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Cummins A, Booth C, Lennon K, McLaughlin K, Prussing E, Newnham L. "A safe space"; A statewide evaluation of Midwifery Antenatal and Postnatal Service (MAPS) using the quality maternal newborn care, evidence informed framework. Women Birth 2024; 37:101642. [PMID: 38964229 DOI: 10.1016/j.wombi.2024.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The World Health Organization recommends Midwifery Continuity of Care (MCoC) due to the consistent improvements in outcomes for mothers and babies. Surveys from the United Kingdom and Australia reported large numbers of midwives are unable to commit to the on call component required to provide MCoC across the continuum. To address this challenge a modified MCoC model called Midwifery Antenatal and Postnatal Services (MAPS) has been introduced. The aim of this study was to evaluate MAPS services in six sites across one State in Australia. METHODS A multi-site qualitative descriptive study was undertaken framed by the Quality Maternal Newborn Care (QMNC) Framework. The QMNC framework was used to develop focus group questions for data collection, and as a lens for analysing data. Data were collected via focus groups from midwives and women at six sites ranging from metropolitan to regional and rural settings and thematically analysed. FINDINGS Participants (n=80) included women (n=28), midwives (n=44) and MAPS managers (n=8). This paper reports the findings from the women and midwives, presented under three themes: Getting onto the program, Knowing the story and Building confidence by sharing information. Each theme had subthemes and the findings were aligned either positively or negatively with the QMNC framework. CONCLUSION This study found the MAPS model aligns in positive ways with the QMNC quality care framework with some recommendations to improve quality care. Midwives want to provide continuity of care and MAPS is a useful model for providing continuity through the antenatal and postnatal periods.
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Affiliation(s)
- Allison Cummins
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia.
| | - Chelsea Booth
- Nursing and Midwifery Office, New South Wales Ministry of Health, Australia
| | - Kelley Lennon
- Nursing and Midwifery Office, New South Wales Ministry of Health, Australia
| | - Karen McLaughlin
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Elysse Prussing
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Liz Newnham
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
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Shenton EK, Carter AG, Gabriel L, Slavin V. Improving maternal and neonatal outcomes for women with gestational diabetes through continuity of midwifery care: A cross-sectional study. Women Birth 2024; 37:101597. [PMID: 38547549 DOI: 10.1016/j.wombi.2024.101597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
PROBLEM Gestational Diabetes Mellitus (GDM) is a complication of pregnancy which may exclude women from midwife-led models of care. BACKGROUND There is a paucity of research evaluating the safety and feasibility of continuity of midwifery care (CoMC) for women with GDM. AIM To investigate the impact of CoMC on maternal and neonatal outcomes, for otherwise low-risk women with GDM. METHODS This exploratory cross-sectional study observed maternal and neonatal outcomes including onset of labour, augmentation, labour analgesia, mode of birth, perineal trauma, gestation at birth, shoulder dystocia, infant birth weight, neonatal feeding at discharge. FINDINGS Participants were 287 otherwise low-risk pregnant women, who developed GDM, and either received CoMC (n=36) or standard hospital maternity care (non-CoMC) (n=251). Women with GDM who received CoMC were significantly more likely to experience an spontaneous onset of labour (OR 6.3; 95% CI 2.7-14.5; p<.001), labour without an epidural (OR 4.2; 95% CI 2.0 - 9.2,<0.001) and exclusively breastfeed (OR 4.3; 95% CI 1.26 - 14.32; p=0.02). DISCUSSION Receiving CoMC may be a public health initiative which not only improves maternal and neonatal outcomes, but also long-term morbidity associated with GDM. CONCLUSION Findings provide preliminary evidence suggesting CoMC improves maternal and neonatal outcomes and is likely a safe and viable option for otherwise low-risk women with GDM. Larger studies are recommended to confirm findings and explore the full impact of CoMC for women with GDM.
