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van Wijngaarden M, Blonk H, Simmelink R, van der Lee N, van der Vliet-Torij HH, Nieuwenhuijze M, de Jonge A, Verhoeven C. Working in smaller teams in community midwifery practices to foster continuity of carer: Midwives' experiences - A qualitative study in the Netherlands. Women Birth 2024; 37:101663. [PMID: 39154393 DOI: 10.1016/j.wombi.2024.101663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/09/2024] [Accepted: 07/31/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Midwife-led continuity of carer (MLCC) improves health outcomes and increases pregnant women's satisfaction. Working in smaller teams in community midwifery practices is one of the ways to promote continuity of carer. AIM To gain insight into the experiences of Dutch community midwives regarding working in smaller teams, by identifying motivators and barriers. METHODS A qualitative study was conducted using individual, semi-structured interviews (n=9). The sample was purposively selected. The interviews were analysed using the Abbreviated Grounded Theory. FINDINGS Four themes were identified: 1) Ideal implementation of working in smaller teams, 2) Best care for pregnant women, 3) Conflicts with the current maternity care system, 4) Personal interests of the midwife. The core concept connecting all themes was midwives' experiences of an 'inner conflict' regarding working in smaller teams. CONCLUSION A strong motivation for working in smaller teams is the wish to provide the best care for pregnant women through offering more continuity of carer. The structure of maternity care, financially and organisationally, acts as a barrier in the transition to working in smaller teams. How community midwives manage these motivators and barriers depends on their personal interests, vision, and personal life. The balance between the motivators and barriers can create an inner conflict among the midwives. This inner conflict encompasses an ethical issue: what is the best care and what is it worth? A discussion within the professional group concerning the practical and ethical aspects of working in smaller teams is needed to find ways to reduce the inner conflict of community midwives who wish to work in smaller teams, thereby promoting the implementation of MLCC.
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Affiliation(s)
| | - Hinke Blonk
- Midwifery Academy Amsterdam, the Netherlands
| | - Renate Simmelink
- Midwifery Academy Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Department of Midwifery Science, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, the Netherlands
| | | | | | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Ank de Jonge
- Midwifery Academy Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Department of Midwifery Science, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, the Netherlands
| | - Corine Verhoeven
- Midwifery Academy Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Department of Midwifery Science, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
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Middlemiss AL, Channon S, Sanders J, Kenyon S, Milton R, Prendeville T, Barry S, Strange H, Jones A. Barriers and facilitators when implementing midwifery continuity of carer: a narrative analysis of the international literature. BMC Pregnancy Childbirth 2024; 24:540. [PMID: 39143464 PMCID: PMC11325633 DOI: 10.1186/s12884-024-06649-y] [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: 01/17/2024] [Accepted: 06/18/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Midwifery continuity of carer (MCoC) is a model of care in which the same midwife or small team of midwives supports women throughout pregnancy, birth and the postnatal period. The model has been prioritised by policy makers in a number of high-income countries, but widespread implementation and sustainability has proved challenging. METHODS In this narrative review and synthesis of the global literature on the implementation and sustainability of midwifery continuity of carer, we identify barriers to, and facilitators of, this model of delivering maternity care. By mapping existing research evidence onto the Consolidated Framework for Implementation Research (CFIR), we identify factors for organisations to consider when planning and implementing midwifery continuity of carer as well as gaps in the current research evidence. RESULTS Analysing international evidence using the CFIR shows that evidence around midwifery continuity of carer implementation is patchy and fragmented, and that the impetus for change is not critically examined. Existing literature pays insufficient attention to core aspects of the innovation such as the centrality of on call working arrangements and alignment with the professional values of midwifery. There is also limited attention to the political and structural contexts into which midwifery continuity of carer is introduced. CONCLUSIONS By synthesizing international research evidence with the CFIR, we identify factors for organisations to consider when planning and implementing midwifery continuity of carer. We also call for more systematic and contextual evidence to aid understanding of the implementation or non-implementation of midwifery continuity of carer. Existing evidence should be critically evaluated and used more cautiously in support of claims about the model of care and its implementation, especially when implementation is occurring in different settings and contexts to the research being cited.
