1
|
Combellick JL, Telfer ML, Ibrahim BB, Novick G, Morelli EM, James-Conterelli S, Kennedy HP. Midwifery care during labor and birth in the United States. Am J Obstet Gynecol 2023; 228:S983-S993. [PMID: 37164503 DOI: 10.1016/j.ajog.2022.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 05/12/2023]
Abstract
The intrapartum period is a crucial time in the continuum of pregnancy and parenting. Events during this time are shaped by individuals' unique sociocultural and health characteristics and by their healthcare providers, practice protocols, and the physical environment in which care is delivered. Childbearing people in the United States have less opportunity for midwifery care than in other high-income countries. In the United States, there are 4 midwives for every 1000 live births, whereas, in most other high-income countries, there are between 30 and 70 midwives. Furthermore, these countries have lower maternal and neonatal mortality rates and have consistently lower costs of care. National and international evidences consistently report that births attended by midwives have fewer interventions, cesarean deliveries, preterm births, inductions of labor, and more vaginal births after cesarean delivery. In addition, midwifery care is consistently associated with respectful care and high patient satisfaction. Midwife-physician collaboration exists along a continuum, including births attended independently by midwives, births managed in consultation with a physician, and births attended primarily by a physician with a midwife acting as consultant on the normal aspects of care. This expert review defined midwifery care and provided an overview of midwifery in the United States with an emphasis on the intrapartum setting. Health outcomes associated with midwifery care, specific models of intrapartum care, and workforce issues have been presented within national and international contexts. Recommendations that align with the integration of midwifery have been suggested to improve national outcomes and reduce pregnancy-related disparities.
Collapse
Affiliation(s)
| | | | | | - Gina Novick
- Yale University School of Nursing, Orange, CT
| | | | | | | |
Collapse
|
2
|
Larsson B, Elfving M, Vesterlund E, Karlström A, Hildingsson I. Fulfilment of expectations on birth and the postpartum period - A Swedish cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100748. [PMID: 35728347 DOI: 10.1016/j.srhc.2022.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The fulfilment of birth expectations is important to women and strongly related to birth satisfaction. OBJECTIVE The aim of this study was to investigate women's expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled. METHODS A longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences. RESULTS The majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women's expectations and experiences. Most likely to be fulfilled were women's expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled. CONCLUSIONS Pregnant women's expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.
Collapse
Affiliation(s)
- Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | - Elin Vesterlund
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
| |
Collapse
|
3
|
Martin-Arribas A, Escuriet R, Borràs-Santos A, Vila-Candel R, González-Blázquez C. A comparison between midwifery and obstetric care at birth in Spain: Across-sectional study of perinatal outcomes. Int J Nurs Stud 2021; 126:104129. [PMID: 34890836 DOI: 10.1016/j.ijnurstu.2021.104129] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The organizational structure of maternity services determines the choice of which professionals provide care during pregnancy, birth, and the postnatal period, and it influences the kind of care they deliver and the level of continuity of care offered. There is considerable evidence that demonstrates a relationship between how care is provided and the maternal and neonatal health outcomes. Registered midwives and obstetricians provide maternity care across Spain. To date, no studies have assessed whether maternity outcomes differ between these two groups. OBJECTIVE The aim of this study was to examine the association between the care received (midwifery care versus obstetric care) and the maternal and neonatal outcomes in women with normal, low- and medium-risk pregnancies in Spain from 2016 to 2019. DESIGN A prospective, multicentre, cross-sectional study was carried out as part of COST Action IS1405 at 44 public hospitals in Spain in the years 2016-2019. The protocol can be accessed through the registry ISRCTN14062994. The sample size of this study was 11,537 women. The primary outcome was mode of birth. The secondary outcomes included augmentation with oxytocin, use of epidural analgesia, women's position at birth, perineal integrity, third stage of labour management, maternal and neonatal admission to intensive care, Apgar score, neonatal resuscitation, and early initiation of breastfeeding. Chi-square tests for categorical variables and independent sample t-test for continuous variables to assess differences between the midwifery and obstetric groups were calculated. Odds ratio with intervals of confidence at 95% were calculated for obstetric interventions and perinatal outcomes. A multivariate logistic regression model was applied in order to examine the effect of type of healthcare provider on perinatal outcomes. These models were adjusted for care provider, type of onset of labour, use of anaesthesia, pregnancy risk, maternal age, parity, and gestational age at birth. RESULTS Midwifery care was associated with lower rates of operative births and severe perineal damage and had no higher adverse outcomes. No statistically significant differences were observed in the use of other obstetric interventions between the two groups. CONCLUSIONS The findings of this study should encourage a shift in the current maternity care system towards a greater integration of midwifery-led services in order to achieve optimal birth outcomes for women and newborns. REGISTRY NUMBER ISRCTN14062994.
Collapse
Affiliation(s)
- Anna Martin-Arribas
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain; Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.
| | - Ramon Escuriet
- Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain.
| | - Alicia Borràs-Santos
- Gimbernat School of Nursing, Universitat Autònoma de Barcelona (UAB), Sant Cugat del Vallès, Spain.
| | - Rafael Vila-Candel
- La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Alzira, Valencia, Spain; Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain; Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.
| | - Cristina González-Blázquez
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.
| |
Collapse
|
4
|
Coates D, Catling C. The Use of Ethnography in Maternity Care. Glob Qual Nurs Res 2021; 8:23333936211028187. [PMID: 34263014 PMCID: PMC8243125 DOI: 10.1177/23333936211028187] [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] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
While the value of ethnography in health research is recognized, the extent to which it is used is unclear. The aim of this review was to map the use of ethnography in maternity care, and identify the extent to which the key principles of ethnographies were used or reported. We systematically searched the literature over a 10-year period. Following exclusions we analyzed 39 studies. Results showed the level of detail between studies varied greatly, highlighting the inconsistencies, and poor reporting of ethnographies in maternity care. Over half provided no justification as to why ethnography was used. Only one study described the ethnographic approach used in detail, and covered the key features of ethnography. Only three studies made reference to the underpinning theoretical framework of ethnography as seeking to understand and capture social meanings. There is a need to develop reporting guidelines to guide researchers undertaking and reporting on ethnographic research.