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Affiliation(s)
- Eleanor K Shenton
- Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6153, Australia.
| | - Amanda G Carter
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD 4131, Australia
| | - Laura Gabriel
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD 4131, Australia
| | - Valerie Slavin
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD 4131, Australia; Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
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Wynter K, Watkins V, Kavanagh S, Hosking S, Rasmussen B, Maindal HT, Macdonald J. Health literacy among fathers and fathers-to-be: a multi-country, cross-sectional survey. Health Promot Int 2023; 38:daad131. [PMID: 37851463 PMCID: PMC10583760 DOI: 10.1093/heapro/daad131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
During pregnancy and early fatherhood, men are at higher risk of poor health, exacerbated by low engagement by healthcare services. Yet the transition to fatherhood presents an opportunity for men to improve their health and health behaviours. Health literacy refers to individuals' competence in accessing and applying health information. Poor health literacy is associated with poor health and low help-seeking. The aim of this study was to identify health literacy strengths, needs and profiles among fathers. Men who were expecting a baby ('antenatal') or had become fathers in the past 18 months ('postnatal') were recruited through an international, online paid survey platform. The survey included the nine-scale Health Literacy Questionnaire (HLQ). Of 889 survey respondents (n = 416, 46.5% antenatal; n = 473, 53.5% postnatal), 274 (31.0%) were residing in the USA and 239 (27.0%) in the UK. Relatively higher scores were reported for HLQ scales relating to having sufficient information and finding and understanding this information, as well as social support for health. Relatively lower scores were obtained for scales relating to actively managing one's own health and navigating the health care system. Three scale scores were significantly lower among nulliparous than multiparous men. Seven health literacy profiles were identified. In conclusion, while fathers have some health literacy strengths, they also experience some barriers, particularly first-time fathers. Awareness of diverse health literacy profiles among fathers may assist in developing strategies to strengthen health services' capacity to meet fathers' needs and reduce risks to their health at this critical juncture in families' lives.
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Affiliation(s)
- Karen Wynter
- Department of Psychiatry, School of Clinical Sciences, Monash University, Level 3, P Block, 246 Clayton Road, Clatyon, Victoria, 3168, Australia
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Vanessa Watkins
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Shane Kavanagh
- School of Health and Social Development, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Sarah Hosking
- The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, 199 Ryrie Street Geelong, Victoria, 3220, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation (IHT) – Western Health Partnership, Deakin University, Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Campusvej 55, Odense, 5230, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Bartholins Alle 2, 2. sal, Aarhus, 8000, Denmark
| | - Jacqui Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia
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Midwifery continuity of care for women with complex pregnancies in Australia: An integrative review. Women Birth 2023; 36:e187-e194. [PMID: 35869009 DOI: 10.1016/j.wombi.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND All women require access to quality maternity care. Continuity of midwifery care can enhance women's experiences of childbearing and is associated with positive outcomes for women and infants. Much research on these models has been conducted with women with uncomplicated pregnancies; less is known about outcomes for women with complexities. AIM To explore the outcomes and experiences for women with complex pregnancies receiving midwifery continuity of care in Australia. METHODS This integrative review used Whittemore and Knafl's approach. Authors searched five electronic databases (PubMed/MEDLINE, EMBASE, CINAHL, Scopus, and MAG Online) and assessed the quality of relevant studies using the Critical Appraisal Skills Programme (CASP) appraisal tools. FINDINGS Fourteen studies including women with different levels of obstetric risk were identified. However, only three reported outcomes separately for women categorised as either moderate or high risk. Perinatal outcomes reported included mode of birth, intervention rates, blood loss, perineal trauma, preterm birth, admission to special care and breastfeeding rates. Findings were synthesised into three themes: 'Contributing to safe processes and outcomes', 'Building relational trust', and 'Collaborating and communicating'. This review demonstrated that women with complexities in midwifery continuity of care models had positive experiences and outcomes, consistent with findings about low risk women. DISCUSSION The nascency of the research on midwifery continuity of care for women with complex pregnancies in Australia is limited, reflecting the relative dearth of these models in practice. CONCLUSION Despite favourable findings, further research on outcomes for women of all risk is needed to support the expansion of midwifery continuity of care.
