1
|
Turkmani S, Nove A, Bazirete O, Hughes K, Pairman S, Callander E, Scarf V, Forrester M, Mandke S, Homer CSE. Exploring networks of care in implementing midwife-led birthing centres in low- and middle-income countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001936. [PMID: 37220124 DOI: 10.1371/journal.pgph.0001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/27/2023] [Indexed: 05/25/2023]
Abstract
The evidence for the benefits of midwifery has grown over the past two decades and midwife-led birthing centres have been established in many countries. Midwife-led care can only make a sustained and large-scale contribution to improved maternal and newborn health outcomes if it is an integral part of the health care system but there are challenges to the establishment and operation of midwife-led birthing centres. A network of care (NOC) is a way of understanding the connections within a catchment area or region to ensure that service provision is effective and efficient. This review aims to evaluate whether a NOC framework-in light of the literature about midwife-led birthing centres-can be used to map the challenges, barriers and enablers with a focus on low-to-middle income countries. We searched nine academic databases and located 40 relevant studies published between January 2012 and February 2022. Information about the enablers and challenges to midwife-led birthing centres was mapped and analysed against a NOC framework. The analysis was based on the four domains of the NOC: 1) agreement and enabling environment, 2) operational standards, 3) quality, efficiency, and responsibility, 4) learning and adaptation, which together are thought to reflect the characteristics of an effective NOC.Of the 40 studies, half (n = 20) were from Brazil and South Africa. The others covered an additional 10 countries. The analysis showed that midwife-led birthing centres can provide high-quality care when the following NOC elements are in place: a positive policy environment, purposeful arrangements which ensure services are responsive to users' needs, an effective referral system to enable collaboration across different levels of health service and a competent workforce committed to a midwifery philosophy of care. Challenges to an effective NOC include lack of supportive policies, leadership, inter-facility and interprofessional collaboration and insufficient financing. The NOC framework can be a useful approach to identify the key areas of collaboration required for effective consultation and referral, to address the specific local needs of women and their families and identify areas for improvement in health services. The NOC framework could be used in the design and implementation of new midwife-led birthing centres.
Collapse
Affiliation(s)
- Sabera Turkmani
- Burnet Institute, Melbourne, Victoria, Australia
- University of Technology Sydney, Sydney, Australia
| | | | - Oliva Bazirete
- Novametrics Ltd, Duffield, United Kingdom
- University of Rwanda, Kigali, Rwanda
| | | | - Sally Pairman
- International Confederation of Midwives, The Hague, Netherlands
| | | | | | - Mandy Forrester
- International Confederation of Midwives, The Hague, Netherlands
| | - Shree Mandke
- International Confederation of Midwives, The Hague, Netherlands
| | - Caroline S E Homer
- Burnet Institute, Melbourne, Victoria, Australia
- University of Technology Sydney, Sydney, Australia
| |
Collapse
|
2
|
Nove A, Bazirete O, Hughes K, Turkmani S, Callander E, Scarf V, Forrester M, Mandke S, Pairman S, Homer CS. Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey. Midwifery 2023; 123:103717. [PMID: 37182478 PMCID: PMC10281083 DOI: 10.1016/j.midw.2023.103717] [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: 01/26/2023] [Revised: 04/22/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
Evidence about the safety and benefits of midwife-led care during childbirth has led to midwife-led settings being recommended for women with uncomplicated pregnancies. However, most of the research on this topic comes from high-income countries. Relatively little is known about the availability and characteristics of midwife-led birthing centres in low- and middle-income countries (LMICs). This study aimed to identify which LMICs have midwife-led birthing centres, and their main characteristics. The study was conducted in two parts: a scoping review of peer-reviewed and grey literature, and a scoping survey of professional midwives' associations and United Nations Population Fund country offices. We used nine academic databases and the Google search engine, to locate literature describing birthing centres in LMICs in which midwives