Collapse
|
5
|
Martín-Arribas A, Vila-Candel R, O’Connell R, Dillon M, Vila-Bellido I, Beneyto MÁ, De Molina-Fernández I, Rodríguez-Conesa N, González-Blázquez C, Escuriet R. Transfers of Care between Healthcare Professionals in Obstetric Units of Different Sizes across Spain and in a Hospital in Ireland: The MidconBirth Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8394. [PMID: 33202745 PMCID: PMC7696735 DOI: 10.3390/ijerph17228394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In Europe, the majority of healthy women give birth at conventional obstetric units with the assistance of registered midwives. This study examines the relationships between the intrapartum transfer of care (TOC) from midwife to obstetrician-led maternity care, obstetric unit size (OUS) with different degrees of midwifery autonomy, intrapartum interventions and birth outcomes. METHODS A prospective, multicentre, cross-sectional study promoted by the COST Action IS1405 was carried out at eight public hospitals in Spain and Ireland between 2016-2019. The primary outcome was TOC. The secondary outcomes included type of onset of labour, oxytocin stimulation, epidural analgesia, type of birth, episiotomy/perineal injury, postpartum haemorrhage, early initiation of breastfeeding and early skin-to-skin contact. A logistic regression was performed to ascertain the effects of studied co-variables on the likelihood that participants had a TOC; Results: Out of a total of 2,126 low-risk women, those whose intrapartum care was initiated by a midwife (1772) were selected. There were statistically significant differences between TOC and OUS (S1 = 29.0%, S2 = 44.0%, S3 = 52.9%, S4 = 30.2%, p < 0.001). Statistically differences between OUS and onset of labour, oxytocin stimulation, type of birth and episiotomy or perineal injury were observed (p = 0.009, p < 0.001, p < 0.001, p < 0.001 respectively); Conclusions: Findings suggest that the model of care and OUS have a significant effect on the prevalence of intrapartum TOC and the birth outcomes. Future research should examine how models of care differ as a function of the OUS in a hospital, as well as the cost-effectiveness for the health care system.
Collapse
Affiliation(s)
- Anna Martín-Arribas
- GHenderS Research Group, School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (A.M.-A.); (R.E.)
- Faculty of Medicine, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain;
| | - Rafael Vila-Candel
- La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
- Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain
| | - Rhona O’Connell
- School of Nursing and Midwifery, University College Cork, T12 YN60 Cork, Ireland;
| | - Martina Dillon
- Cork University Maternity Hospital, Wilton, T12 YE02 Cork, Ireland;
| | - Inmaculada Vila-Bellido
- Verge dels Lliris Hospital, Poligon de Caramanxel s/n, 03804 Alcoi, Spain; (I.V.-B.); (M.Á.B.)
| | - M. Ángeles Beneyto
- Verge dels Lliris Hospital, Poligon de Caramanxel s/n, 03804 Alcoi, Spain; (I.V.-B.); (M.Á.B.)
| | | | | | | | - Ramón Escuriet
- GHenderS Research Group, School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (A.M.-A.); (R.E.)
- Catalan Health Service, Government of Barcelona, 08028 Catalonia, Spain
| |
Collapse
|
6
|
Darling F, McCourt PC, Cartwright DM. Facilitators and barriers to the implementation of a physiological approach during labour and birth: A systematic review and thematic synthesis. Midwifery 2020; 92:102861. [PMID: 33137546 DOI: 10.1016/j.midw.2020.102861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore facilitators and barriers to the implementation of a physiological approach to care during labour and birth in obstetric settings. To explore how facilitators and barriers located at three levels: organisation, professional groups (midwives and obstetricians) and women, interact to influence the implementation of a physiological approach. METHOD A systematic review of the literature, identified 32 eligible studies from four databases reporting relevant qualitative data. Findings from these studies were thematically synthesised in three phases: line by line coding of findings from primary studies, development of descriptive themes and analytical themes. This review is reported in line with PRISMA guidelines. FINDINGS At an organisational level, centralisation of care in obstetric units limited time for labouring and professional care to support a physiological labour and birth. Risk management strategies ostensibly designed to promote safety sustained a risk-based approach. At a professional level, important barriers include hierarchical decision-making led by obstetricians, midwifery acquiescence, obstetric and midwifery risk preoccupation, rationalisation of the routine use of clinical intervention and an erosion of midwifery skills and knowledge. At the level of the woman, barriers include a lack of knowledge and reliance on professional decision-making. Facilitators include collaborative working by midwives and obstetricians, a valuing of midwifery autonomy and women's questioning of inappropriate intervention use. KEY CONCLUSIONS Contrary to evidence-based guidelines that recommend a physiological approach, a risk-based approach informs practices in obstetric units. Primary research has mainly identified barriers to implementing a physiological approach at a professional level, and this has been studied largely from a midwifery perspective. To aid comprehensive investigations of facilitators and barriers and their interactive influences, this review identifies important research gaps for study across all levels: organisation, professionals (midwives and obstetricians) and women. IMPLICATIONS FOR PRACTICE Risk preoccupations and rationalisation, with negative influences on knowledge and skills in the use of a physiological approach, must prompt reflection and action amongst professional groups. Power imbalances between midwives and obstetricians need to be addressed, drawing on experiences in units where collaborative working and midwifery autonomy is fostered.