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Labouring Together: Women's Experiences of “Getting the Care that I Want and Need” in Maternity Care. Midwifery 2022; 113:103420. [DOI: 10.1016/j.midw.2022.103420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/24/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
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Bradford BF, Wilson AN, Portela A, McConville F, Fernandez Turienzo C, Homer CSE. Midwifery continuity of care: A scoping review of where, how, by whom and for whom? PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000935. [PMID: 36962588 PMCID: PMC10021789 DOI: 10.1371/journal.pgph.0000935] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022]
Abstract
Systems of care that provide midwifery care and services through a continuity of care model have positive health outcomes for women and newborns. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? Using a scoping review framework, we searched electronic and grey literature databases for reports in any language between January 2012 and January 2022, which described current and recent trials, implementation or scaling-up of midwifery continuity of care studies or initiatives in high-, middle- and low-income countries. After screening, 175 reports were included, the majority (157, 90%) from high-income countries (HICs) and fewer (18, 10%) from low- to middle-income countries (LMICs). There were 163 unique studies including eight (4.9%) randomised or quasi-randomised trials, 58 (38.5%) qualitative, 53 (32.7%) quantitative (cohort, cross sectional, descriptive, observational), 31 (19.0%) survey studies, and three (1.9%) health economics analyses. There were 10 practice-based accounts that did not include research. Midwives led almost all continuity of care models. In HICs, the most dominant model was where small groups of midwives provided care for designated women, across the antenatal, childbirth and postnatal care continuum. This was mostly known as caseload midwifery or midwifery group practice. There was more diversity of models in low- to middle-income countries. Of the 175 initiatives described, 31 (18%) were implemented for women, newborns and families from priority or vulnerable communities. With the exception of New Zealand, no countries have managed to scale-up continuity of midwifery care at a national level. Further implementation studies are needed to support countries planning to transition to midwifery continuity of care models in all countries to determine optimal model types and strategies to achieve sustainable scale-up at a national level.
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Affiliation(s)
- Billie F Bradford
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Alyce N Wilson
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Anayda Portela
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Fran McConville
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | | | - Caroline S E Homer
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
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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.
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Hastings-Tolsma M, Temane A, Tagutanazvo OB, Lukhele S, Nolte AG. Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study. Health SA 2021; 26:1524. [PMID: 34192066 PMCID: PMC8182560 DOI: 10.4102/hsag.v26i0.1524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Midwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care. AIM This research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings. SETTING Midwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital. METHODS A convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: 'How is it for you to be a midwife in South Africa?' Transcribed interviews were analysed using thematic coding. RESULTS Five themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife. CONCLUSION Midwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services. CONTRIBUTION This research provides evidence of the midwifery experience with implications for needed health policy change.
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Affiliation(s)
- Marie Hastings-Tolsma
- Louise Herrington School of Nursing, Faculty of Nursing/Midwifery, Baylor University, Dallas, Texas, United States of America
| | - Annie Temane
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Oslinah B. Tagutanazvo
- Department of Midwifery Science, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | - Sanele Lukhele
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Anna G. Nolte
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
- Netcare Education, Netcare, Johannesburg, South Africa
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Heinonen K. Strengthening Antenatal Care towards a Salutogenic Approach: A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105168. [PMID: 34068114 PMCID: PMC8152723 DOI: 10.3390/ijerph18105168] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
The aim was to explore how midwives, public health nurses and nurses view caring in antenatal care (ANC) as provided for mothers and fathers/partners. Based on Noblit and Hare (1988), meta-ethnography was used to address meaning by synthesizing knowledge and understanding inductively through selected qualitative studies (n = 16). Four core themes were identified: (1) supporting the parents to awaken to parenthood and creating a firm foundation for early parenting and their new life situation; (2) guiding parents on the path to parenthood and new responsibility; (3) ensuring normality and the bond between baby and parents while protecting life; and (4) promoting the health and wellbeing of the family today and in the future. The overarching theme can be expressed as "helping the woman and her partner prepare for their new life with the child by providing individualized, shared care, firmly grounded and with a view of the future". Caring in antenatal care (ANC) is being totally present, listening and using multidimensional professional competence but also being open-minded to new aspects and knowledge. The health promotion and positive health aspects should be considered an important part of supporting parents and the whole family now and in the future. A more conscious salutogenic approach to ANC would lead to more favorable results and could be a fruitful research topic in the future. There is a need to provide midwives/nurses with enough time to allow them to concentrate on specific needs and support for different kind of families in ANC but also training for midwives to make them more familiar with online and other options.