or nurse-midwives were the lead care providers. The review included 101 items published between January 2012 and February 2022. The survey consisted of a structured online questionnaire, and responses were received from 77 of the world's 137 low- and middle-income countries. We found at least one piece of evidence indicating that midwife-led birthing centres existed in 57 low- and middle-income countries. The evidence was relatively strong for 24 of these countries, i.e. there was evidence from at least two of the three types of source (peer-reviewed literature, grey literature, and survey). Only 14 of them featured in the peer-reviewed literature. Low- and lower-middle-income countries were more likely than upper-middle-income countries to have midwife-led birthing centres. The most common type of midwife-led birthing centre was freestanding. Public-sector midwife-led birthing centres were more common in middle-income than in low-income countries. Some were staffed entirely by midwives and some by a multidisciplinary team. We identified challenges to the midwifery philosophy of care and to effective referral systems. The peer-reviewed literature does not provide a comprehensive picture of the locations and characteristics of midwife-led birthing centres in low- and middle-income countries. Many of our findings echo those from high-income countries, but some appear to be specific to some or all low- and middle-income countries. The study highlights knowledge gaps, including a lack of evidence about the impact and costs of midwife-led birthing centres in low- and middle-income countries.
Collapse
Affiliation(s)
| | - Oliva Bazirete
- Novametrics Ltd, Duffield, Derbyshire, UK; University of Rwanda School of Nursing and Midwifery, Kigali, Rwanda
| | | | - Sabera Turkmani
- Burnet Institute Global Women's and Newborn Health Group, Melbourne, Vic, Australia
| | - Emily Callander
- Monash University Health Systems Services & Policy Unit, Melbourne, Vic, Australia
| | - Vanessa Scarf
- University of Technology Sydney School of Nursing and Midwifery, Sydney, NSW, Australia
| | - Mandy Forrester
- International Confederation of Midwives, The Hague, The Netherlands
| | - Shree Mandke
- International Confederation of Midwives, The Hague, The Netherlands
| | - Sally Pairman
- International Confederation of Midwives, The Hague, The Netherlands
| | - Caroline Se Homer
- Burnet Institute Global Women's and Newborn Health Group, Melbourne, Vic, Australia; University of Technology Sydney School of Nursing and Midwifery, Sydney, NSW, Australia
| |
Collapse
|
3
|
Batinelli L, Thaels E, Leister N, McCourt C, Bonciani M, Rocca-Ihenacho L. What are the strategies for implementing primary care models in maternity? A systematic review on midwifery units. BMC Pregnancy Childbirth 2022; 22:123. [PMID: 35152880 PMCID: PMC8842978 DOI: 10.1186/s12884-022-04410-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background Midwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effective option. However, they still do not represent the mainstream option of maternity care in many countries. Understanding effective strategies to integrate this model of care into maternity services could support and inform the MU implementation process that many countries and regions still need to approach. Methods A systematic search and screening of qualitative and quantitative research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines. Included articles were appraised using the CASP checklist. A meta-synthesis approach to analysis was used. No exclusion criteria for time or context were applied to ensure inclusion of different implementation attempts even under different historical and social circumstances. A sensitivity analysis was conducted to reflect the major contribution of higher quality studies. Results From 1037 initial citations, twelve studies were identified for inclusion in this review after a screening process. The synthesis highlighted two broad categories: implementation readiness and strategies used. The first included aspects related to cultural, organisational and professional levels of the local context whilst the latter synthesised the main actions and key points identified in the included studies when implementing MUs. A logic model was created to synthesise and visually present the findings. Conclusions The studies selected were from a range of settings and time periods and used varying strategies. Nonetheless, consistencies were found across different implementation processes. These findings can be used in the systematic scaling up of MUs and can help in addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.