Collapse
Affiliation(s)
- Florence Darling
- Midwife, 3(rd) year PhD Student, City University of London, School of Health Sciences, Myddelton Street Building, City, University of London, Myddelton Street, EC1R 1UW, London, United Kingdom.
| | | | | |
Collapse
|
7
|
Anna MA, Olga CV, Rocío CS, Isabel SP, Xavier ET, Pablo RC, Montserrat PA, Cristina GB, Ramon E. Midwives' experiences of the factors that facilitate normal birth among low risk women in public hospitals in Catalonia (Spain). Midwifery 2020; 88:102752. [PMID: 32521407 DOI: 10.1016/j.midw.2020.102752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal birth has major benefits for women and infants. Nevertheless, during the last few decades, the advancement in technology and an increasing domination of obstetrician-led childbirths have resulted in the medicalization of childbirth. Midwives are interested in amending this trend and aim to support women to achieve the best possible birth experience for them. OBJECTIVE This study aimed to explore midwives' experiences on the facilitators and barriers of normal birth in conventional obstetric units. DESIGN A descriptive qualitative study. Three focus groups were audio recorded and transcribed verbatim. Recurrent themes were identified and formulated. Feedback from data were analysed using thematic analysis. Investigator triangulation was used during the analysis. SETTING Midwives from eleven different public hospitals in Catalonia participated in the study. PARTICIPANTS A purposive sample of 33 midwives participated in the focus groups. FINDINGS Midwives identified several factors that complicated their task of facilitating normal birth. Barriers included: (1) inadequate institutional support; (2) existing obstetrician-led practices, (3) lack of evidence-based practice and (4) midwives' lack of awareness of professional competencies. Factors facilitating normal birth included: (1) midwives' positive perceptions of normal birth, (2) midwives' additional effort and (3) women's awareness of normal birth. KEY CONCLUSIONS Midwives wishing to promote normal birth in obstetric units face a number of challenges and often feel unsupported. Nonetheless, the midwives perceive the increasing women's demand for normal births as an opportunity to implement changes in such a way that women are involved in the decision-making process and midwives act as their advocates. IMPLICATIONS FOR PRACTICE There is a need to increase the midwifery workforce and enhance regulations and funding strategies to support their practice as well as normal birth. Policy makers in settings without well-functioning midwife-led care should consider implementing this model after successfully scaling up of the number of midwives and ensuring an effective midwifery training.
Collapse
Affiliation(s)
- Martin-Arribas Anna
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.; School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Canet-Velez Olga
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Casañas Sanchez Rocío
- Escola Superior d'Infermeria del Mar (ESIM), Universidad Pompeu Fabra (UPF), Carrer Dr. Aiguader 80, 08003 Barcelona, Spain.; Centre d'Higiene Mental Les Corts, CHM Salut Mental Barcelona, Carrer de Numància 103 Baixos, 08029 Barcelona, Spain..
| | - Salgado Poveda Isabel
- Vall d'Hebron University Hospital, Carrer Vall d'Hebron 119-129, 08035 Barcelona, Spain..
| | - Espada-Trespalacios Xavier
- Obstetric care area. Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Bacelona, Spain..
| | - Rodriguez Coll Pablo
- Maternal and Child Healthcare Department. Fundació Sanitària de Mollet, Ronda Pinetons 8, 08100 Mollet del Vallès, Bacelona, Spain..
| | | | - González-Blázquez Cristina
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain..
| | - Escuriet Ramon
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain..
| |
Collapse
|
8
|
Kingdon C, Downe S, Betran AP. Interventions targeted at health professionals to reduce unnecessary caesarean sections: a qualitative evidence synthesis. BMJ Open 2018; 8:e025073. [PMID: 30559163 PMCID: PMC6303601 DOI: 10.1136/bmjopen-2018-025073] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To establish the views and experiences of healthcare professionals in relation to interventions targeted at them to reduce unnecessary caesareans. DESIGN Qualitative evidence synthesis. SETTING Studies undertaken in high-income, middle-income and low-income settings. DATA SOURCES Seven databases (CINAHL, MEDLINE, PsychINFO, Embase, Global Index Medicus, POPLINE and African Journals Online). Studies published between 1985 and June 2017, with no language or geographical restrictions. We hand-searched reference lists and key citations using Google Scholar. STUDY SELECTION Qualitative or mixed-method studies reporting health professionals' views. DATA EXTRACTION AND SYNTHESIS Two authors independently assessed study quality prior to extraction of primary data and authors' interpretations. The data were compared and contrasted, then grouped into summary of findings (SoFs) statements, themes and a line of argument synthesis. All SoFs were Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessed. RESULTS 17 papers were included, involving 483 health professionals from 17 countries (nine high-income, six middle-income and two low-income). Fourteen SoFs were identified, resulting in three core themes: philosophy of birth (four SoFs); (2) social and cultural context (five SoFs); and (3) negotiation within system (five SoFs). The resulting line of argument suggests three key mechanisms of effect for change or resistance to change: prior beliefs about birth; willingness or not to engage with change, especially where this entailed potential loss of income or status (including medicolegal barriers); and capacity or not to influence local community and healthcare service norms and values relating to caesarean provision. CONCLUSION For maternity care health professionals, there is a synergistic relationship between their underpinning philosophy of birth, the social and cultural context they are working within and the extent to which they were prepared to negotiate within health system resources to reduce caesarean rates. These findings identify potential mechanisms of effect that could improve the design and efficacy of change programmes to reduce unnecessary caesareans. PROSPERO REGISTRATION NUMBER CRD42017059455.