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Affiliation(s)
- Kristiina Heinonen
- Health Care and Health Promotion, Metropolia University of Applied Sciences, P.O. Box 4000, FI-00079 Helsinki, Finland;
- Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1, FI-70210 Kuopio, Finland
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Dahl B, Heinonen K, Bondas TE. From Midwife-Dominated to Midwifery-Led Antenatal Care: A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8946. [PMID: 33271896 PMCID: PMC7730105 DOI: 10.3390/ijerph17238946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 11/16/2022]
Abstract
Provision of antenatal care includes risk identification, prevention and management of pregnancy-related diseases, but also health education, health promotion, support and guidance to smooth the transition to parenthood. To ensure good perinatal health, high-quality, free and easily accessed antenatal care is essential. The aim of this study was to identify, integrate and synthesize knowledge of midwives' experiences of providing antenatal care, attending to clients' individual needs whilst facing multiple challenges. We conducted a meta-ethnography, which is a seven-step grounded, comparative and interpretative methodology for qualitative evidence synthesis. A lines-of-argument synthesis based on two metaphors was developed, based on refutational themes emerging from an analogous translation of findings in the included 14 papers. The model reflects midwives' wished-for transition from a midwife-dominated caring model toward a midwifery-led model of antenatal care. Structural, societal and personal challenges seemingly influenced midwives' provision of antenatal care. However, it emerged that midwives had the willingness to change rigid systems that maintain routine care. The midwifery-led model of care should be firmly based in midwifery science and evidence-based antenatal care that emphasize reflective practices and listening to each woman and her family. The change from traditional models of antenatal care towards increased use of digitalization no longer seems to be a choice, but a necessity given the ongoing 2020 pandemic.
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Affiliation(s)
- Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South Eastern Norway, P.O. Box 235, N-3603 Kongsberg, Norway
| | - Kristiina Heinonen
- Metropolia University of Applied Sciences, Health Promotion, P.O. Box 4000, FI-00079 Metropolia, Helsinki, Finland;
- Department of Nursing Science, University of Eastern Finland, Finland, Yliopistonranta 1, 70210 Kuopio, Finland
| | - Terese Elisabet Bondas
- Faculty of Health Sciences, University of Stavanger, P.O. Box 8600, N-4036 Stavanger, Norway;
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Alexander C, Bogossian F, New K. Australian midwives and clinical investigation: Exploration of the personal and professional impact. Women Birth 2020; 34:38-47. [PMID: 32948468 DOI: 10.1016/j.wombi.2020.09.002] [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: 08/25/2019] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of regulation of health professionals is public protection. Concerns regarding professional conduct or midwifery care can lead to clinical investigation. Midwifery literature reveals midwives feel ill-equipped and unprepared for clinical investigation and experience stress and abreaction. AIM To explore the lived experience of clinical investigation and identify the personal and professional impact on Australian midwives. METHOD Semi-structured interviews of a purposive sample of Australian midwives. Data analysis was informed by a phenomenological conceptual framework derived from Husserl, Heidegger and Merleau-Ponty. FINDINGS Twelve midwives were interviewed, with seven under current investigation. Discussion involved personal and professional experiences of three or more investigations each, over a period of three to five years. Most investigations were instigated by hospitals with two complaints from women. Seven participants were alleged negligent following adverse neonatal outcomes and five had misconduct allegations. Midwives were employed or in private practice and half provided homebirth services. Themes included being safe, being connected, time and being, perception and well-being. DISCUSSION The investigative process involves different health services, state and national bodies using varying powers and processes over protracted time periods. Participants discussed aspects such as disrespect, inequity, powerlessness, silence and ostracization. Midwives who successfully navigated clinical investigation developed resilience through reflection on clinical practice in a culture of safety. CONCLUSION The process of regulating midwives, designed to protect the Australian public, may be harming investigated midwives. Understanding the personal and professional impact of clinical investigation needs to underpin midwifery education, clinical practice, inform policy and regulatory reform.
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Affiliation(s)
- Catherine Alexander
- The University of Queensland, School of Nursing, Midwifery and Social Work Level 3, Chamberlain Building (35), St Lucia, Qld 4072, Australia.