Collapse
|
4
|
Studying the effect of a supportive communication techniques program on the quality gap among women who gave birth in local childbirth outposts, south-east Iran. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01059-3] [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
|
5
|
Moudi Z, Talebi B, Faramarzi M, Ansari H. Effect of a Supportive Communication Educational Program on Women's Satisfaction With Childbirth Experiences in Local Safe Delivery Posts in Iran. INTERNATIONAL JOURNAL OF CHILDBIRTH 2019. [DOI: 10.1891/2156-5287.8.4.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSETo investigate the effect of a supportive communication educational program on satisfaction with childbirth experiences among the women giving birth in the local safe delivery posts (SDPs).METHODSThis quasi-experimental study was conducted during September 23, 2017 and December 22, 2017. In the first phase, seven midwives were subjected to a supportive communication training program in one of two unique local SDPs in Zahedan, Iran. In the second phase, 300 women who gave birth at the SDPs (150 cases in each SDP) were entered into the study. The data were collected using the Mackey Childbirth Satisfaction Rating Scale (MCSRS).RESULTSThe intervention group had a higher mean childbirth satisfaction score in all five subdomains, compared to the control group. However, this difference was statistically significant only in the “general” (p < .001) and “self” (p = .003) subdomains of the MCSRS. The regression model showed if the women's labor experience was just like the way they expected, they were 5.99 times more likely to be satisfied with childbirth care in SDPs.CONCLUSIONAs the findings indicated, this program made childbirth care experiences more satisfactory for disadvantaged women.
Collapse
|
6
|
Zhang X, Zhou L, Antwi HA. The impact of China's latest population policy changes on maternity insurance-a case study in Jiangsu Province. Int J Health Plann Manage 2018; 34:e617-e633. [PMID: 30295341 DOI: 10.1002/hpm.2677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/12/2022] Open
Abstract
This study aims to examine the impact of China's population policy changes on social insurance. Nearly 4 decades ago, China ushered in the 1-child policy as a family planning policy to control the adverse effect of high population growth. The current maternity insurance system in China is designed to fit the operations of the 1-child policy. However, the implementation of the comprehensive 2-child policy can pose a challenge to the sustainability of the current maternity insurance scheme hence the call for reform. The study empanels a novel and comprehensive system dynamic model that incorporates all the related factors that influence the income and expenditure of maternity insurance in the Jiangsu Province. Data are mainly derived from the historical data of the Statistical Yearbook of Jiangsu Province and the National Bureau of Statistics of China. These are used to construct and simulate a system dynamic model to determine a sustainable contribution rate for maternity insurance. In conclusion, if the rate of contribution of the current maternity insurance policy is not increased, the burden of implementing the comprehensive 2-child policy will exacerbate the current deficit balance of the maternity insurance fund. The existing maternity insurance benefits thus cannot be maintained, and women's health will be threatened. In the short term, the study proposes an increase in the rate of premium payment to prolong the life of the maternity insurance. In the long term, there is a need to improve the level of coordination and expand the coverage of maternity insurance.
Collapse
Affiliation(s)
- Xiaotian Zhang
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Lvlin Zhou
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Henry Asante Antwi
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China
| |
Collapse
|
7
|
Moudi Z, Phanodi Z, Ansari H, Zohour MM. Decisional conflict and regret: shared decision-making about pregnancy affected by β-thalassemia major in Southeast of Iran. J Hum Genet 2017; 63:309-317. [PMID: 29273732 DOI: 10.1038/s10038-017-0379-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/26/2017] [Accepted: 10/08/2017] [Indexed: 11/09/2022]
Abstract
To study the effect of shared decision-making (SDM) on decisional conflict (DC) scores immediately after consultation and to assess the decisional regret (DR) scores in the first 3 months following women's decision regarding termination of pregnancy. This quasi-experimental study was conducted during August 3rd-February 20th, 2016. We included 80 women whose fetuses were diagnosed with β-thalassemia major (β-TM) through chorionic villi sampling and were referred to the only prenatal diagnosis center at Ali-Asghar Hospital, Zahedan, Iran. While the control group went through the routine procedures, the intervention group received a 90-min counseling session based on SDM. The demographic characteristics form and DC scale were filled out immediately after the consultation session. After 3 months, the women were contacted via telephone call to collect data on their level of DR. The mean DC score was significantly (P = < 0.0025) lower in the intervention group (8.47 ± 4.63) compared with the control group (44.10 ± 14.5). Moreover, the mean score of DR was significantly (P = 0.004) lower in the intervention group (9.37 ± 15.44) compared with the control group (24.37 ± 23.42). SDM consultation can help women experience significantly lower levels of DC and DR.