Collapse
Affiliation(s)
- Carol Kingdon
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Ana Pilar Betran
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
9
|
Shahrki SK, Abazari F, Nayer ND, Pouraboli B. An ethnographic study in nursing homes in Iran. Int J Palliat Nurs 2018; 24:540-547. [PMID: 30457466 DOI: 10.12968/ijpn.2018.24.11.540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: The approach of death is an undeniable part of ageing and death is the most important concern for elderly people who live in nursing homes. This study examines describes how care home residents feel when they recognise that they are close to death. AIMS: The aim of this study was to explore the experiences of elderly residents who are dying in nursing homes as well as their caregivers toward death in an Iranian context. METHODS: A focused ethnographic research design was chosen. The research sample consisted of 25 nursing home staff-three nurses, 18 healthcare assistants, two administrators, a social worker and a psychologist-and 10 elderly people in two nursing homes in Iran. Data was collected through field notes, observations and semistructured, in-depth interviews. Data was analysed using thematic analysis. FINDINGS: There were two main themes of: seeking the embrace of a calm death; and waiting for death. Within these, four subthemes were identified. CONCLUSION: The perceptions of the participants originated from the nursing home culture and their beliefs in eternal life. Training staff about the cultural needs of dying people and end-of-life care would be the most effective way to improve the experience of dying for nursing home residents.
Collapse
Affiliation(s)
| | - Farokh Abazari
- Assistant Professor, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Nahid Dehghan Nayer
- Professor, Nursing Management Department, School of Nursing and Midwifery. Tehran University of Medical Sciences, Tehran, Iran
| | - Batool Pouraboli
- Assistant Professor of nursing, School of Nursing and Midwifery, Department of Pediatric and Neonatal Nursing, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Kingdon C, Downe S, Betran AP. Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies. PLoS One 2018; 13:e0203274. [PMID: 30180198 PMCID: PMC6122831 DOI: 10.1371/journal.pone.0203274] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/19/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE When medically indicated, caesarean section can prevent deaths and other serious complications in mothers and babies. Lack of access to caesarean section may result in increased maternal and perinatal mortality and morbidity. However, rising caesarean section rates globally suggest overuse in healthy women and babies, with consequent iatrogenic damage for women and babies, and adverse impacts on the sustainability of maternity care provision. To date, interventions to ensure that caesarean section is appropriately used have not reversed the upward trend in rates. Qualitative evidence has the potential to explain why and how interventions may or may not work in specific contexts. We aimed to establish stakeholders' views on the barriers and facilitators to non-clinical interventions targeted at organizations, facilities and systems, to reduce unnecessary caesarean section. METHODS We undertook a systematic qualitative evidence synthesis using a five-stage modified, meta-ethnography approach. We searched MEDLINE, CINAHL, PsychINFO, EMBASE and grey literature databases (Global Index Medicus, POPLINE, AJOL) using pre-defined terms. Inclusion criteria were qualitative and mixed-method studies, investigating any non-clinical intervention to reduce caesarean section, in any setting and language, published after 1984. Study quality was assessed prior to data extraction. Interpretive thematic synthesis was undertaken using a barriers and facilitators lens. Confidence in the resulting Summaries of Findings was assessed using GRADE-CERQual. RESULTS 8,219 studies were identified. 25 studies were included, from 17 countries, published between 1993-2016, encompassing the views of over 1,565 stakeholders. Nineteen Summary of Findings statements were derived. They mapped onto three distinct themes: Health system, organizational and structural factors (6 SoFs); Human and cultural factors (7 SoFs); and Mechanisms of effect to achieve change factors (6 SoFs). The synthesis showed how inter- and intra-system power differentials, and stakeholder commitment, exert strong mechanisms of effect on caesarean section rates, independent of the theoretical efficacy of specific interventions to reduce them. CONCLUSIONS Non-clinical interventions to reduce caesarean section are strongly mediated by organisational power differentials and stakeholder commitment. Barriers may be greatest where implementation plans contradict system and cultural norms. PROTOCOL REGISTRATION PROSPERO: CRD42017059456.
Collapse
Affiliation(s)
- Carol Kingdon
- Department of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Soo Downe
- Department of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Ana Pilar Betran
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| |
Collapse
|
11
|
Hallgrimsdottir H, Shumka L, Althaus C, Benoit C. Fear, Risk, and the Responsible Choice: Risk Narratives and Lowering the Rate of Caesarean Sections in High-income Countries. AIMS Public Health 2017; 4:615-632. [PMID: 30155505 PMCID: PMC6111264 DOI: 10.3934/publichealth.2017.6.615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/11/2017] [Indexed: 11/18/2022] Open
Abstract
In Canada, as elsewhere in the world, caesarean sections are the most common surgical procedure performed in hospitals annually. Recent national statistics indicate 28% of infants in Canada are born by c-section while in the United States that number rises to 33%. This is despite World Health Organization recommendations that at a population level only 10-15% of births warrant this form of medical intervention. This trend has become cause for concern in recent decades due to the short and long-term health risks to pregnant women and infants, as well as the financial burden it places on public health care systems. Others warn this trend may result in a collective loss of cultural knowledge of a normal physiological process and, in the process, establish a new "normal" childbirth. Despite a range of interventions to curb c-section rates-enhanced prenatal care and innovation in pregnancy monitoring, change in hospital level policies, procedures and protocols, as well as public education campaigns-they remain stubbornly resistant to stabilization, let alone, reduction in high-income countries. We explore-through a review of the academic and grey literature-the role of cultural and social narratives around risk, and the responsibilization of the pregnant woman and the medical practitioner in creating this kind of resistance to intervention today.