| | - Fiona Bogossian
- The University of Queensland, School of Nursing, Midwifery and Social Work Level 3, Chamberlain Building (35), St Lucia, Qld 4072, Australia; University of the Sunshine Coast, Sippy Downs, Qld 4558, Australia
| | - Karen New
- The University of Queensland, School of Nursing, Midwifery and Social Work Level 3, Chamberlain Building (35), St Lucia, Qld 4072, Australia
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Keedle H, Peters L, Schmied V, Burns E, Keedle W, Dahlen HG. Women's experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia. BMC Pregnancy Childbirth 2020; 20:381. [PMID: 32605586 PMCID: PMC7325036 DOI: 10.1186/s12884-020-03075-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women but internationally VBAC rates remain low. In Australia women planning a VBAC may experience different models of care including continuity of care (CoC). There are a limited number of studies exploring the impact and influence of CoC on women's experiences of planning a VBAC. Continuity of care (CoC) with a midwife has been found to increase spontaneous vaginal birth and decrease some interventions. Women planning a VBAC prefer and benefit from CoC with a known care provider. This study aimed to explore the influence, and impact, of continuity of care on women's experiences when planning a VBAC in Australia. METHODS The Australian VBAC survey was designed and distributed via social media. Outcomes and experiences of women who had planned a VBAC in the past 5 years were compared by model of care. Standard fragmented maternity care was compared to continuity of care with a midwife or doctor. RESULTS In total, 490 women completed the survey and respondents came from every State and Territory in Australia. Women who had CoC with a midwife were more likely to feel in control of their decision making and feel their health care provider positively supported their decision to have a VBAC. Women who had CoC with a midwife were more likely to have been active in labour, experience water immersion and have an upright birthing position. Women who received fragmented care experienced lower autonomy and lower respect compared to CoC. CONCLUSION This study recruited a non-probability based, self-selected, sample of women using social media. Women found having a VBAC less traumatic than their previous caesarean and women planning a VBAC benefited from CoC models, particularly midwifery continuity of care. Women seeking VBAC are often excluded from these models as they are considered to have risk factors. There needs to be a focus on increasing shared belief and confidence in VBAC across professions and an expansion of midwifery led continuity of care models for women seeking a VBAC.
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Affiliation(s)
- Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Lilian Peters
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Amsterdam University Medical Centers, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Elaine Burns
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Warren Keedle
- School of Environmental Sciences, Charles Sturt University, Bathurst, Australia
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework. Women Birth 2020; 33:125-134. [DOI: 10.1016/j.wombi.2019.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 11/23/2022]
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14
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Cooper M, McCutcheon H, Warland J. Water immersion policies and guidelines: How are they informed? Women Birth 2019; 32:246-254. [DOI: 10.1016/j.wombi.2018.08.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
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15
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Transitioning across professional boundaries in midwifery models of care: A literature review. Women Birth 2019; 32:195-203. [DOI: 10.1016/j.wombi.2018.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/24/2022]
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16
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Tunçer Ünver G, Harmanci Seren AK. Defining the patient safety attitudes and influencing factors of health professionals working at maternity hospitals. J Nurs Manag 2018; 26:579-586. [PMID: 29484755 DOI: 10.1111/jonm.12585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
AIM To determine patient safety attitudes of midwives, nurses and physicians and to examine the difference or correlation in patient safety attitudes of midwives, nurses and physicians working in maternity hospitals. BACKGROUND It has been suggested that it is necessary to define the factors affecting patient safety attitudes of health professionals working in maternity hospitals. METHODS A descriptive and correlational design was employed.The sample comprised 58 midwives, 134 nurses and 63 physicians (255) in two maternity hospitals in Istanbul, Turkey. The data were collected using an 'information form' and a 'Patient Safety Attitude Questionnaire'. RESULTS The safety attitudes of participants were generally found to be negative. However, midwives had more positive patient safety attitudes and the age, unit, adequacy of patient safety training and the importance of patient safety were the most effective variables. CONCLUSIONS As health professionals working in maternity hospitals generally have negative patient safety attitudes and because patient safety training provided better attitudes among the participants, these training programmes should be developed and implemented considering the differences among age groups and units. IMPLICATIONS FOR PRACTICE Health professionals have different views on the patient safety culture; therefore, training needs to involve everyone to create a shared vision for patient safety.
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Affiliation(s)
- Gamze Tunçer Ünver
- Florence Nightingale Faculty of Nursing, Department of Nursing Management, Istanbul University, Istanbul, Turkey
| | - Arzu Kader Harmanci Seren
- Florence Nightingale Faculty of Nursing, Department of Nursing Management, Istanbul University, Istanbul, Turkey
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17
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Midwives experiences of participating in a midwifery research project: A qualitative study. Women Birth 2018; 31:e115-e121. [DOI: 10.1016/j.wombi.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/26/2017] [Accepted: 07/10/2017] [Indexed: 11/18/2022]
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18
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The journey from pain to power: A meta-ethnography on women's experiences of vaginal birth after caesarean. Women Birth 2017; 31:69-79. [PMID: 28655602 DOI: 10.1016/j.wombi.2017.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/01/2017] [Accepted: 06/06/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vaginal birth after caesarean can be a safe and satisfying option for many women who have had a previous caesarean, yet rates of vaginal birth after caesarean remain low in the majority of countries. Exploring women's experiences of vaginal birth after caesarean can improve health practitioners' understanding of the factors that facilitate or hinder women in the journey to have a vaginal birth after caesarean. METHODS This paper reports on a meta-ethnographic review of 20 research papers exploring women's experience of vaginal birth after caesarean in a variety of birth locations. Meta-ethnography utilises a seven-stage process to synthesise qualitative research. RESULTS The overarching theme was 'the journey from pain to power'. The theme 'the hurt me' describes the previous caesarean experience and resulting feelings. Women experience a journey of 'peaks and troughs' moving from their previous caesarean to their vaginal birth after caesarean. Achieving a vaginal birth after caesarean was seen in the theme 'the powerful me,' and the resultant benefits are described in the theme 'the ongoing journey'. CONCLUSION Women undergo a journey from their previous caesarean with different positive and negative experiences as they move towards their goal of achieving a vaginal birth after caesarean. This 'journey from pain to power' is strongly influenced by both negative and positive support provided by health care practitioners. Positive support from a health care professional is more common in confident practitioners and continuity of care with a midwife.
