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Midwife-led continuity of care improved maternal and neonatal health outcomes in north Shoa zone, Amhara regional state, Ethiopia: A quasi-experimental study. Women Birth 2021; 35:340-348. [PMID: 34489211 DOI: 10.1016/j.wombi.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In a low-resource setting, information on the effect of midwife-led continuity of care (MLCC) is limited. Therefore, this study aimed to determine the effect of MLCC on maternal and neonatal health outcomes in the Ethiopian context. METHOD A study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals of the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low risk women were allocated to one of two groups; the midwife-led continuity of care (MLCC or intervention group) (received all antenatal, labour, birth, and immediate postnatal care from a single midwife or backup midwife) (n = 589) and the Shared model of care (SMC or comparison group) (received care from different staff members at different times) (n = 589). The two outcomes studied were Spontaneous vaginal birth and preterm birth. Outcome variables were compared using multivariate generalized linear models (GLMs) and reported using adjusted risk ratios (aRR) with 95% confidence intervals. FINDINGS Women in MLCC were, in comparison with women in the SMC group more likely to have spontaneous vaginal birth (aRR of 1.198 (95% CI 1.101-1.303)). Neonates of women in MLCC were in comparison with those in SMC less likely to be preterm (aRR of 0.394; 95% CI (0.227-0.683)). CONCLUSION In this study, use of the MLCC model improved maternal and neonatal health outcomes. To scale up and further investigate the effect and feasibility of this model in a low resource setting could be of considerable importance in Ethiopia and other Sub-Saharan Africa countries.
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Gu C, Lindgren H, Wang X, Zhang Z, Liang S, Ding Y, Qian X. Developing a midwifery service task list for Chinese midwives in the task-shifting context: a Delphi study. BMJ Open 2021; 11:e044792. [PMID: 34266838 PMCID: PMC8286777 DOI: 10.1136/bmjopen-2020-044792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 06/16/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop and validate a midwifery-led task list in the task-shifting context. DESIGN An extensive literature review followed by a two-iterative Delphi survey. SETTING Twenty university hospitals, three non-university hospitals and four university colleges from nine provincial regions of China. PARTICIPANTS Purposive non-probability sampling of a national panel of experts in maternal healthcare, obstetrics, nursing and midwifery. Experts in the panel were asked to rate each midwifery service item regarding importance, feasibility and advancement on a 5-point scale, in order to determine those best suited for midwifery-led practice in China. RESULTS Two rounds of Delphi surveys were completed before consensus was achieved, with effective response rate ranging from 96.4% (27/28) to 100% (27/27), indicating a high positive coefficient of the experts. The authority coefficient of experts was 0.882, indicating the high reliability of this study. The Kendall harmony coefficient (W) in the two rounds of consultations was 0.196 (p<0.001) and 0.324 (p<0.001), respectively. A detailed, three-level midwifery-led task list was developed, including 3 domains of midwifery practice (first-level indicators), 13 types of task (second-level indicators) and 58 midwifery service items (third-level indicators). The 3 domains of midwifery practice involved the appropriate scope of practice for Chinese midwives, including antenatal care, intrapartum care and postnatal care. The 58 service items embraced core components of caring task in the Chinese midwifery profession. CONCLUSION This study outlines the first midwifery-led task list that defines clearly the Chinese midwives' scope of practice. It will provide a foundational framework for future midwifery practice in China and abroad, and can be used to inform the design of midwifery-led task shifting interventions in various maternity settings.