Collapse
Affiliation(s)
| | - Leah Shumka
- Department of Gender Studies, University of Victoria, Victoria BC, Canada
| | - Catherine Althaus
- School of Social and Political Sciences, University of Melbourne and Australia and New Zealand School of Government
| | - Cecilia Benoit
- Department of Sociology and the Canadian Institute of Substance Use Research, University of Victoria, Victoria BC, Canada
| |
Collapse
|
12
|
Saftner MA, Neerland C, Avery MD. Enhancing women's confidence for physiologic birth: Maternity care providers' perspectives. Midwifery 2017; 53:28-34. [PMID: 28743051 DOI: 10.1016/j.midw.2017.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this research study was to explore MCP's beliefs and attitudes about physiologic birth and to identify components of antenatal care that providers believe may impact a woman's confidence for physiologic labor and birth. METHODS This qualitative descriptive study included maternity care providers (N=31) in the Midwestern United States. Providers participated in semi-structured interviews to describe their beliefs about physiologic birth, their role in providing information to women and specific care practices to promote women's confidence for physiologic birth. FINDINGS Six themes emerged including: positive beliefs about physiologic birth, trusted relationship with provider, woman centered care, education and knowledge, barriers to confidence, and antenatal practices to enhance confidence. Variations in beliefs occurred amongst providers with different training (i.e., physicians and midwives). CONCLUSION Maternity care providers, including midwives, family physicians and obstetrician-gynecologists, overwhelmingly support a physiologic approach to labor and birth. These providers had a number of suggestions about how antenatal care could be enhanced in an effort to increase women's confidence during the antenatal period. Supporting physiologic birth is imperative for providers who wish to enhance outcomes for mothers and babies.
Collapse
Affiliation(s)
- Melissa A Saftner
- The University of Minnesota School of Nursing, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
| | - Carrie Neerland
- The University of Minnesota School of Nursing, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
| | - Melissa D Avery
- The University of Minnesota School of Nursing, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
| |
Collapse
|
13
|
Jackson C, Land V, Holmes EJB. Healthcare professionals' assertions and women's responses during labour: A conversation analytic study of data from One born every minute. PATIENT EDUCATION AND COUNSELING 2017; 100:465-472. [PMID: 27769589 DOI: 10.1016/j.pec.2016.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 08/10/2016] [Accepted: 10/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Communication during labour is consequential for women's experience yet analyses of situated labour-ward interaction are rare. This study demonstrates the value of explicating the interactional practices used to initiate 'decisions' during labour. METHODS Interactions between 26 labouring women, their birth partners and HCPs were transcribed from the British television programme, One Born Every Minute. Conversation analysis was used to examine how decisions were initiated and accomplished in interaction. FINDINGS HCPs initiate decision-making using interactional practices that vary the 'optionality' afforded labouring women in the responsive turn. Our focus here is on the minimisation of optionality through 'assertions'. An 'assertive' turn-design (e.g. 'we need to…') conveys strong expectation of agreement. HCPs assert decisions in contexts of risk but also in contexts of routine activities. Labouring women tend to acquiesce to assertions. CONCLUSION The expectation of agreement set up by an assertive initiating turn can reduce women's opportunities to participate in shared decision-making (SDM). PRACTICE IMPLICATIONS When decisions are asserted by HCPs there is a possible dissonance between the tenets of SDM in British health policy and what occurs in situ. This highlights an educational need for HCPs in how best to afford labouring women more optionality, particularly in low-risk contexts.
Collapse
|
14
|
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]
|
15
|
Darling F. Practitioners' views and barriers to implementation of the Keeping Birth Normal tool: A pilot study. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/bjom.2016.24.7.508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
16
|
Davis DL, Homer CSE. Birthplace as the midwife's work place: How does place of birth impact on midwives? Women Birth 2016; 29:407-415. [PMID: 26996415 DOI: 10.1016/j.wombi.2016.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/04/2016] [Accepted: 02/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND In, many high and middle-income countries, childbearing women have a variety of birthplaces available to them including home, birth centres and traditional labour wards. There is good evidence indicating that birthplace impacts on outcomes for women but less is known about the impact on midwives. AIM To explore the way that birthplace impacts on midwives in Australia and the United Kingdom. METHOD A qualitative descriptive study was undertaken. Data were gathered through focus groups conducted with midwives in Australia and in the United Kingdom who worked in publicly-funded maternity services and who provided labour and birth care in at least two different settings. FINDINGS Five themes surfaced relating to midwifery and place including: 1. practising with the same principles; 2. creating ambience: controlling the environment; 3. workplace culture: being watched 4. Workplace culture: "busy work" versus "being with"; and 5. midwives' response to place. DISCUSSION While midwives demonstrate a capacity to be versatile in relation to the physicality of birthplaces, workplace culture presents a challenge to their capacity to "be with" women. CONCLUSION Given the excellent outcomes of midwifery led care, we should focus on how we can facilitate the work of midwives in all settings. This study suggests that the culture of the birthplace rather than the physicality is the highest priority.