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Fenwick J, Brittain H, Gamble J. Australian private midwives with hospital visiting rights in Queensland: Structures and processes impacting clinical outcomes. Women Birth 2017; 30:497-505. [PMID: 28522387 DOI: 10.1016/j.wombi.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Reporting the outcomes for women and newborns accessing private midwives with visiting rights in Australia is important, especially since this data cannot currently be disaggregated from routinely collected perinatal data. AIM 1) Evaluate the outcomes of women and newborns cared for by midwives with visiting access at one Queensland facility and 2) explore private midwives views about the structures and processes contributing to clinical outcomes. METHODS Mixed methods. An audit of the 'all risk' 529 women receiving private midwifery care. Data were compared with national core maternity variables using Chi square statistics. Telephone interviews were conducted with six private midwives and data analysed using thematic analysis. FINDINGS Compared to national data, women with a private midwife were significantly more likely to be having a first baby (49.5% vs 43.6% p=0.007), to commence labour spontaneously (84.7% vs 52.7%, p<0.001), experience a spontaneous vaginal birth (79% vs 54%, p<0.001) and not require pharmacological pain relief (52.9% vs 23.1%, p<0.001). The caesarean section rate was significantly lower than the national rate (13% vs 32.8%, p<0.001). In addition fewer babies required admission to the Newborn Care Unit (5.1% vs 16%, p<0.001). Midwives were proud of their achievements. Continuity of care was considered fundamental to achieving quality outcomes. Midwives valued the governance processes embedded around the model. CONCLUSIONS Private midwives with access to the public system is safe. Ensuring national data collection accurately captures outcomes relative to model of care in both the public and private sector should be prioritised.
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Affiliation(s)
- J Fenwick
- Menzies Health Institute Queensland: Maternal, Newborn and Families Research Group, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Australia; Women-Newborn-Children Services Gold Coast University Hospital, Maternal, Newborn and Families Research Group, Australia.
| | - H Brittain
- Women-Newborn-Children Services Gold Coast University Hospital, Maternal, Newborn and Families Research Group, Australia.
| | - J Gamble
- Menzies Health Institute Queensland: Maternal, Newborn and Families Research Group, School of Nursing & Midwifery, Griffith University, Australia.
