal College of Physicians of Ireland, Dublin, Ireland
| | - Brid Shine
- Coombe Women & Infants University Hospital, Dublin, Ireland
| | - Mairie Cregan
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Féileacáin, Stillbirth and Neonatal Death Association of Ireland, Cork, Ireland
| | | | | | - Aisling Martin
- Coombe Women & Infants University Hospital, Dublin, Ireland
- UCD Centre for Human Reproduction, Dublin, Ireland
| | | | | | - Chris Fitzpatrick
- Coombe Women & Infants University Hospital, Dublin, Ireland
- UCD Centre for Human Reproduction, Dublin, Ireland
| | - Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
- * E-mail:
| | - Keelin O’Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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Cetin K, Worku D, Demtse A, Melberg A, Miljeteig I. "Death audit is a fight" - provider perspectives on the ethics of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system in Ethiopia. BMC Health Serv Res 2022; 22:1214. [PMID: 36175949 PMCID: PMC9524002 DOI: 10.1186/s12913-022-08568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal and neonatal health are regarded as important indicators of health in most countries. Death auditing through, for example, the Maternal and Perinatal Death Surveillance and Response (MPDSR) is viewed as key to preventing maternal and newborn mortality. However, little is known about the implications of implementing perinatal auditing for healthcare professionals in low-income contexts. This study aimed to explore the ethical and practical consequences clinicians experience concerning MPDSR reporting practices in Ethiopia. METHODS: Qualitative semi-structured in-depth individual interviews were conducted with 16 healthcare workers across professions at selected facilities in Ethiopia. The interview questions were related to clinicians' experiences with, and perceptions of, death auditing. Their strategies for coping with newborn losses and the related reporting practices were also explored. The material was analyzed following systematic text condensation, and the NVivo11 software was used for organizing and coding the data material. RESULTS Participants experienced fear of punishment and blame in relation to the perinatal death auditing process. They found that auditing did not contribute to reducing perinatal deaths and that their motivation to stick to the obligation was negatively affected by this. Performing audits without available resources to provide optimal care or support in the current system was perceived as unfair. Some hid information or misreported information in order to avoid accusations of misconduct when they felt they were not to blame for the baby's death. Coping strategies such as engaging in exceedingly larger work efforts, overtreating patients, or avoiding complicated medical cases were described. CONCLUSIONS Experiencing perinatal death and death reporting constitutes a double burden for the involved healthcare workers. The preventability of perinatal death is perceived as context-dependent, and both clinicians and the healthcare system would benefit from a safe and blame-free reporting environment. To support these healthcare workers in a challenging clinical reality, guidelines and action plans that are specific to the Ethiopian context are needed.
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Affiliation(s)
- Kaya Cetin
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway.
| | - Dawit Worku
- Addis Center for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Demtse
- Addis Center for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrea Melberg
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
| | - Ingrid Miljeteig
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Stabnick A, Yeboah M, Arthur-Komeh J, Ankobea F, Moyer CA, Lawrence ER. "Once you get one maternal death, it's like the whole world is dropping on you": experiences of managing maternal mortality amongst obstetric care providers in Ghana. BMC Pregnancy Childbirth 2022; 22:206. [PMID: 35287601 PMCID: PMC8919901 DOI: 10.1186/s12884-022-04535-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/11/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Maternal mortality has a significant global impact, especially in low-resource settings. Little prior research has been conducted on the potential effects of poor maternal outcomes on the personal and professional well-being of healthcare providers. This study explores the in-depth experiences and perspectives of obstetric providers in Ghana who work in a setting with frequent maternal mortalities. METHODS This is a qualitative study of semi-structured interviews conducted at the Komfo Anokye Teaching Hospital in Ghana. Participants were obstetric healthcare providers, defined as midwives, house officers currently rotating on the obstetrics/gynecology service, and obstetrician/gynecologists at any training or practice level (residents, fellows, and specialists). Interviews were audio-recorded, transcribed verbatim, and uploaded into NVivo for qualitative analysis. Using the Attride-Stirling qualitative model, an incremental and iterative process was used to code interviews with keyword phrases and develop a framework of organizing and global themes. RESULTS Interviews were conducted with 27 participants-15 midwives and 12 physicians (three obstetrician/gynecologist residents, six obstetrician/gynecologist specialists, and three house officers), with sample size determined by data saturation. Obstetric providers' experiences in a setting with frequent maternal mortalities were dependent on their level of preparedness to manage maternal mortalities and the workplace environment. Providers' level of preparedness was dependent on both the training they had received on the medical management of obstetric emergencies, as well as a lack of training on the mental health aspects of coping with maternal mortality. The impact of the workplace environment was dependent on systems failures and limited resources, blame from colleagues and supervisors, and a lack of support in the workplace. In turn, obstetric providers' experiences managing frequent maternal mortalities impacted their clinical care performance and mental health. CONCLUSIONS Maternal deaths have profound personal and professional impacts on the healthcare providers who manage them. A large need exists for additional institutional training and support for obstetric providers who manage maternal mortality, especially in low-resource settings like Ghana.