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Affiliation(s)
| | - Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Tina Prendeville
- Women's Health Research Centre, Imperial College London & Imperial College NHS Trust, London, UK
| | - Susan Barry
- Division of Women's Children's and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
| | | | - Aled Jones
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
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Vermeulen J, Buyl R, Luyben A, Fleming V, Tency I, Fobelets M. How to promote midwives' recognition and professional autonomy? A document analysis study. Midwifery 2024; 138:104138. [PMID: 39146900 DOI: 10.1016/j.midw.2024.104138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/12/2024] [Accepted: 08/07/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To identify challenges associated with midwives' professional autonomy in Belgium and develop recommendations to promote midwives' recognition and professional autonomy. DESIGN Through a document analysis study we identified challenges, categorized them into themes and linked them with Greenwood's sociological criteria for a profession. This involved an in-depth synthesis of findings from our published studies to comprehensively examine the challenges to optimizing midwifery autonomy and to develop corresponding recommendations. FINDINGS We identified challenges related to midwife-led continuity care models, regulation of the midwifery profession, collaboration with stakeholders, professional esteem and professional culture. Based on them, our recommendations include prioritizing midwife-led continuity of care, fostering collaboration, tailoring continuous professional development, increasing public awareness and advocating for policy changes. The attribute of a profession which is lacking the most in midwifery in Belgium is recognized authority, which may result in midwives being undervalued, underutilized and underpaid. KEY CONCLUSIONS In this paper we identified challenges in Belgian midwives' recognition and professional autonomy and provided recommendations to address them, emphasizing the importance of recognized authority in midwifery. Implementing these recommendations can positively impact midwives' recognition and autonomy in Belgium and potentially in other countries. IMPLICATIONS FOR PRACTICE It is essential for policy makers to address the issue of the lack of recognized authority in midwifery, as it plays a critical role in facilitating decision-making, policy development, and the professionalization of the field. Implementing the outlined recommendations can drive positive changes in midwifery recognition and autonomy in Belgium and beyond.
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Affiliation(s)
- Joeri Vermeulen
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Life Sciences and Medicine, Faculty of Sciences, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium.
| | - Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ans Luyben
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, UK; Frauenzentrum (Centre for Women's Health), Lindenhofgruppe, Bern, Switzerland
| | - Valerie Fleming
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Inge Tency
- Midwifery Department, Odisee University of Applied Sciences, Sint Niklaas, Belgium
| | - Maaike Fobelets
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium; Department of Teacher Education, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Carvajal B, Hancock A, Lewney K, Hagan K, Jamieson S, Cooke A. A global overview of midwives' working conditions: A rapid review of literature on positive practice environment. Women Birth 2024; 37:15-50. [PMID: 37648619 DOI: 10.1016/j.wombi.2023.08.007] [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: 04/24/2023] [Revised: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND In the United Kingdom (UK), a critical shortage of midwives puts pressure on the already overworked midwives working in maternity services. Considering the challenges that midwives in the UK face, this rapid review was conducted to inform a larger-scale initiative to improve the working conditions of midwives in an acute NHS Trust in the Midlands area of the UK. OBJECTIVE To describe midwives' perceptions and experiences of positive practice environments. METHODS A search strategy to identify literature about midwives' perceptions and experiences of positive practice environments was conducted in Medline, CINAHL Plus and Embase databases. Literature screening was conducted independently in two steps using an eligibility tool. The articles' quality assessment was conducted using the Mixed Method Appraisal Tool. Data were extracted using the Job Quality framework and managed using NVivo12. RESULTS Seventy articles were included in this review. Midwives' working conditions can be improved in all seven areas of the Job Quality framework. Most articles in the review reported the negative aspects of midwives' working environments, making it challenging for the team to define a positive practice environment for midwives. Despite this, authors discuss that a positive practice environment is at least sustained by ensuring midwives' ability to provide care; providing good employment conditions; developing respectful organisations; and increasing team resources, such as those that improve team resilience. CONCLUSIONS Midwives' working conditions are universally challenging. Failure to address the situation will compromise recruitment and retention, increasing the shortage of midwives. Provision of safe and respectful care appears to be directly linked to midwives' safe and respectful working conditions.