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20
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Jepsen I, Juul S, Foureur M, Sørensen EE, Nøhr EA. Is caseload midwifery a healthy work-form? – A survey of burnout among midwives in Denmark. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 11:102-106. [DOI: 10.1016/j.srhc.2016.12.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/16/2016] [Indexed: 11/26/2022]
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21
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Jepsen I, Mark E, Foureur M, Nøhr EA, Sørensen EE. A qualitative study of how caseload midwifery is experienced by couples in Denmark. Women Birth 2017; 30:e61-e69. [DOI: 10.1016/j.wombi.2016.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/16/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022]
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22
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Lewis L, Hauck YL, Crichton C, Pemberton A, Spence M, Kelly G. An overview of the first ‘no exit’ midwifery group practice in a tertiary maternity hospital in Western Australia: Outcomes, satisfaction and perceptions of care. Women Birth 2016; 29:494-502. [DOI: 10.1016/j.wombi.2016.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
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23
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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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24
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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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25
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A qualitative study of how caseload midwifery is constituted and experienced by Danish midwives. Midwifery 2016; 36:61-9. [DOI: 10.1016/j.midw.2016.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 11/22/2022]
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26
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Healy S, Humphreys E, Kennedy C. Midwives’ and obstetricians’ perceptions of risk and its impact on clinical practice and decision-making in labour: An integrative review. Women Birth 2016; 29:107-16. [DOI: 10.1016/j.wombi.2015.08.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/25/2015] [Accepted: 08/21/2015] [Indexed: 10/23/2022]
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Holten L, de Miranda E. Women׳s motivations for having unassisted childbirth or high-risk homebirth: An exploration of the literature on 'birthing outside the system'. Midwifery 2016; 38:55-62. [PMID: 27055760 DOI: 10.1016/j.midw.2016.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 02/26/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE to identify and analyze literature exploring women׳s motivations to 'birth outside the system'. DESIGN scoping review and thematic analysis of (mostly) qualitative studies. FINDINGS fifteen studies of women choosing an unassisted birth, homebirth in countries where homebirth was not integrated into the maternity care system, or a midwife-attended high-risk homebirth were identified from Sweden, USA, Australia, Canada and Finland. Five main themes emerged as the most important factors: (1) resisting the biomedical model of birth by trusting intuition, (2) challenging the dominant discourse on risk by considering the hospital as a dangerous place, (3) feeling that true autonomous choice is only possible at home, (4) perceiving birth as an intimate or religious experience, and (5) taking responsibility as a reflection of true control over decision-making. KEY CONCLUSIONS concerns over consent, intervention and loss of the birthing experience may be driving women away from formal healthcare. There is a lack of fit between the health needs of pregnant women and the current system of maternity care. Biomedical and alternative ׳outside the system׳ discourses on authoritative knowledge, risk, autonomy and responsibility must be negotiated to find a common ground wherein a dialogue can take place between client and health professional. IMPLICATIONS FOR PRACTICE more research is needed to explore the scope of the phenomenon of women birthing outside the system and the experiences of midwives and obstetricians in the care of such women. This knowledge can be used to improve the maternity care system, so that fewer women will choose to withdraw from it.
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Affiliation(s)
- Lianne Holten
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Vlaardingenlaan 1, 1059 GL Amsterdam, The Netherlands.
| | - Esteriek de Miranda
- Department of Obstetrics & Gynaecology, Academic Medical Center, P.O.B. 22660, 1100 DD Amsterdam, The Netherlands.
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28
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Plint E, Davis D. Sink or Swim: Water Immersion for Labor and Birth in a Tertiary Maternity Unit in Australia. INTERNATIONAL JOURNAL OF CHILDBIRTH 2016. [DOI: 10.1891/2156-5287.6.4.206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE: This study aimed to describe and compare the attitudes and practices of midwives and obstetric doctors in a tertiary setting regarding water immersion for labor and birth and to identify strategies for improving bath usage in the facility.DESIGN: A questionnaire consisting of 47 multiple choice and 2 open-ended questions was distributed to midwives and obstetric doctors providing labor care in the facility.FINDINGS: Obstetric doctors were unsupportive. Birth suite midwives, despite assigning value to it, rarely facilitated water immersion. Only continuity midwives routinely facilitated water immersion. The main identified strategies for increasing bath usage in labor were staff training and support, antenatal education, and increased access to continuity of care.CONCLUSION: Providing bath access and supporting guidelines is not sufficient to increase water immersion for labor and birth in a tertiary setting. Additional strategies are needed to incorporate this practice into standard care in the birth suite.
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29
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Barnett L, Hauck YL, Lewis L. Midwives’ Journey Through the First Year of a Hospital-Based Midwifery Group Practice. INTERNATIONAL JOURNAL OF CHILDBIRTH 2016. [DOI: 10.1891/2156-5287.6.4.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM:To explore the experiences of midwives involved in the first midwifery group practice situated at a Western Australian tertiary maternity hospital.METHODS:A descriptive phenomenology study was undertaken to extract common themes from interview transcripts using the 6-step process by Braun and Clarke. Seven midwives participated in 2 interviews over 12 months.FINDINGS:Six months into the midwifery group practice (MGP) journey, 5 themes were captured: “adapting to a new way of working,” “working out the glitches,” “work–life balance,” “opportunity to grow,” and “perceived benefits for women.” After 12 months, 2 themes emerged: “making progress into new ways of working” and “future sustainability.”CONCLUSIONS:Midwives felt women must be realistically informed of what an MGP offers. Priorities were regular meetings for open communication, taking scheduled days off and leave, and providing mentoring. Insight around benefits and challenges encountered by MGP midwives can inform health services, considering offering a similar service and ensure its sustainability.