Collapse
Affiliation(s)
- Deborah L Davis
- University of Canberra, Australia; ACT Government, Health Directorate, Australia.
| | | |
Collapse
|
17
|
Bowden C, Sheehan A, Foureur M. Birth room images: what they tell us about childbirth. A discourse analysis of birth rooms in developed countries. Midwifery 2016; 35:71-7. [PMID: 27060403 DOI: 10.1016/j.midw.2016.02.003] [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: 05/14/2015] [Revised: 12/21/2015] [Accepted: 02/01/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE this study examined images of birth rooms in developed countries to analyse the messages and visual discourse being communicated through images. DESIGN a small qualitative study using Kress and van Leeuwen's (2006) social semiotic theoretical framework for image analysis, a form of discourse analysis. SETTING/PARTICIPANTS forty images of birth rooms were collected in 2013 from Google Images, Flickr, Wikimedia Commons and midwifery colleagues. The images were from obstetric units, alongside and freestanding midwifery units located in developed countries (Australia, Canada, Europe, New Zealand, United Kingdom and the United States of America). MAIN FINDINGS findings demonstrated three kinds of birth room images; the technological, the 'homelike', and the hybrid domesticated birth room. The most dominant was the technological birth room, with a focus on the labour bed and medical equipment. The visual messages from images of the technological birth room reinforce the notion that the bed is the most appropriate place to give birth and the use of medical equipment is intrinsically involved in the birth process. Childbirth is thus construed as risky/dangerous. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE as images on the Internet inform and persuade society about stereotypical behaviours, the trends of our time and sociocultural norms, it is important to recognise images of the technological birth room on the Internet may be influential in dictating women's attitudes, choices and behaviour, before they enter the birth room.
Collapse
Affiliation(s)
| | - Athena Sheehan
- School of Nursing and Midwifery at Western Sydney University, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health at the University of Technology Sydney, Australia; Victoria University of Wellington, New Zealand; University of Southern Denmark
| |
Collapse
|
18
|
Kerrigan A, Kingdon C, Cheyne H. Obesity and normal birth: A qualitative study of clinician's management of obese pregnant women during labour. BMC Pregnancy Childbirth 2015; 15:256. [PMID: 26459259 PMCID: PMC4603577 DOI: 10.1186/s12884-015-0673-2] [Citation(s) in RCA: 8] [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: 01/20/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Currently one-fifth of women in the UK are obese. Obese, pregnant woman are at an increased risk of experiencing complications of labour and serious morbidity. However, they are also more likely to undergo medical interventions such as induction of labour and caesarean section which in themselves confer additional health risks for obese women such as wound infection and deep vein thrombosis. Reducing unnecessary interventions and increasing normal birth rates for obese women would substantially improve their postnatal health and wellbeing and reduce the burden of NHS resources required to care for them post operatively. This research aimed to explore practitioners' experiences of and strategies for providing intrapartum care to obese women. METHOD A qualitative methodology was adopted, focus groups and individual interviews were conducted with health professionals. Audio recordings were transcribed verbatim and data analysed using a framework approach. RESULTS Twenty-four health professionals participated; Six Consultant Obstetricians two Consultant Anaesthetists and 16 midwives. Three key themes emerged from the data: medicalisation of obese birth; promotion of normal obese birth; and the complexities and contradictions in staff attitudes and behaviours. The overall interpretation is that positive approaches to obese birth offer opportunities to promote normal birth. However, many health professionals find the provision of intrapartum care to obese women challenging, and attitudes and behaviours towards the promotion of normal birth are heterogeneous, complex and contradictory. CONCLUSION The care of obese women during labour is generally medicalised and focussed on the associated risks. However, although there are conflicting views on how to care for obese women, some practitioners do strive to promote normality and optimise the potential for normal birth by challenging current practices and utilise some 'interventions' in order to facilitate normality and mobility during childbirth. Obesity is a major and growing health problem and a major cause of morbidity and mortality for pregnant women. It is essential that more positive proactive guidelines are available to maximise normal birth if the postnatal health of obese women is to be improved.
Collapse
Affiliation(s)
- Angela Kerrigan
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA, United Kingdom.
| | - Carol Kingdon
- School of Health, University of Central Lancashire, Preston, PR1 2HE, United Kingdom.
| | - Helen Cheyne
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA, United Kingdom.
| |
Collapse
|
19
|
Hildingsson I. Women's birth expectations, are they fulfilled? Findings from a longitudinal Swedish cohort study. Women Birth 2015; 28:e7-13. [DOI: 10.1016/j.wombi.2015.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/28/2014] [Accepted: 01/31/2015] [Indexed: 11/28/2022]
|
20
|
Avery MD, Saftner MA, Larson B, Weinfurter EV. A Systematic Review of Maternal Confidence for Physiologic Birth: Characteristics of Prenatal Care and Confidence Measurement. J Midwifery Womens Health 2014; 59:586-595. [DOI: 10.1111/jmwh.12269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
21
|
Abstract
Intrapartum nurses assume a central role in the birth process and make decisions driven by a set of beliefs. Therefore, the purpose of this study was to develop a valid and reliable instrument to measure birth beliefs of intrapartum nurses related to birth practice. A total of 313 intrapartum nurses accessed this online, self-administered instrument over a 3-month period. The Theory of Planned Behavior guided development of the Intrapartum Nurses' Beliefs Related to Birth Practice scale and provided a basis for the connection between beliefs and practice. This article describes the psychometric analysis of the instrument. Findings include a moderate, positive correlation with a similar instrument, a Cronbach α of 0.797, and 2 factors identifying belief systems. With further revision, this instrument may provide an accurate measure of the birth beliefs of intrapartum nurses.