Collapse
Affiliation(s)
- Zahra Moudi
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Zenab Phanodi
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | | |
Collapse
|
8
|
Moudi Z, Miri-Moghaddam E. Decisions Regarding Pregnancy Termination Due to β-Thalassemia Major: a Mixed-Methods Study in Sistan and Baluchestan, Iran. J Genet Couns 2016; 26:556-566. [DOI: 10.1007/s10897-016-0019-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
|
9
|
Moudi Z, Tabatabaei SM. Birth outcomes in a tertiary teaching hospitals and local outposts: a novel approach to service delivery from Iran. Public Health 2016; 135:114-21. [PMID: 27003671 DOI: 10.1016/j.puhe.2016.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 02/02/2016] [Accepted: 02/15/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare the outcomes of childbirth care in a tertiary teaching hospital and Safe Delivery Posts (SDPs) to determine the safety of out-of-hospital care by midwives in Zahedan, Iran. STUDY DESIGN A quasi-experimental design was applied in this study. METHODS In this study, 2063 women who gave birth in SDPs, along with 983 women who underwent vaginal delivery in a tertiary teaching hospital, were evaluated in 2011-2012. Retrospective chart review was applied to collect data from the medical records of mothers and neonates. Only low-risk women with a singleton live birth, cephalic presentation, gestational age ≥37 weeks, spontaneous labour, and no prior history of uterine scar were recruited. RESULTS Based on the findings, episiotomy, perineal tear, cervical laceration, postpartum haemorrhage and need for blood transfusion (or hysterectomy) were less commonly reported in the SDP group, compared to the hospital group. In the SDP group, 15 (0.73%) women were transferred to the hospital after delivery. Overall, one (0.10%) case from the hospital group and two (0.10%) cases from the SDP group were admitted to the intensive care unit. One-minute Apgar score lower than seven, resuscitation, NICU admission and neonatal death were more commonly reported in the hospital group, compared to the SDP group. Overall, hospital transfer was reported in 12 (0.58%) neonates born in SDPs. CONCLUSION In the present study, women who gave birth in SDPs had more opportunities to experience natural birth with fewer adverse outcomes. However, considering the possibility of life-threatening complications for mothers and newborns, substantial evidence is required to improve the quality of care before implementing such novel strategies in different settings.
Collapse
Affiliation(s)
- Z Moudi
- Pregnancy Health Research Center, Zahedan University of Medical Science, Zahedan, Iran; Midwifery Department, Nursing and Midwifery School, Mashahir Square, Zahedan, Iran.
| | - S M Tabatabaei
- Department of Statistic and Epidemiology, Zahedan University of Medical Science, Iran.
| |
Collapse
|
10
|
Tabatabaei SM, Behmanesh Pour F, Share Mollashahi S, Sargazi Moakhar Z, Zaboli M. The Quality Gap in the Services Provided by Rural Maternity Units in Southeast of Iran. HEALTH SCOPE 2015. [DOI: 10.17795/jhealthscope-25344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Tabatabaei SM, Sargazi Moakhar Z, Behmanesh Pour F, Shaare Mollashahi S, Zaboli M. Hospitalized Pregnant Women Who Leave Against Medical Advice: Attributes and Reasons. Matern Child Health J 2015. [DOI: 10.1007/s10995-015-1811-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|