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Peterwerth NH, Halek M, Schäfers R. Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:155. [PMID: 38389073 PMCID: PMC10882933 DOI: 10.1186/s12884-024-06338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Risk perception is fundamental to decision-making; therefore its exploration is essential to gaining a comprehensive understanding of the decision-making process for peripartum interventions. The aim of this study was to investigate associations between personal and systemic factors of the work setting and the risk perception of obstetric healthcare professionals, and in turn how this might influence decisions regarding obstetric interventions. METHODS Case vignettes were used to measure risk perception. A quantitative cross-sectional online survey was performed within an exploratory sequential mixed-methods design, and an intervention readiness score created. Associations were calculated using location and dispersion measures, t-tests and correlations in addition to multiple linear regression. RESULTS Risk perception, as measured by the risk assessment score, was significantly lower (average 0.8 points) for midwives than for obstetricians (95%-CI [-0.673; -0.317], p < .001). Statistically significant correlations were found for: years of experience and annual number of births in the current workplace, but this was not clinically relevant; hours worked, with the groups of participants working ≥ 30,5 h showing a statistically significant higher risk perception than participants working 20,5-30 h (p = .005); and level of care of the current workplace, with the groups of participants working in a birth clinic (Level IV) showing a statistically significant lower risk perception than participants working in Level I hospital (highly specialised obstetric and neonatal care; p = .016). The option of midwife-led birthing care showed no correlation with risk perception. The survey identified that risk perception, occupation, years in the profession and number of hours worked (i.e. full or part time) represent significant influences on obstetric healthcare professionals' willingness to intervene. CONCLUSIONS The results of the survey give rise to the hypothesis that the personal and systemic factors of professional qualification, occupation, number of hours worked and level of acuity of the workplace are related to the risk perception of obstetric healthcare professionals. In turn, risk perception itself made a significant contribution to explaining differences in willingness to intervene, suggesting that it influences obstetricians' and midwives' decision-making. Overall, however, the correlations were weak and should be interpreted cautiously. The significant variations in the use of interventions must be addressed in order to provide the highest quality and best possible care for childbearing women and their families. To this end, developing strategies to improve interdisciplinary relationships and collaboration is of great importance. TRIAL REGISTRATION German Clinical Trials Register DRKS00017172 (18.06.2019).
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Affiliation(s)
- Nina H Peterwerth
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Germany.
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Rainhild Schäfers
- Institute of Midwifery Science, Faculty of Medicine, University of Münster, Malmedyweg 17-19, 48149, Münster, Germany
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Curtin M, Murphy M, Savage E, O’Driscoll M, Leahy-Warren P. Midwives', obstetricians', and nurses' perspectives of humanised care during pregnancy and childbirth for women classified as high risk in high income countries: A mixed methods systematic review. PLoS One 2023; 18:e0293007. [PMID: 37878625 PMCID: PMC10599554 DOI: 10.1371/journal.pone.0293007] [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: 12/23/2022] [Accepted: 10/04/2023] [Indexed: 10/27/2023] Open
Abstract
Women classified as 'high risk' or 'complicated' in pregnancy and childbirth have increased difficulty in accessing humanised care/humanisation in childbirth due to perceptions that this approach rejects the use of intervention and/or technology. Humanised care recognises the psychological and physical needs of women in pregnancy and birth. A mixed methods systematic review using a convergent segregated approach was undertaken using the Joanne Briggs Institute (JBI) methodology. The objective of the review was to identify the presence of humanisation for women with high risk pregnancy and/or childbirth in high income countries. Studies were included if they measured humanisation and/or explored the perspectives of midwives, obstetricians, or nurses on humanisation for women classified as having a high-risk or complicated pregnancy or childbirth in a high income country. Qualitative data were analysed using a meta-aggregative approach and a narrative synthesis was completed for the quantitative data. All studies were assessed for their methodological quality using the MMAT tool. Four databases were searched, and nineteen studies met the inclusion criteria. A total of 1617 participants from nine countries were included. Three qualitative findings were synthesised, and a narrative synthesis of quantitative data was completed. The integration of qualitative and quantitative data identified complimentary findings on: (i) the importance of developing a harmonised relationship with women; (ii) increased time counselling women on their choices; and (iii) fear of professional reputational damage if caring outside of protocols. Negotiating with women outside of protocols may have a wider impact on the professional than first thought. Understanding how healthcare professionals individualise care for women at risk in labour requires further investigation.