Collapse
|
22
|
Cook E, Avery M, Frisvold M. Formulating evidence-based guidelines for certified nurse-midwives and certified midwives attending home births. J Midwifery Womens Health 2014; 59:153-9. [PMID: 24597859 DOI: 10.1111/jmwh.12142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Implementing national home birth guidelines for certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States may facilitate a common approach to safe home birth practices. Guidelines are evidence-based care recommendations for specified clinical situations that can be modified by individual providers to meet specific client needs. METHODS Following a review of home birth guidelines from multiple countries, a set of home birth practices guidelines for US CNMs/CMs was drafted. Fifteen American Midwifery Certification Board, Inc. (AMCB)-certified home birth midwives who participate in the American College of Nurse-Midwives (ACNM) home birth electronic mailing list considered the use of such a document in their practices and reviewed and commented on the guidelines. RESULTS The proposed guidelines addressed client screening, informed consent, antepartum care, routine intrapartum care, obstetric complications and hospital transports, postpartum care, neonatal care, gynecologic care, primary care, peer reviews, recordkeeping, and physician collaboration. The reviewers had varying assessments as to whether the guidelines reflected international standards and current best evidence. The primary concern expressed was that an adoption of national guidelines could compromise provider autonomy. DISCUSSION Incorporation of evidence-based guidelines is an ACNM standard and was recommended by the Home Birth Consensus Summit. Clinical practice guidelines are informed by current evidence and supported by experts in a given discipline. Implementation of guidelines ensures optimal patient care and is becoming increasingly central to reimbursement and to medicolegal support. A set of practice guidelines based on current best evidence and internationally accepted standards was developed and reviewed by an interested group of US CNMs/CMs. Further discussion with home birth midwives and other stakeholders about the development and implementation of home birth guidelines is needed, especially in light of this project's finding of less support for national home birth guidelines among the reviewers subsequent to versus prior to their review of the draft guidelines.
Collapse
|
23
|
Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. Development and Validation of a National Data Registry for Midwife‐Led Births: The Midwives Alliance of North America Statistics Project 2.0 Dataset. J Midwifery Womens Health 2014; 59:8-16. [DOI: 10.1111/jmwh.12165] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
The experiences of midwives when caring for obese women in labour, a qualitative study. Midwifery 2014; 30:103-11. [DOI: 10.1016/j.midw.2013.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 01/29/2013] [Accepted: 02/24/2013] [Indexed: 01/26/2023]
|
25
|
Kennedy HP, Grant J, Walton C, Sandall J. Elective caesarean delivery: a mixed method qualitative investigation. Midwifery 2013; 29:e138-44. [PMID: 23434026 DOI: 10.1016/j.midw.2012.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/04/2012] [Accepted: 12/17/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND the rates of primary, repeat, and elective caesarean deliveries have risen dramatically over the past several decades. The reasons for the rise are complex and likely reflect a cultural shift to a greater acceptance of surgical birth as a reasonable option, which may favour infant over maternal outcomes. The purpose of this interpretive qualitative study was to explore the complexities of women's and clinicians' choices around elective caesarean delivery. METHOD this analysis was part of an institutional ethnography to understand the complex issues of childbearing care. Two English National Health Service Maternity Service Providers in an inner city setting were chosen for their reputation for commitment to normalising birth and decreasing caesarean birth rate. A sample of 27 women and 34 clinicians (midwifery, obstetric, anaesthesia) were interviewed and/or observed in practice settings. We also conducted a documentary analysis of local policy guidelines on elective caesarean delivery. Narrative analysis was conducted on interview, field observation, and document review data. Coding was conducted by three independent analysts and checked for consistency using Atlas.ti qualitative software. RESULTS variations on elective caesarean choice and outcomes seemed to reflect how the team worked together and their underlying philosophies and commitments about caesarean birth. Four themes reflected the issues around elective caesarean birth: (1) the culture of caesarean, (2) caesarean counseling, (3) perceptions of choice and (4) negotiating the rules. CONCLUSIONS counselling about elective caesarean and vaginal birth after a prior caesarean is complex and reflects an intersection of culture and science. Women and clinicians enter the discussion with different backgrounds and concerns, but ultimately want the best outcome possible. Future exploration should address shared decision-making, evidence-based clinical guidelines, and the social context of care.
Collapse
Affiliation(s)
- Holly Powell Kennedy
- Yale University School of Nursing, 100 Church Street South, PO Box 9740, New Haven, CT 06536, USA.
| | | | | | | |
Collapse
|
26
|
Hildingsson I, Johansson M, Karlström A, Fenwick J. Factors Associated With a Positive Birth Experience: An Exploration of Swedish Women’s Experiences. INTERNATIONAL JOURNAL OF CHILDBIRTH 2013. [DOI: 10.1891/2156-5287.3.3.153] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: The birth of a baby is a powerful life event that has implications for a woman’s well-being and future health. A positive birth experience promotes a sense of achievement, enhances feeling of self-worth, and facilitates confidence—all of which are important for a healthy adaptation to motherhood and psychological growth. Understanding what constitutes a positive birth experience is critical to providing maternity care that meets childbearing women’s individual needs, preferences, and priorities.OBJECTIVE: To explore the prevalence of Swedish women reporting a very positive birth experience 2 months and 1 year after childbirth and identify factors associated with this experience. In addition, the study aimed to identify whether women’s assessment of their birth experience changed over time.METHOD: A prospective, longitudinal study where the main outcome variable was perceptions of a very positive birth experience. The study was undertaken in a Northern region of Sweden in 2007. Women were recruited at their ultrasound examination in midpregnancy. Data was collected via questionnaires. There were 928 women who responded to questions about their birth experience at 2 months postpartum. Nearly 83% of these women (n= 763) also completed the questionnaire package 1 year after birth. Descriptive statistics were used together with Friedman’s test to detect changes over time. Logistic regression analysis was performed to reveal which factors contributed most to a very positive birth experience.RESULT: More than a third of the women reported a very positive birth experience. Women’s assessment of birth changed over time with 22% of the women becoming more positive and 15% more negative. Important associated factors for a very positive birth experience included positive feelings about the approaching birth as well as feeling in control, using no or only cognitive forms of pain management, and achieving a spontaneous vaginal birth. Furthermore, how women rated their midwifery care was also shown to affect their assessment of their birth experience.CONCLUSION: This study found that women’s birth experiences changed over time and most becoming more positive after 1 year. Factors associated with a very positive birth experience were related to women’s prenatal attitudes, intrapartum procedures, pain relief used, and care received during labor and birth. Respectful individualized midwifery care that remains focused on the woman and keeping birth normal increases positive perceptions of the birth experience.