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Affiliation(s)
- Chunyi Gu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
- Global Health Institute, Fudan University, Shanghai, China
| | - Helena Lindgren
- Department of Women's and Children's Health, Reproductive Health, Karolinska Institute, Stockholm, Sweden
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zheng Zhang
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Shuang Liang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
- Global Health Institute, Fudan University, Shanghai, China
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Liu Y, Li T, Guo N, Jiang H, Li Y, Xu C, Yao X. Women's experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China. BMC Pregnancy Childbirth 2021; 21:151. [PMID: 33607963 PMCID: PMC7893951 DOI: 10.1186/s12884-021-03638-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low risk pregnancy ending in a vaginal birth is best served and guided by a midwife. Utilizing a midwife in such cases offers many emotional and economic advantages and does not increase the risks for mother or neonate. However, women's experience and satisfaction of midwife-led maternity care is rarely reported in China. The primary objective of this study is to describe the experience of Chinese women receiving midwife-led maternity care, and to report their satisfaction level of the experience. METHODS The study is a cross-sectional survey of 4192 women who had natural birth from March-June 2019 in a maternity care center, Shanghai, China. We used a self-administered questionnaire addressing items related to women's experience during childbirth, as well as their satisfaction with midwife-led maternity care. We also included demographic and perinatal characteristics of each participant. Descriptive statistics and correlations analysis between groups of different experience and satisfaction were used. RESULTS In this sample, 87.7% of women had a Doula and a family member present during childbirth. Epidural anesthesia was used in 75.6% and episiotomy was needed in 23.2%. Free positioning during the first stage of labor and free positioning during the second stage of labor and delivery were adopted in 84.3 and 67.9% of the cases, respectively. Moderate to severe perineal pain and moderate to severe perineal edema were reported in 43.1 and 12.2% of the participants, respectively. High satisfaction level was found when there was midwife-led prenatal counseling and presence of Doula and family member, Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during the first stage of labor, and midwifes' postpartum guidance. Negative satisfaction was seen with perineal pain and edema. CONCLUSION Women in this survey generally had high satisfaction with midwife-led maternity care. This satisfaction is probably felt because of the prenatal counseling by the midwife and allowing a Doula and a family member in the room during childbirth. Other intangible factors to improve the satisfaction level were Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during first stage of labor, and early skin to skin contact.
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Affiliation(s)
- Ying Liu
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Tengteng Li
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Nafei Guo
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Hui Jiang
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China.
| | - Yuehong Li
- Delivery Room, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Chenying Xu
- Delivery Room, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Xiao Yao
- Delivery Room, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
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Dias PF, Miranda TPS, Santos RDP, Paula EMD, Bem MMDS, Mendes MA. Concept formation of ambience for labor and normal institutionalized delivery. Rev Bras Enferm 2019; 72:348-359. [PMID: 31851273 DOI: 10.1590/0034-7167-2018-0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 06/17/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to develop the concept ambience for labor and normal institutionalized delivery, identifying in the literature its antecedent, defining attributes and the consequent. METHOD the method used was the analysis of literature, corresponding to the first stage of the qualitative method of concept analysis. The theoretical operation was performed in the databases CINAHL COCHRANE, LILACS, PsycINFO, and PubMed. RESULTS aspects of the parturient woman and the qualification of the physical and social space are presented as the antecedent. The defining attributes outline the assistance interaction process with Non-Invasive Technologies. As the consequent, we highlight the outcome for normal delivery, pain relief and comfort, woman satisfaction and well-being. FINAL CONSIDERATIONS the analysis of the antecedent, defining attributes and the consequent allowed the elaboration of an unprecedent theoretical proposition of this concept.
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Wahlström S, Björklund M, Munck B. The professional role of skilled birth attendants' in Nepal - A phenomenographic study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 21:60-66. [PMID: 31395235 DOI: 10.1016/j.srhc.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to describe the Nepali Skilled Birth Attendants' (SBAs) perceptions of their professional role. METHODS Fifteen Nepalese SBAs were interviewed using a semi-structured interview guide. A phenomenographic approach was chosen to describe their qualitatively different and unreflective conceptions of the professional role. Data was analysed in a seven-step process and three description categories and six conceptions emerged. RESULTS The SBAs described the role as provider, the role as counsellor and the role as educator. As provider, the SBA maintained midwifery nursing and prevented maternal deaths. As counsellor, the SBA advocated and empowered women and facilitated family planning. As educator, the SBA promoted health of families and health in the society. She also tutored students and colleagues about skills and human rights. CONCLUSION The SBAs' vulnerability emerged especially in rural areas while preventing complications and newborn and maternal death in rural areas where she often worked alone with lack of proper equipment and access to other medical professionals. The SBAs perceived that their professional roles required knowledge and experiences, were safety was closely linked to health education. Ethical dilemma could arose when they had to relate to the families' cultural decisions. Education was a key factor connected to close life-saving procedures and to retain good quality and safety in newborn and maternal healthcare. The SBAs switched between their three roles, always striving to be aware of compliance with the Sustainable Development Goals policy.