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Affiliation(s)
- Anna Stabnick
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Michael Yeboah
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | - Johnny Arthur-Komeh
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | - Frank Ankobea
- Department of Obstetrics and Gynecology, KNUST-SMD, Kumasi, Ghana
| | - Cheryl A. Moyer
- Global REACH, Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Emma R. Lawrence
- Global REACH, Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
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Becker J, Becker C, Oprescu F, Wu CJJ, Moir J, Shimwela M, Gray M. Silent voices of the midwives: factors that influence midwives' achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry. BMC Pregnancy Childbirth 2022; 22:39. [PMID: 35034616 PMCID: PMC8761383 DOI: 10.1186/s12884-021-04339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery). METHODS This was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes. RESULTS Thematic analysis of the midwives' responses revealed three factors that influence successful resuscitation: 1. Hands-on training ("HOT") with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills; 2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and. 3. Strategies that reduce barriers. Immediately after birth, live resuscitation can commence at the mother's bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation. The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research. CONCLUSIONS Training in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of "HOT" real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife's beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.
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Affiliation(s)
- Jan Becker
- Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia. .,University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD, 4556, Australia. .,General Division of the Order of Australia, Office of the Official Secretary to the Governor-General, Government House, ACT, 2600, Canberra, Australia.
| | - Chase Becker
- Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia.,University of Nicosia Medical School in Partnership with St George's University of London, Makedonitissis 46, Nicosia, 2417, Cyprus
| | - Florin Oprescu
- School of Health and Behavioural Sciences, University of Sunshine Coast (USC), 90 Sippy Downs Dr, Sippy Downs, QLD, 4556, Australia
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), 1 Morton Bay Parade, Petrie, QLD, 4502, Australia.,Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia
| | - James Moir
- Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia.,Clinical Director, QLD Fertility Group Sunshine Coast, 44 Clarkes Road, Diddillibah, QLD, 4559, Australia
| | - Meshak Shimwela
- Internal Medicine, Temeke Regional Referral Hospital, Temeke Road, Adjacent Sterio Market, Dar es Salaam, Tanzania
| | - Marion Gray
- Centre for Health Research/School of Health and Wellbeing; Associate Dean (Clinical), Faculty of Health, Engineering and Sciences, University of the Southern Queensland, Sinnathamby Blvd, Springfield Central, Queensland, 4300, Australia
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Midwives' strategies for coping with barriers to providing quality maternal and neonatal care: a Glaserian grounded theory study. BMC Health Serv Res 2021; 21:1190. [PMID: 34732179 PMCID: PMC8565049 DOI: 10.1186/s12913-021-07049-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Midwives face direct and indirect barriers in their workplaces that have negative consequences on their ability to provide quality care to women and neonates, however, they still carry on with their duties. This study aimed at investigating the coping strategies that Ghanaian midwives adopt to be able to complete their work. Methods Glaserian Grounded theory was used in this study. Data were collected through non-participant observations and semi-structured interviews. The study participants included 29 midwives who worked in labour/birthing environments and a pharmacist, a social worker, a national Health Insurance Scheme manager and a health services manager. Findings The midwives’ motivation due to their strong desire to save the lives of women and neonates and their strong affection for the midwifery profession was identified to help them cope with the barriers that they faced in their workplaces. The midwives’ motivation was found to spur actions such as improvising, taking control of the birthing process and the birthing environment and the maintenance of social and professional networks to help them to complete their duties. Conclusion Ghanaian midwives face myriad barriers in their workplaces; however, they are able to adopt coping strategies that enable them to complete their duties. The provision of care resources for maternity services in the country will reduce the barriers that the midwives face and improve the quality of maternal and neonatal care. In the short term however, pre and post midwifery educational programmes should focus on developing resilience in the midwifery workforce to help midwives cope more effectively with the challenges that they face in their workplaces. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07049-0.