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Grigg CP, Tracy SK, Schmied V, Monk A, Tracy MB. Women's experiences of transfer from primary maternity unit to tertiary hospital in New Zealand: part of the prospective cohort Evaluating Maternity Units study. BMC Pregnancy Childbirth 2015; 15:339. [PMID: 26679339 PMCID: PMC4683773 DOI: 10.1186/s12884-015-0770-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 12/02/2015] [Indexed: 12/04/2022] Open
Abstract
Background There is worldwide debate regarding the appropriateness and safety of different birthplaces for well women. The Evaluating Maternity Units (EMU) study’s primary objective was to compare clinical outcomes for well women intending to give birth in either a tertiary level maternity hospital or a freestanding primary level maternity unit. Little is known about how women experience having to change their birthplace plans during the antenatal period or before admission to a primary unit, or transfer following admission. This paper describes and explores women’s experience of these changes-a secondary aim of the EMU study. Methods This paper utilised the six week postpartum survey data, from the 174 women from the primary unit cohort affected by birthplace plan change or transfer (response rate 73 %). Data were analysed using descriptive statistics and thematic analysis. The study was undertaken in Christchurch, New Zealand, which has an obstetric-led tertiary maternity hospital and four freestanding midwife-led primary maternity units (2010–2012). The 702 study participants were well, pregnant women booked to give birth in one of these facilities, all of whom received continuity of midwifery care, regardless of their intended or actual birthplace. Results Of the women who had to change their planned place of birth or transfer the greatest proportion of women rated themselves on a Likert scale as unbothered by the move (38.6 %); 8.8 % were ‘very unhappy’ and 7.6 % ‘very happy’ (quantitative analysis). Four themes were identified, using thematic analysis, from the open ended survey responses of those who experienced transfer: ‘not to plan’, control, communication and ‘my midwife’. An interplay between the themes created a cumulatively positive or negative effect on their experience. Women’s experience of transfer in labour was generally positive, and none expressed stress or trauma with transfer. Conclusions The women knew of the potential for change or transfer, although it was not wanted or planned. When they maintained a sense control, experienced effective communication with caregivers, and support and information from their midwife, the transfer did not appear to be experienced negatively. The model of continuity of midwifery care in New Zealand appeared to mitigate the negative aspects of women’s experience of transfer and facilitate positive birth experiences.
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Affiliation(s)
| | | | | | - Amy Monk
- University of Sydney, Sydney, NSW, Australia
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31
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Newnham EC, McKellar LV, Pincombe JI. Documenting risk: A comparison of policy and information pamphlets for using epidural or water in labour. Women Birth 2015; 28:221-7. [PMID: 25704865 DOI: 10.1016/j.wombi.2015.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/29/2015] [Accepted: 01/31/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Approximately 30% of Australian women use epidural analgesia for pain relief in labour, and its use is increasing. While epidural analgesia is considered a safe option from an anaesthetic point of view, its use transfers a labouring woman out of the category of 'normal' labour and increases her risk of intervention. Judicious use of epidural may be beneficial in particular situations, but its current common use needs to be assessed more closely. This has not yet been explored in the Australian context. AIM To examine personal, social, institutional and cultural influences on women in their decision to use epidural analgesia in labour. Examining this one event in depth illuminates other birth practices, which can also be analysed according to how they fit within prevailing cultural beliefs about birth. METHODS Ethnography, underpinned by a critical medical anthropology methodology. RESULTS These findings describe the influence of risk culture on labour ward practice; specifically, the policies and practices surrounding the use of epidural analgesia are contrasted with those on the use of water. Engaging with current risk theory, we identify the role of power in conceptualisations of risk, which are commonly perpetuated by authority rather than evidence. CONCLUSIONS As we move towards a risk-driven society, it is vital to identify both the conception and the consequences of promulgations of risk. The construction of waterbirth as a 'risky' practice had the effect of limiting midwifery practice and women's choices, despite evidence that points to the epidural as the more 'dangerous' option.
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Affiliation(s)
- Elizabeth C Newnham
- University of South Australia, School of Nursing and Midwifery, GPO Box 2471, Adelaide, South Australia 5001, Australia.
| | - Lois V McKellar
- University of South Australia, School of Nursing and Midwifery, GPO Box 2471, Adelaide, South Australia 5001, Australia
| | - Jan I Pincombe
- University of South Australia, School of Nursing and Midwifery, GPO Box 2471, Adelaide, South Australia 5001, Australia
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