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Affiliation(s)
- Solveig Wahlström
- Department of Nursing, School of Health and Welfare, Jönköping University, P.O. Box 1026, SE-551 11 Jönköping, Sweden; ADULT Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Margereth Björklund
- Department of Nursing, School of Health and Welfare, Jönköping University, P.O. Box 1026, SE-551 11 Jönköping, Sweden; ADULT Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Berit Munck
- Department of Nursing, School of Health and Welfare, Jönköping University, P.O. Box 1026, SE-551 11 Jönköping, Sweden; ADULT Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Hua J, Zhu L, Du L, Li Y, Wu Z, Wo D, Du W. Effects of midwife-led maternity services on postpartum wellbeing and clinical outcomes in primiparous women under China's one-child policy. BMC Pregnancy Childbirth 2018; 18:329. [PMID: 30103732 PMCID: PMC6090670 DOI: 10.1186/s12884-018-1969-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 08/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Midwife-led maternity services have been implemented in China in response to the high rates of primiparous women and Caesarean Sections (CS) which may be related to China's one-child policy. However, few studies in China have been reported on the effectiveness of Midwife-led Care at Delivery (MCD) and the Continuity of Midwife-led Care (CMC) on postpartum wellbeing and other clinical outcomes. Therefore, evidence-based clinical validation is needed to develop an optimal maternity service for childbearing women in China. METHODS A concurrent cohort study design was conducted with 1730 pregnant women recruited from 9 hospitals in Shanghai. Among the 1730 participants at baseline, 1568 participants completed the follow-up questionnaire, with a follow-up rate of 90.6%. RESULTS Compared with the routine Obstetrician-led Maternity Care (OMC), Midwife-led Care at Delivery (MCD) was associated with CS rate (OR were 0.16; 95%CI: 0.11 to 0.25) and a higher total score of postpartum wellbeing (βwere 2.70; 95%CI: 0.70 to 4.70) when adjusting for the baseline differences and other confounders during delivery or postpartum period. Moreover, continuity of Midwife-led Care (CMC) was associated with CS rate (OR were 0.30; 95%CI: 0.23 to 0.41), as well as increased rate of breastfeeding within the first 24 h (OR were 2.49; 95% CI: 1.47 to 4.23), higher postpartum satisfaction (β = 4.52; 95% CI: 1.60 to 12.68), lower anxiety (βwere 0.66; 95% CI: 0.16 to 1.17), increased self-control (βwere 0.39; 95% CI: 0.02 to 0.76) and a higher total score of postpartum wellbeing (βwere 3.14; 95% CI: 1.54 to 4.75). CONCLUSION CMC is the optimal service for low-risk primiparous women under China's one-child policy, and is worthwhile for a general implementation across China.
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Affiliation(s)
- Jing Hua
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 2699 Gaoke Road, Shanghai, 200042, China.
| | - Liping Zhu
- Shanghai Maternity and Child Health Care Center, P.O. 339 Gaoke Road, Shanghai, 200042, China.
| | - Li Du
- Shanghai Maternity and Child Health Care Center, P.O. 339 Gaoke Road, Shanghai, 200042, China
| | - Yu Li
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 2699 Gaoke Road, Shanghai, 200042, China
| | - Zhuochun Wu
- Health Statistics and Social Medicine Department of Public health School, Fudan University, Shanghai, 200002, China
| | - Da Wo
- Research Center for Translational Medicine, East Hospital, Tongji University School of Medicine, Shanghai, 200002, China
| | - Wenchong Du
- Division of Psychology, Nottingham Trent University, Chaucer Building 4013, Burton Street, Nottingham, NG1 4BU, UK
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Shakibazadeh E, Namadian M, Bohren MA, Vogel JP, Rashidian A, Nogueira Pileggi V, Madeira S, Leathersich S, Tunçalp Ӧ, Oladapo OT, Souza JP, Gülmezoglu AM. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG 2017; 125:932-942. [PMID: 29117644 PMCID: PMC6033006 DOI: 10.1111/1471-0528.15015] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/26/2022]
Abstract
Background What constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable. Objectives To develop a conceptualisation of RMC. Search strategy Key databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies. Selection criteria Primary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date. Data collection and analysis A combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings. Main results Sixty‐seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent. Conclusions This review presents an evidence‐based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes. Tweetable abstract Understanding respectful maternity care – synthesis of evidence from 67 qualitative studies. Understanding respectful maternity care – synthesis of evidence from 67 qualitative studies.