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Affiliation(s)
- Mary Curtin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Margaret Murphy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Watson V, Bryers H, Krucien N, Erdem S, Burnside M, van Woerden HC. The Perception of Women in Rural and Remote Scotland About Intrapartum Care: A Qualitative Study. THE PATIENT 2023; 16:117-125. [PMID: 36348151 DOI: 10.1007/s40271-022-00608-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The views of mothers are important in shaping policy and practice regarding options for intrapartum care. Mothers in rural and remote areas face unique challenges accessing services, and these need to be well understood. Therefore, our aim was to understand the compromises that women who live in remote and rural settings, more than 1 h from a maternity unit, face regarding intrapartum care. METHODS Qualitative semi-structured telephone interviews (n = 14) were undertaken in rural Scotland with 13 women who had young children and one who was pregnant. Interviews were transcribed and thematically analysed by two researchers. RESULTS Key themes identified were women's perceptions about risk and the safety of different pathways of maternity care and birth locations; the actual and perceived distance between home and the place of birth, and the type of maternity care available at a place of birth. Mothers in rural and remote areas face particular challenges in choosing where to have their babies. In addition to clinical decisions about 'place of birth' agreed with healthcare professionals, they have to mentally juggle the implications of giving birth when at a distance from family support and away from familiar surroundings. It was clear that many women from rural communities have a strong sense of 'place' and that giving birth in a geographical location, community and culture that feels familiar is important to many of them. CONCLUSIONS Health care staff need to appreciate the impact of non-clinical factors that are important to mothers in remote and rural areas and acknowledge these, even when they cannot be accommodated. Local and national policy also needs to reflect and respond to the practical challenges faced by rurality.
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Affiliation(s)
- Verity Watson
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Helen Bryers
- NHS Highland, Assynt House, Beechwood Park, Inverness, IV2 3BW, UK
- Centre for Rural Health, Institute of Applied Health Science, Centre for Health Science, University of Aberdeen, Old Perth Road, Inverness, IV2 3JH, UK
| | - Nicolas Krucien
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Seda Erdem
- Economics Division, Stirling Management School, University of Stirling, Stirling, FK9 4LA, UK
| | - Mary Burnside
- NHS Highland, Assynt House, Beechwood Park, Inverness, IV2 3BW, UK
| | - Hugo C van Woerden
- Division of Rural Health and Wellbeing, Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH, UK.
- Institute of Nursing and Health Research, Ulster University, Belfast, UK.