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Lawrence ER, Stabnick A, Arthur-Komeh J, Moyer CA, Yeboah M. Preparedness to deal with maternal mortality among obstetric providers at an urban tertiary hospital in Ghana. Int J Gynaecol Obstet 2021; 154:358-365. [PMID: 33314104 DOI: 10.1002/ijgo.13537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/25/2020] [Accepted: 12/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study explores the impacts of managing frequent maternal mortalities on obstetric healthcare providers in Ghana. METHODS Two hundred and seventy obstetric providers at the Komfo Anokye Teaching Hospital in Ghana completed an electronic survey. Questions included coping strategies, sources and adequacy of support, training, and emotional impact. Logistic regression assessed predictors of perceived preparedness to manage maternal mortalities. RESULTS Over half of participants (55.1%) did not report adequate support to deal with maternal death and only 35.9% received training. The vast majority (96.4%) agreed that managing maternal deaths takes a large emotional toll-27.6% considered giving up their obstetric practice, half experienced guilt or shame, and half worried about legal or disciplinary action. After adjusting for age, gender, years in practice, and annual maternal mortalities managed, perceived adequacy of support (odds ratio [OR] 6.6, 95% confidence interval [CI] 3.0-14.7, P < 0.001) and receiving training (OR 9.5, 95% CI 3.5-25.8, P < 0.001) were significantly associated with preparedness to deal with maternal mortality. CONCLUSION Managing maternal mortalities has significant emotional impact on obstetric healthcare providers. Preparedness to deal with maternal death is significantly improved when providers receive adequate support and training.
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Affiliation(s)
- Emma R Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anna Stabnick
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Johnny Arthur-Komeh
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Cheryl A Moyer
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Yeboah
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Azeez S, Obst KL, Oxlad M, Due C, Middleton P. Australian fathers' experiences of support following neonatal death: a need for better access to diverse support options. J Perinatol 2021; 41:2722-2729. [PMID: 34556801 PMCID: PMC8460396 DOI: 10.1038/s41372-021-01210-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To explore fathers' experiences of support following neonatal death, including the availability and perceived adequacy of support, barriers and facilitators to support and desired support. STUDY DESIGN Semi-structured interviews were conducted with ten Australian fathers who had experienced the death of a baby in the neonatal period at least 6 months previously. Data were analysed using thematic analysis. RESULTS Two overarching themes were identified: From hospital to home: Continuity of care and Self and community barriers to support. Fathers who could access the support they required found this to be beneficial. Overall, however, supports were perceived as inadequate in variety and availability, with more follow-up support from the hospital desired. Fathers highlighted limited opportunities to form emotional connections with others and a strong desire to talk about their baby. CONCLUSION Healthcare professionals and support organisations can more effectively assist fathers by increasing the variety of supports available and facilitating follow-up or referrals after hospital discharge.