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Affiliation(s)
- E Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - M Namadian
- Social Determinants of Health Research Centre, Zanjan University of Medical Sciences, Zanjan, Iran
| | - M A Bohren
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - J P Vogel
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - A Rashidian
- Department of Information, Evidence and Research, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - V Nogueira Pileggi
- GLIDE Technical Cooperation and Research, Ribeirão Preto, São Paulo, Brazil.,Department of Paediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - S Madeira
- Social Department of Ribeirão Preto, Medical School, University of São Paulo, São Paulo, Brazil
| | - S Leathersich
- King Edward Memorial Hospital for Women, Subiaco, WA, Australia
| | - Ӧ Tunçalp
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - O T Oladapo
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - J P Souza
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - A M Gülmezoglu
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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Bagheri A, Simbar M, Samimi M, Nahidi F, Alavi Majd H, Eskandari N, Abbaszadeh F. Concepts and Dimensions in Continuous Midwifery Care Models Based on the Experiences and Expectations of Stakeholders: A Meta-Synthesis. Nurs Midwifery Stud 2016. [DOI: 10.17795/nmsjournal33946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Concepts and Dimensions in Continuous Midwifery Care Models Based on the Experiences and Expectations of Stakeholders: A Meta-Synthesis. Nurs Midwifery Stud 2016. [DOI: 10.5812/nmsjournal.33946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Long Q, Allanson ER, Pontre J, Tunçalp Ö, Hofmeyr GJ, Gülmezoglu AM. Onsite midwife-led birth units (OMBUs) for care around the time of childbirth: a systematic review. BMJ Glob Health 2016; 1:e000096. [PMID: 28588944 PMCID: PMC5321346 DOI: 10.1136/bmjgh-2016-000096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 01/11/2023] Open
Abstract
Introduction To ensure timely access to comprehensive emergency obstetric care in low- and middle-income countries, a number of interventions have been employed. This systematic review assesses the effects of onsite midwife-led birth units (OMBUs) embedded within hospitals which provide comprehensive emergency obstetric and newborn care. Methods Both interventional and observational studies that compared OMBUs with standard medical-led obstetric care were eligible for inclusion. Cochrane Central Register of Controlled Trials, PubMed/Medline, EMBASE, CINAHL, Science Citation and Social Sciences Citation Index, Global Health Library and one Chinese database were searched. Meta-analysis was conducted to synthesise data from randomised controlled trials (RCTs). Findings of observational studies were summarised by forest plots with brief narratives. Results Three RCTs, one controlled before-and-after study and six cohort studies were included. There were no or very few maternal and perinatal deaths in either OMBUs or standard obstetric units, with no significant differences between the two. Women giving birth in OMBUs were less likely to use epidural analgesia (risk ratio (RR) 0.67, 95% CI 0.55 to 0.82; three trials, n=2431). The UK national cohort study and two other cohorts in China and Nepal found less oxytocin augmentation, more spontaneous vaginal deliveries, fewer caesarean sections and fewer episiotomies performed in OMBUs than in standard obstetric units. These differences were not statistically significant in RCTs and the remaining cohorts. One study investigated satisfaction with midwife-led birth care among women and midwives, with positive findings in both groups favouring OMBUs. In addition, two studies found that the total cost of birth was lower in OMBUs than in standard obstetric units. Conclusions OMBUs could be an alternative model for providing safe and cost-effective childbirth care, which may be particularly important in low- and middle-income countries to meet the growing demand for facility-based birth for low-risk women and improve efficiency of health systems.