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Zondag DC, van Haaren-Ten Haken TM, Offerhaus PM, Maas VYF, Nieuwenhuijze MJ. Knowledge and skills used for clinical decision-making on childbirth interventions: A qualitative study among midwives in the Netherlands. Eur J Midwifery 2022; 6:56. [PMID: 36119405 PMCID: PMC9434498 DOI: 10.18332/ejm/151653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Appropriate use of interventions in maternity care is a worldwide issue. Midwifery-led models of care are associated with more efficient use of resources, fewer medical interventions, and improved outcomes. However, the use of interventions varies considerably between midwives. The aim of this study was to explore how knowledge and skills influence clinical decision-making of midwives on the appropriate use of childbirth interventions. METHODS A qualitative study using in-depth interviews with 20 primary care midwives was performed in June 2019. Participants’ clinical experience varied in the use of interventions. The interviews combined a narrative approach with a semi-structured question route. Data were analyzed using deductive content analysis. RESULTS ‘Knowledge’, ‘Critical thinking skills’, and ‘Communication skills’ influenced midwives’ clinical decision-making towards childbirth interventions. Midwives obtained their knowledge through the formal education program and extended their knowledge by reflecting on experiences and evidence. Midwives with a low use of interventions seem to have a higher level of reflective skills, including reflection-in-action. These midwives used a more balanced communication style with instrumental and affective communication skills in interaction with women, and have more skills to engage in discussions during collaboration with other professionals, and thus personalizing their care. CONCLUSIONS Midwives with a low use of interventions seemed to have the knowledge and skills of a reflective practitioner, leading to more personalized care compared to standardized care as defined in protocols. Learning through reflectivity, critical thinking skills, and instrumental and affective communication skills, need to be stimulated and trained to pursue appropriate, personalized use of interventions.
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Affiliation(s)
- Dirkje C. Zondag
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC), Maastricht University, Maastricht, Netherlands
| | | | - Pien M. Offerhaus
- Research Centre for Midwifery Science, Zuyd University, Maastricht, Netherlands
| | - Veronique Y. F. Maas
- Department of Obstetrics and Gynaecology, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Marianne J. Nieuwenhuijze
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC), Maastricht University, Maastricht, Netherlands
- Research Centre for Midwifery Science, Zuyd University, Maastricht, Netherlands
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Isacson M, Anderssonb O, Thies-Lagergrene L. Midwives’ decision-making process when a non-vigorous neonate is born – a Swedish qualitative interview study. Midwifery 2022; 114:103455. [DOI: 10.1016/j.midw.2022.103455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022]
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Prescribing antibiotics: Factors driving decision-making in general practice. A discrete choice experiment. Soc Sci Med 2022; 305:115033. [PMID: 35617765 DOI: 10.1016/j.socscimed.2022.115033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antimicrobial resistance is a threat to human health. We need to strive for a rational use of antibiotics to reduce the selection of resistant bacteria. Most antibiotics are prescribed in general practice, but little is known about factors influencing general practitioners' (GPs) decision-making when prescribing antibiotics. AIM To 1) assess the importance of factors that influence decisions by GPs to prescribe antibiotics for acute respiratory tract infections (RTIs) and 2) identify segments of GPs influenced differently when deciding to prescribe antibiotics. METHODS A questionnaire survey including a discrete choice experiment was conducted. Danish GPs were asked to indicate whether they would prescribe antibiotics in six hypothetical choice sets with six variables: whether the GP is behind schedule, patient's temperature, patient's general condition, lung auscultation findings, C-reactive protein (CRP) level, and whether the patient expects antibiotics. Error component and latent class models were estimated and the probabilities of prescribing in different scenarios were calculated. RESULTS The questionnaire was distributed to every Danish GP (n = 3,336); 1,152 (35%) responded. Results showed that GPs were influenced by (in prioritised order): CRP level (Relative importance (RI) 0.54), patient's general condition (RI 0.20), crackles at auscultation (RI 0.15), and fever (RI 0.10). Being behind schedule and patient expectations had no significant impact on antibiotic prescription at the aggregate level. The latent class analysis identified five classes of GPs: generalists, CRP-guided, general condition-guided, reluctant prescribers, and stethoscopy-guided. For all classes, CRP was the most important driver, while GPs were heterogeneously affected by other drivers. CONCLUSION The most important factor affecting Danish GPs' decision to prescribe antibiotics at the aggregate level, in subgroups of GPs, and across latent classes was the CRP value. Hence, the use of CRP testing is an important factor to consider in order to promote rational antibiotic use in the battle against antimicrobial resistance.