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Affiliation(s)
- Shazleen Azeez
- School of Psychology, University of Adelaide, Adelaide, SA, Australia.
| | - Kate Louise Obst
- grid.1010.00000 0004 1936 7304School of Psychology, University of Adelaide, Adelaide, SA Australia
| | - Melissa Oxlad
- grid.1010.00000 0004 1936 7304School of Psychology, University of Adelaide, Adelaide, SA Australia
| | - Clemence Due
- grid.1010.00000 0004 1936 7304School of Psychology, University of Adelaide, Adelaide, SA Australia
| | - Philippa Middleton
- grid.430453.50000 0004 0565 2606South Australian Health and Medical Research Institute, Adelaide, SA Australia
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Toma G, Essuman A, Fetters MD. Family medicine residency training in Ghana after 20 years: resident attitudes about their education. Fam Med Community Health 2020; 8:fmch-2020-000394. [PMID: 33093166 PMCID: PMC7583799 DOI: 10.1136/fmch-2020-000394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective In addition to assessing educational needs of family medicine trainees in Ghana, we sought to assess whether those entering the training programme aimed to pursue an academic career. Design A case study using an anonymous cross-sectional survey through collaboration between faculty members from the family medicine departments of Ghana and the University of Michigan. Setting The family medicine postgraduate trainees and the most recent graduates in the three training sites, Accra, Kumasi and Mampong, as well as modular residents in Ghana served as the targeted participants during data collection between October and November of 2018. Participants Second and third year family medicine residents, fellows (known as senior residents in Ghana) and recent graduates were invited to participate in this study. Thirty-five of 77 eligible subjects provided responses (46% response rate), but five records were eliminated due to incomplete data to yield a survey completion rate of 39% (30/77). Result Participants were mostly men (n=19), and the average age of respondents was 37 years old. The participants indicated the residency programmes needed more faculty 97% (n=29), supervision during outpatient care 87% (n=26) and lectures 83% (n=25). The main reason provided by respondents for entering residency programme in family medicine, which is currently not required for practising primary care in Ghana, was to obtain more education 93% (n=28). Participants who had completed the residency programme were much more likely to be interested in becoming faculty compared with those still in residency (p <0.001). Conclusion The research confirms the need for more faculty and the importance of investing in faculty development resources for ensuring a robust programme. These findings provide constructive feedback that could improve residency curricula of the local and regional family medicine training programmes and supports investing in trainees and new graduates as future faculty candidates.
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Affiliation(s)
- Ghazwan Toma
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Akye Essuman
- Family Medicine Unit, Department of Community Health, University of Ghana, Accra, Ghana
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
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Laing RE, Fetherston CM, Morrison P. Responding to catastrophe: A case study of learning from perinatal death in midwifery practice. Women Birth 2020; 33:556-565. [PMID: 32113870 DOI: 10.1016/j.wombi.2020.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/18/2020] [Accepted: 02/17/2020] [Indexed: 02/05/2023]
Abstract
PROBLEM/BACKGROUND Perinatal death has far reaching emotional effects for all involved in this devastating event. The opportunity for learning as a result of this catastrophe, however, remains unexplored. AIM To explore midwives' experiences of caring through, and learning from, perinatal death, to better inform the effective planning and delivery of education that optimises both midwifery and self-care. METHODS A naturalistic interpretive multiple case study design. Seventeen midwives, located in Australia, participated in an online group activity hosted as a blog, followed by telephonic focus groups and in-depth email interviews. FINDINGS Thematic data analysis revealed seven major themes: Grappling with the reality of perinatal death; Struggling with personal and professional heartache; Seeking the space to grieve as a professional; Being with the woman and her family; Finding a new purpose; Strengthened through support; and Developing the courage to care. DISCUSSION The initial turmoil and impact of loss reflected the catastrophic nature of perinatal death. Midwives uncovered a journey to acceptance and learning, realising a determination to enhance expertise and discovering value in experiential knowledge. Insecurity regarding competence and confidence to manage perinatal death and bereavement care was highlighted. However, sharing their stories revealed professional fulfilment, personal strength, and solidarity amongst midwives who have endured similar experiences. CONCLUSION A coordinated approach to support and the dissemination of experiential knowledge and learning could be developed within an online model of narrative sharing and discussion. Debriefing, support and sharing of expertise in this way may foster engagement within and beyond the workplace.