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Affiliation(s)
- Qian Long
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Emma R Allanson
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Faculty of Medicine, Dentistry and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, Australia
| | - Jennifer Pontre
- King Edward Memorial Hospital, Subiaco, Perth, Western Australia, Australia
| | - Özge Tunçalp
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - George Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Walter Sisulu University and Eastern Cape Department of Health, Frere Maternity Hospital, Johannesburg, South Africa
| | - Ahmet Metin Gülmezoglu
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Raven J, van den Broek N, Tao F, Kun H, Tolhurst R. The quality of childbirth care in China: women's voices: a qualitative study. BMC Pregnancy Childbirth 2015; 15:113. [PMID: 25971553 PMCID: PMC4457993 DOI: 10.1186/s12884-015-0545-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/05/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In the context of improved utilisation of health care and outcomes, rapid socio-economic development and health system reform in China, it is timely to consider the quality of services. Data on quality of maternal health care as experienced by women is limited. This study explores women's expectations and experiences of the quality of childbirth care in rural China. METHODS Thirty five semi-structured interviews and five focus group discussions were conducted with 69 women who had delivered in the past 12 months in hospitals in a rural County in Anhui Province. Data were transcribed, translated and analysed using the framework approach. RESULTS Hospital delivery was preferred because it was considered safe. Home delivery was uncommon and unsupported by the health system. Expectations such as having skilled providers and privacy during childbirth were met. However, most women reported lack of cleanliness, companionship during labour, pain relief, and opportunity to participate in decision making as poor aspects of care. Absence of pain relief is one reason why women may opt for a caesarean section. CONCLUSIONS These findings illustrate that to improve quality of care it is crucial to build accountability and communication between providers, women and their families. Ensuring women's participation in decision making needs to be addressed.
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Affiliation(s)
- Joanna Raven
- Department for International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Nynke van den Broek
- Centre of Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, Hefei, China.
| | - Huang Kun
- School of Public Health, Anhui Medical University, Hefei, China.
| | - Rachel Tolhurst
- Department for International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
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Feng XL, Wang Y, An L, Ronsmans C. Cesarean section in the People's Republic of China: current perspectives. Int J Womens Health 2014; 6:59-74. [PMID: 24470775 PMCID: PMC3891566 DOI: 10.2147/ijwh.s41410] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To review the current knowledge on the prevalence, reasons, and consequences of cesarean sections in the People's Republic of China. METHODS Peer-reviewed articles were systematically searched on PubMed. The following Chinese databases were comprehensively searched: the China National Knowledge Infrastructure, Wanfang, and the VIP information. The databases were searched from inception to September 1, 2013. Two reviewers independently screened the titles and abstracts for eligibility. Full texts of eligible papers were reviewed, where relevant references were hand-searched and reviewed. FINDINGS Sixty articles were included from PubMed, 17 articles were intentionally picked out from Chinese journals, and five additional articles were added, for a total of 82 articles for the analysis. With a current national rate near 40%, the literature consistently reported a rapid rise of cesarean sections in the People's Republic of China in the past decades, irrespective of where people lived or their socioeconomic standing. Nonclinical factors were considered as the main drivers fueling the rise of cesareans in the People's Republic of China. There was a lively debate on whether women's preferences or providers' distorted financial incentives affected the rise in cesarean sections. However, recent evidence suggests that it might be the People's Republic of China's health development approach - focusing on specialized care and marginalizing primary care - that is playing a role. Although 30 articles were identified studying the consequences of cesareans, the methodologies are in general weak and the themes are out of focus. CONCLUSION The overuse of cesareans is rising alarmingly in the People's Republic of China and has become a real public health problem. No consensus has been made on the leverage factors that drive the cesarean epidemic, particularly for those nonclinical factors. The more macro level structural factors may have played a part, though further research is warranted to understand the mechanisms. Knowledge of the consequences of cesareans, particularly for women, is limited in the People's Republic of China, leaving a substantial literature gap.
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Affiliation(s)
- Xing Lin Feng
- Department of Health Policy and Administration, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Ying Wang
- Department of Health Policy and Administration, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Lin An
- Department of Women, Children and Adolescent Health, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
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Wang Z, Sun W, Zhou H. Midwife-led care model for reducing caesarean rate: A novel concept for worldwide birth units where standard obstetric care still dominates. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2012. [DOI: 10.1016/j.jmhi.2012.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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