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Peterwerth NH, Halek M, Schäfers R. Intrapartum risk perception-A qualitative exploration of factors affecting the risk perception of midwives and obstetricians in the clinical setting. Midwifery 2021; 106:103234. [PMID: 34998073 DOI: 10.1016/j.midw.2021.103234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/01/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE to gain an in-depth view of the specific risk perception of midwives and obstetricians, in order to achieve a deeper understanding of the situations which midwives and obstetricians perceive as risky and of the factors affecting their risk perception. DESIGN a qualitative approach using focus group discussions was used as part of the first strand within a sequential explorative mixed methods project. PARTICIPANTS 24 midwives and obstetricians providing labour care in the clinical setting ANALYSIS: according to qualitative content analysis. FINDINGS both external and internal factors were identified which potentially influence the risk perception of midwives and obstetricians: (i) the individual perception of the obstetric health professional, (ii) the dyad of obstetric health professional & woman, (iii) being part of a team and (iv) being part of an institution. While risk definitions/classifications and obstetric risk factors were less common topics, structural and organisational factors, such as lack of staff and excessive workload, dominated the discussions about risky situations in the delivery room. KEY CONCLUSION Obstetric health professionals' risk perception is multifactorial and risky situations in the delivery room can be described as a complex construct of various factors. The results suggest that there are different forms of risk perception and different factors which are perceived as risky. IMPLICATIONS FOR PRACTICE Reflection on one's own role and actions should be included in the training of obstetric professionals and also be maintained in everyday professional life.
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Affiliation(s)
- Nina H Peterwerth
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801 Bochum, Germany; School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Stockumer Strasse 12, 58453 Witten, Germany.
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Stockumer Strasse 12, 58453 Witten, Germany
| | - Rainhild Schäfers
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801 Bochum, Germany
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Peterwerth NH, Halek M, Tulka S, Schäfers R. Risk Perception of Health Professionals in Intrapartum Care Decisions: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e21443. [PMID: 33226353 PMCID: PMC7721551 DOI: 10.2196/21443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background Risk perception plays an important role in decision-making processes. Differences in obstetric intervention rates suggest that, in addition to medical indications, the risk perception of obstetric health professionals might have a major influence on their decision-making process during childbirth. Although studies have investigated whether risk perception affects the role of midwifery or influences decision making during childbirth, little is known about what obstetric health professionals actually perceive as risk or risky situations and whether different risk perceptions lead to more interventions during intrapartum care. Objective The objective of this study is to understand the association of risk perception and the decision-making processes of obstetric health professionals (midwives and obstetricians) in Germany during intrapartum care. The study has 3 specific aims: (1) gain insight into what obstetric health professionals perceive as risk in the German clinical setting, (2) assess the extent to which personal and systemic factors have an impact on obstetric health professionals’ risk perception, and (3) investigate whether different perceptions of risk are associated with different decisions being made by obstetric health professionals. Methods This is an exploratory sequential mixed methods study with 2 phases, a qualitative followed by a quantitative phase. In the first phase, qualitative data are collected and analyzed by conducting focus group discussions and applying qualitative content analysis to address aim 1. In the second phase, for aims 2 and 3 and to help explain the qualitative results, quantitative data are collected and analyzed by conducting an observational study using case vignettes within a survey constructed on the basis of the qualitative results. Results Enrollment in the first (qualitative) phase began in July 2019, and data collection and analysis have been completed. The second (quantitative) phase is currently planned, and data collection is expected to start in December 2020. First results of the qualitative phase are expected to be submitted for publication in 2020, with completion of the second phase scheduled for 2021. Conclusions This mixed methods study will examine the perception of risk and its association with the decision-making processes of obstetric health professionals during their care of women in childbirth. The rationale for this approach is that the qualitative data and their analysis explore participants' views in more depth, while the quantitative data will help to provide and explore a general understanding of the research problem. The results are expected to be relevant to health care professionals, policymakers, and educational institutions in order to minimize underuse, overuse, and misuse of interventions during intrapartum care. Trial Registration German Clinical Trials Register DRKS00017172; https://tinyurl.com/y2zoowkx International Registered Report Identifier (IRRID) DERR1-10.2196/21443