Collapse
|
27
|
Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM. J Perinat Educ 2013; 22:14-8. [PMID: 24381472 PMCID: PMC3647729 DOI: 10.1891/1058-1243.22.1.14] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
28
|
|
29
|
Supporting healthy and normal physiologic childbirth: a consensus statement by the American College of Nurse-Midwives, Midwives Alliance of North America, and the National Association of Certified Professional Midwives. J Midwifery Womens Health 2012; 57:529-32. [PMID: 22954092 DOI: 10.1111/j.1542-2011.2012.00218.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
30
|
What is meant by one-to-one support in labour: Analysing the concept. Midwifery 2012; 28:391-7. [DOI: 10.1016/j.midw.2011.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 06/22/2011] [Accepted: 07/09/2011] [Indexed: 11/24/2022]
|
31
|
Kennedy HP, Doig E, Hackley B, Leslie MS, Tillman S. "The midwifery two-step": a study on evidence-based midwifery practice. J Midwifery Womens Health 2012; 57:454-60. [PMID: 22845643 DOI: 10.1111/j.1542-2011.2012.00174.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To date, there has been little documentation of how practice-based midwifery networks in the United States might influence the transfer and development of knowledge in childbearing and women's health care. The first phase of this participatory action research project was to conduct a qualitative study with a community of midwifery practices to understand their perspectives on evidence-based practice and how an organized network could facilitate their work. METHODS Midwives within the community of interest were invited by letter or e-mail to participate in individual or small group interviews about knowledge transfer, primary concerns of evidence-based practice, and potential for a midwifery practice-based research network. Participatory action research strategies and organizational ethnographic approaches to data collection were used to guide qualitative interviews. RESULTS Eight midwifery practices enrolled in the study with 23 midwives participating in interviews. They attended births at 2 hospitals in the community. Two broad areas of discourse about evidence-based practice were identified: 1) challenges from influential persons, finances and resources, and the cultural perception of midwifery, and 2) strategies to foster best practice in the face of those challenges. The midwives believed a research network could be useful in learning collectively about their practices and in the support of their work. DISCUSSION Evidence-based practice is a goal but also has many challenges in everyday implementation. Practice-based research networks hold promise to support clinicians to examine the evidence and form strong coalitions to foster best clinical practice. The second phase of this study will work with this community of midwives to explore collective strategies to examine and improve practice.
Collapse
|
32
|
Brooke-Read M, Baillie L, Mann R, Chadwick S. Electronic health records in maternity: the student experience. ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjom.2012.20.6.440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Melanie Brooke-Read
- Melanie Brooke-Read Midwifery Practice Educator Department of Health & Social Sciences University of Bedfordshire
| | - Lesley Baillie
- Dr Lesley Baillie Reader in Healthcare Department of Health & Social Sciences University of Bedfordshire
| | - Robert Mann
- Robert Mann Practice Educator Mental Health Department of Health & Social Sciences University of Bedfordshire
| | - Sandra Chadwick
- Sandra Chadwick Senior Lecturer Adult Nursing Department of Health & Social Sciences University of Bedfordshire
| |
Collapse
|
33
|
Berg M, Asta Ólafsdóttir Ó, Lundgren I. A midwifery model of woman-centred childbirth care – In Swedish and Icelandic settings. SEXUAL & REPRODUCTIVE HEALTHCARE 2012; 3:79-87. [DOI: 10.1016/j.srhc.2012.03.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 02/26/2012] [Accepted: 03/01/2012] [Indexed: 11/27/2022]
|
34
|
Everly MC. Facilitators and barriers of independent decisions by midwives during labor and birth. J Midwifery Womens Health 2011; 57:49-54. [PMID: 22251912 DOI: 10.1111/j.1542-2011.2011.00088.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to explore the factors that affect labor management decisions of midwives in hospitals and freestanding birth centers. METHODS A qualitative study was conducted using one-on-one tape recorded interviews of midwives who had experience managing labor and birth in both hospitals and freestanding birth centers. Ten interviews consisting of several open-ended questions were conducted, coded, and analyzed in a stepwise fashion to identify codes, categories, and themes. Seven participants reviewed the final framework and confirmed credibility and trustworthiness. RESULTS Four overall themes were identified: trust birth, the woman, the environment, and the labor team. DISCUSSION When making labor management decisions, midwives are affected by their trust in birth, the woman, the health care team, and the birth environment. Midwives report more resistance when making labor management decisions in hospitals. The findings of this study provide insight into both the decision making of midwives and how factors in different environments, in this case hospitals and freestanding birth centers, influence the ability of midwives to make independent labor management decisions.
Collapse
Affiliation(s)
- Marcee C Everly
- College of Nursing, Health and Human Services, Indiana State University, 749 Chestnut Street, Terre Haute, IN 47809, USA.
| |
Collapse
|
35
|
|
36
|
Kennedy HP. The Problem of Normal Birth. J Midwifery Womens Health 2010; 55:199-201. [DOI: 10.1016/j.jmwh.2010.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
|
37
|
Broussard BS, Broussard AB. Preserving normal birth: implementing educational conferences for health care professionals. Nurs Womens Health 2010; 14:472-81. [PMID: 21122082 DOI: 10.1111/j.1751-486x.2010.01594.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brenda S Broussard
- University of Louisiana at Lafayette College of Nursing and Allied Health Professions, Lafayette, LA, USA.
| | | |
Collapse
|