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Affiliation(s)
- Robert E Laing
- Discipline of Nursing, College of Science Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, 6150, WA, Australia.
| | - Catherine M Fetherston
- Discipline of Nursing, College of Science Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, 6150, WA, Australia
| | - Paul Morrison
- Discipline of Nursing, College of Science Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, 6150, WA, Australia
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Shakespeare C, Merriel A, Bakhbakhi D, Baneszova R, Barnard K, Lynch M, Storey C, Blencowe H, Boyle F, Flenady V, Gold K, Horey D, Mills T, Siassakos D. Parents' and healthcare professionals' experiences of care after stillbirth in low- and middle-income countries: a systematic review and meta-summary. BJOG 2018; 126:12-21. [PMID: 30099831 DOI: 10.1111/1471-0528.15430] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement. OBJECTIVE To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs. SEARCH STRATEGY Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL. SELECTION CRITERIA Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs. DATA COLLECTION AND ANALYSIS Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES). MAIN RESULTS In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth. CONCLUSIONS Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately. TWEETABLE ABSTRACT Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs.
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Affiliation(s)
- C Shakespeare
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - A Merriel
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - D Bakhbakhi
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - R Baneszova
- 2nd Department of Obstetrics and Gynaecology, Faculty of Medicine, University Hospital Bratislava, Comenius University, Bratislava, Slovakia
| | - K Barnard
- Library and Knowledge Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - M Lynch
- Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - C Storey
- International Stillbirth Alliance, Bristol, UK
| | - H Blencowe
- London School of Hygiene and Tropical Medicine, London, UK
| | - F Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - K Gold
- Department of Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - D Horey
- La Trobe University, Bundoora, Vic., Australia
| | - T Mills
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - D Siassakos
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
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McNamara K, Meaney S, O'Donoghue K. Intrapartum fetal death and doctors: a qualitative exploration. Acta Obstet Gynecol Scand 2018; 97:890-898. [DOI: 10.1111/aogs.13354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/21/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Karen McNamara
- Pregnancy Loss Research Group; Department of Obstetrics and Gynaecology; University College Cork; Cork Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group; Department of Obstetrics and Gynaecology; University College Cork; Cork Ireland
- National Perinatal Epidemiology Center; University College Cork; Cork Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group; Department of Obstetrics and Gynaecology; University College Cork; Cork Ireland
- The Irish Center for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
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Munabi‐Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Syst Rev 2017; 11:CD011558. [PMID: 29148566 PMCID: PMC5721625 DOI: 10.1002/14651858.cd011558.pub2] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants. A skilled birth attendant (SBA) is a health worker such as a midwife, doctor, or nurse who is trained to manage normal pregnancy and childbirth. (S)he is also trained to identify, manage, and refer any health problems that arise for mother and baby. The skills, attitudes and behaviour of SBAs, and the extent to which they work in an enabling working environment, impact on the quality of care provided. If any of these factors are missing, mothers and babies are likely to receive suboptimal care. OBJECTIVES To explore the views, experiences, and behaviours of skilled birth attendants and those who support them; to identify factors that influence the delivery of intrapartum and postnatal care in low- and middle-income countries; and to explore the extent to which these factors were reflected in intervention studies. SEARCH METHODS Our search strategies specified key and free text terms related to the perinatal period, and the health provider, and included methodological filters for qualitative evidence syntheses and for low- and middle-income countries. We searched MEDLINE, OvidSP (searched 21 November 2016), Embase, OvidSP (searched 28 November 2016), PsycINFO, OvidSP (searched 30 November 2016), POPLINE, K4Health (searched 30 November 2016), CINAHL, EBSCOhost (searched 30 November 2016), ProQuest Dissertations and Theses (searched 15 August 2013), Web of Science (searched 1 December 2016), World Health Organization Reproductive Health Library (searched 16 August 2013), and World Health Organization Global Health Library for WHO databases (searched 1 December 2016). SELECTION CRITERIA We included qualitative studies that focused on the views, experiences, and behaviours of SBAs and those who work with them as part of the team. We included studies from all levels of health care in low- and middle-income countries. DATA COLLECTION AND ANALYSIS One review author extracted data and assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review. MAIN RESULTS We included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America.Our synthesis pointed to a number of factors affecting