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Affiliation(s)
- Nina H Peterwerth
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Bochum, Germany.,School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Sabrina Tulka
- Institute for Medical Biometry and Epidemiology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Rainhild Schäfers
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Bochum, Germany
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Goodarzi B, Walker A, Holten L, Schoonmade L, Teunissen P, Schellevis F, de Jonge A. Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review. PLoS One 2020; 15:e0234252. [PMID: 32511258 PMCID: PMC7279596 DOI: 10.1371/journal.pone.0234252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/21/2020] [Indexed: 01/21/2023] Open
Abstract
Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make cross-setting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annika Walker
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lianne Holten
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - François Schellevis
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Seijmonsbergen-Schermers AE, Zondag DC, Nieuwenhuijze M, van den Akker T, Verhoeven CJ, Geerts CC, Schellevis FG, de Jonge A. Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study. PLoS One 2020; 15:e0229488. [PMID: 32134957 PMCID: PMC7058301 DOI: 10.1371/journal.pone.0229488] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. METHODS In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks' gestation in 2010-2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman's rank correlations. FINDINGS Intrapartum referral rates varied between 55-68% (nulliparous) and 20-32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6-16% (nulliparous) and 16-31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14-42% (nulliparous) and 3-13% (multiparous) and in obstetrician-led births from 46-67% and 14-28% respectively. Rates of postpartum oxytocin varied between 59-88% (nulliparous) and 50-85% (multiparous) and artificial rupture of membranes between 43-52% and 54-61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. CONCLUSIONS Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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Affiliation(s)
- Anna E. Seijmonsbergen-Schermers
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dirkje C. Zondag
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Corine J. Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Caroline C. Geerts
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - François G. Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Thompson SM, Nieuwenhuijze MJ, Low LK, De Vries R. “A powerful midwifery vision”: Dutch student midwives’ educational needs as advocates of physiological childbirth. Women Birth 2019; 32:e576-e583. [DOI: 10.1016/j.wombi.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/28/2018] [Accepted: 12/16/2018] [Indexed: 12/01/2022]
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Kortekaas JC, Bruinsma A, Keulen JKJ, Vandenbussche FP, van Dillen J, de Miranda E. Management of late-term pregnancy in midwifery- and obstetrician-led care. BMC Pregnancy Childbirth 2019; 19:181. [PMID: 31117985 PMCID: PMC6532173 DOI: 10.1186/s12884-019-2294-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/12/2019] [Indexed: 11/24/2022] Open
Abstract
Management of late-term pregnancy in midwifery- and obstetrician-led care. BACKGROUND Since there is no consensus regarding the optimal management in late-term pregnancies (≥41.0 weeks), we explored the variety of management strategies in late-term pregnancy in the Netherlands to identify the magnitude of this variety and the attitude towards late-term pregnancy. METHODS Two nationwide surveys amongst all midwifery practices (midwifery-led care) and all hospitals with an obstetric unit (obstetrician-led care) were performed with questions on timing, frequency and content of consultations/surveillance in late-term pregnancy and on timing of induction. Propositions about late-term pregnancy were assessed using Likert scale questions. RESULTS The response rate was 40% (203/511) in midwifery-led care and 92% (80/87) in obstetrician-led care. All obstetric units made regional protocols with their collaborating midwifery practices about management in late-term pregnancy. Most midwifery-led care practices (93%) refer low-risk women at least once for consultation in obstetrician-led care in late-term pregnancy. The content of consultations varies among hospitals. Membrane sweeping is performed more in midwifery-led care compared to obstetrician-led care (90% vs 31%, p < 0.001). Consultation at 41 weeks should be standard care according to 47% of midwifery-led care practices and 83% of obstetrician-led care units (p < 0.001). Induction of labour at 41.0 weeks is offered less often to women in midwifery-led care in comparison to obstetrician-led care (3% vs 21%, p < 0.001). CONCLUSIONS Substantial practice variation exists within and between midwifery-and obstetrician-led care in the Netherlands regarding timing, frequency and content of antenatal monitoring in late-term pregnancy and timing of labour induction. An evidence based interdisciplinary guideline will contribute to a higher level of uniformity in the management in late- term pregnancies.