SBAs' provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always given sufficient training during their education or after they had begun clinical work. Also, inadequate staffing of facilities could increase the workloads of skilled birth attendants, make it difficult to provide supervision and result in mothers being offered poorer care. In addition, SBAs did not always believe that their salaries and benefits reflected their tasks and responsibilities and the personal risks they undertook. Together with poor living and working conditions, these issues were seen to increase stress and to negatively affect family life. Some SBAs also felt that managers lacked capacity and skills, and felt unsupported when their workplace concerns were not addressed.Possible causes of staff shortages in facilities included problems with hiring and assigning health workers to facilities where they were needed; lack of funding; poor management and bureaucratic systems; and low salaries. Skilled birth attendants and their managers suggested factors that could help recruit, keep, and motivate health workers, and improve the quality of care; these included good-quality housing, allowances for extra work, paid vacations, continuing education, appropriate assessments of their work, and rewards.Skilled birth attendants' ability to provide quality care was also limited by a lack of equipment, supplies, and drugs; blood and the infrastructure to manage blood transfusions; electricity and water supplies; and adequate space and amenities on maternity wards. These factors were seen to reduce SBAs' morale, increase their workload and infection risk, and make them less efficient in their work. A lack of transport sometimes made it difficult for SBAs to refer women on to higher levels of care. In addition, women's negative perceptions of the health system could make them reluctant to accept referral.We identified some other factors that also may have affected the quality of care, which were based on findings assessed as of low or very low confidence. Poor teamwork and lack of trust and collaboration between health workers appeared to negatively influence care. In contrast, good collaboration and teamwork appeared to increase skilled birth attendants' motivation, their decision-making abilities, and the quality of care. Skilled birth attendants' workloads and staff shortages influenced their interactions with mothers. In addition, poor communication undermined trust between skilled birth attendants and mothers. AUTHORS' CONCLUSIONS Many factors influence the care that SBAs are able to provide to mothers during childbirth. These include access to training and supervision; staff numbers and workloads; salaries and living conditions; and access to well-equipped, well-organised healthcare facilities with water, electricity, and transport. Other factors that may play a role include the existence of teamwork and of trust, collaboration, and communication between health workers and with mothers. Skilled birth attendants reported many problems tied to all of these factors.
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Affiliation(s)
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Atle Fretheim
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
- University of OsloInstitute of Health and SocietyOsloNorway
| | - Harriet Nabudere
- Uganda National Health Research OrganisationPlot 2, Berkeley Lane, EntebbeEntebbeUganda
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McNamara K, Meaney S, O'Connell O, McCarthy M, Greene RA, O'Donoghue K. Healthcare professionals' response to intrapartum death: a cross-sectional study. Arch Gynecol Obstet 2017; 295:845-852. [PMID: 28210863 DOI: 10.1007/s00404-017-4309-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exposure to adverse perinatal events can impact on the way healthcare professionals (HCPs) provide patient care. The aim of this study was to document the experiences of HCPs following exposure to intrapartum death (IPD), to identify opinions surrounding education and suitable support strategies, and to ascertain if involvement with an IPD had any impact on clinical practice. METHODS A questionnaire study, with open and closed questions, was developed and set in a tertiary maternity hospital. Consultant obstetricians, trainee obstetricians and midwives were invited to participate. Respondents were questioned about the impact that an intrapartum death had on them, the support they received in the immediate aftermath and their opinions regarding ongoing education and training in the areas of intrapartum death and self-care. RESULTS Eighty percent of HCPs in our study had a direct involvement with an IPD. Most (82%) HCPs received no training in dealing with IPD while 94% had no education on self-care strategies. Despite it being desired by most (80%), debriefing was offered to just 11% of HCPs who were involved in an IPD. Three main qualitative themes emerged from the data; the personal impact of IPDs on HCPs, implications for professional practice and future patient care, and the importance on non-judgemental support. CONCLUSION Maternity hospitals need to improve their support structures for HCPs following an IPD. It is hoped that this study will inform future educational practice and identify potential support strategies.
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Affiliation(s)
- Karen McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.
| | - S Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - O O'Connell
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
| | - M McCarthy
- Cork University Maternity Hospital, Cork, Ireland
| | - R A Greene
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - K O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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