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Affiliation(s)
- Joep C. Kortekaas
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA Nijmegen, the Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Aafke Bruinsma
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Judit K. J. Keulen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Frank P.H.A. Vandenbussche
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA Nijmegen, the Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA Nijmegen, the Netherlands
| | - Esteriek de Miranda
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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Influencing factors in midwives’ decision-making during childbirth: A qualitative study in the Netherlands. Women Birth 2019; 32:e197-e203. [DOI: 10.1016/j.wombi.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 11/19/2022]
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14
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Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete Choice Experiments in Health Economics: Past, Present and Future. PHARMACOECONOMICS 2019; 37:201-226. [PMID: 30392040 PMCID: PMC6386055 DOI: 10.1007/s40273-018-0734-2] [Citation(s) in RCA: 407] [Impact Index Per Article: 81.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. METHODS A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. RESULTS Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. CONCLUSIONS The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
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Affiliation(s)
- Vikas Soekhai
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University, Raleigh, NC USA
| | - Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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15
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Goodarzi B, Holten L, van El C, de Vries R, Franx A, Houwaart E. Risk and the politics of boundary work: preserving autonomous midwifery in the Netherlands. HEALTH RISK & SOCIETY 2018. [DOI: 10.1080/13698575.2018.1558182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Bahareh Goodarzi
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG - Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Lianne Holten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG - Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Carla van El
- Amsterdam UMC, Vrije Universiteit Amsterdam, Community Genetics Department of Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond de Vries
- Academie Verloskunde Maastricht, Zuyd University, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Eddy Houwaart
- Department Health, Ethics and Society Faculty of Health, Medicine and Life Sciences Maastricht University, Maastricht, The Netherlands
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Thompson SM, Nieuwenhuijze MJ, Low LK, de Vries R. Exploring Dutch midwives' attitudes to promoting physiological childbirth: A qualitative study. Midwifery 2016; 42:67-73. [DOI: 10.1016/j.midw.2016.09.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 09/14/2016] [Accepted: 09/26/2016] [Indexed: 11/24/2022]
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Romijn MSc A, Muijtjens Dr Ir AMM, de Bruijne Dr MC, Donkers Dr HHLM, Wagner Prof Dr C, de Groot Prof Dr CJM, Teunissen Dr PW. What is normal progress in the first stage of labour? A vignette study of similarities and differences between midwives and obstetricians. Midwifery 2016; 41:104-109. [PMID: 27586088 DOI: 10.1016/j.midw.2016.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/22/2016] [Accepted: 08/15/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE intrapartum referrals are high-risk situations. To ensure patient safety, care professionals need to have a shared understanding of a labouring woman's situation. We aimed to gain insight into similarities and differences between midwives and obstetricians in the assessment of a prolonged first stage of labour and the decision to refer a woman to a clinical setting in the Netherlands. DESIGN factorial survey. SETTING in the Netherlands, the main caregivers for women with low risks of pathology are primary-care midwives working in the locality. Approximately half of all women start labour under supervision of primary-care midwives. Roughly 40% of these women are referred to a hospital during labour, where obstetricians take over responsibility. In 2013, the reason for referral for 5161 women (14.1% of all referrals during labour) was a prolonged first stage of labour. PARTICIPANTS respondents consisted of primary-care midwives (N=69), obstetricians (N=47) and hospital based midwives, known as clinical midwives (N=31). MEASUREMENTS each respondent assessed seven hypothetical vignettes. The assessment of a prolonged first stage of labour and the decision to refer a woman to a clinical setting based on this indication were used as outcome measures, rated on a 7-point Likert scale (1=very unlikely to 7=very likely). Data were analysed using a linear multilevel model with a two-level hierarchy. FINDINGS compared to primary-care midwives, obstetricians were more likely to define a prolonged first stage of labour when progress in cervical dilation was slow (b: 1.11; 95% CI: 0.66 - 1.57). The attributes parity, progress, intensity of uterine contractions and the woman's state of mind, were used by all three groups in the decision to refer a woman to clinical setting based on a prolonged first stage of labour. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: we found relevant interprofessional differences and similarities in the assessment of a prolonged first stage of labour and consequent referral. Further interprofessional alignment of clinical assessments, for instance through interprofessional discussions and a review of professional guidelines, might help to improve collaborative care.
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Affiliation(s)
- A Romijn MSc
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
| | - A M M Muijtjens Dr Ir
- Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands.
| | - M C de Bruijne Dr
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
| | - H H L M Donkers Dr
- Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands.
| | - C Wagner Prof Dr
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands; NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | - C J M de Groot Prof Dr
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - P W Teunissen Dr
- Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
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Offerhaus PM, Geerts C, de Jonge A, Hukkelhoven CWPM, Twisk JWR, Lagro-Janssen ALM. Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study. BMC Pregnancy Childbirth 2015; 15:42. [PMID: 25885706 PMCID: PMC4342018 DOI: 10.1186/s12884-015-0471-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The primary aim of this study was to describe the variation in intrapartum referral rates in midwifery practices in the Netherlands. Secondly, we wanted to explore the association between the practice referral rate and a woman's chance of an instrumental birth (caesarean section or vaginal instrumental birth). METHODS We performed an observational study, using the Dutch national perinatal database. Low risk births in all primary care midwifery practices over the period 2008-2010 were selected. Intrapartum referral rates were calculated. The referral rate among nulliparous women was used to divide the practices in three tertile groups. In a multilevel logistic regression analysis the association between the referral rate and the chance of an instrumental birth was examined. RESULTS The intrapartum referral rate varied from 9.7 to 63.7 percent (mean 37.8; SD 7.0), and for nulliparous women from 13.8 to 78.1 percent (mean 56.8; SD 8.4). The variation occurred predominantly in non-urgent referrals in the first stage of labour. In the practices in the lowest tertile group more nulliparous women had a spontaneous vaginal birth compared to the middle and highest tertile group (T1: 77.3%, T2:73.5%, T3: 72.0%). For multiparous women the spontaneous vaginal birth rate was 97%. Compared to the lowest tertile group the odds ratios for nulliparous women for an instrumental birth were 1.22 (CI 1.16-1.31) and 1.33 (CI 1.25-1.41) in the middle and high tertile groups. This association was no longer significant after controlling for obstetric interventions (pain relief or augmentation). CONCLUSIONS The wide variation between referral rates may not be explained by medical factors or client characteristics alone. A high intrapartum referral rate in a midwifery practice is associated with an increased chance of an instrumental birth for nulliparous women, which is mediated by the increased use of obstetric interventions. Midwives should critically evaluate their referral behaviour. A high referral rate may indicate that more interventions are applied than necessary. This may lead to a lower chance of a spontaneous vaginal birth and a higher risk on a PPH. However, a low referral rate should not be achieved at the cost of perinatal safety.
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Affiliation(s)
- Pien M Offerhaus
- KNOV (Royal Dutch Organisation for Midwives), P.O. Box 2001, 3500GA, Utrecht, the Netherlands.
| | - Caroline Geerts
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, the Netherlands.
| | - Ank de Jonge
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, the Netherlands.
| | | | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, the Netherlands.
| | - Antoine L M Lagro-Janssen
- Radboud University Nijmegen Medical Centre, Internal postal code 118, P.O. Box 9101, 6500HB, Nijmegen, the Netherlands.
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