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Affiliation(s)
- Bielka Carvajal
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; Departamento de Promocion de la Salud de la Mujer y el Recien Nacido, Universidad de Chile, Chile.
| | - Angela Hancock
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; School of Nursing and Midwifery, Keele University, UK
| | - Katharine Lewney
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
| | - Karen Hagan
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
| | - Sarah Jamieson
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
| | - Alison Cooke
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; School of Nursing and Midwifery, Keele University, UK
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Jakobsen MH, Udjus E, Røseth I, Dahl B. Midwives' experiences with accompaniment service work in Norway: A qualitative study. Eur J Midwifery 2023; 7:5. [PMID: 36844193 PMCID: PMC9951232 DOI: 10.18332/ejm/160074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/28/2023] Open
Abstract
INTRODUCTION The centralization of health services appears to be prevalent both in and outside Europe. As the distance to the nearest birth institution increases, so does the risk of unplanned births outside of an institution. A primary factor to prevent this is having a skilled birth attendant present. This study examines midwives' experiences of working in the accompaniment services in Norway. METHODS This was a qualitative interview study of 12 midwives working in the accompaniment services in Norway. Semi-structured interviews were conducted in January 2020. Systematic text condensation was used to analyze the data. RESULTS The analysis identified four main themes. The midwives felt that accompaniment service work was a heavy responsibility, but it was professionally fulfilling. They felt that being on call was a lifestyle, and they were motivated by their relationships with the pregnant women. Presenting themselves as confident midwives helped the women to feel reassured. The midwives considered the cooperation within the health service to be key to good transport midwifery. CONCLUSIONS The midwives who worked in the accompaniment services felt that their responsibility for caring for women in labor was challenging, but meaningful. Their professional knowledge was important for identifying the risk of complications and handling difficult situations. Despite carrying a heavy workload, they continued to work in the accompaniment services to ensure that women who had to travel long distances to birth institutions received appropriate help.
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Affiliation(s)
- Marita H. Jakobsen
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Elise Udjus
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Idun Røseth
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway,Department of Child and Adolescent Mental Health, Telemark Hospital Trust, Skien, Norway
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
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Brigante L, Coxon K, Fernandez Turienzo C, Sandall J. "She was there all the time". A qualitative study exploring how women at higher risk for preterm birth experience midwifery continuity of care. Women Birth 2023:S1871-5192(23)00016-1. [PMID: 36682950 DOI: 10.1016/j.wombi.2023.01.003] [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: 06/28/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
PROBLEM There is a paucity of research on experiences and views of women at higher risk of preterm birth of midwifery continuity of care. BACKGROUND Midwifery continuity of care (MCoC) has been associated with improved maternal outcomes and with lower levels of preterm births and stillbirths. The majority of MCoC studies have focused on women without risk factors and little has been published on women with obstetric complexities. The aim of this study is to explore the views and experiences of women identified as a higher risk of preterm birth who have had continuity of care from midwives. DESIGN Face-to-face, semi-structured interviews with 16 women identified as at increased risk of preterm birth and experienced continuity of midwifery care across pregnancy, birth and the postnatal period. Care had been provided by the pilot intervention group for the pilot study of midwifery practice in preterm birth including women's experiences (POPPIE) trial. FINDINGS Women valued continuity of midwifery care across the care pathway and described the reassurance provided by having 24 h a day, seven days a week access to known midwives. Consistency of care, advocacy and accessibility to the team were described as the main factors contributing to their feelings of safety and control. KEY CONCLUSIONS Recognising that known midwives were 'there all the time' made women feel listened to and actively involved in clinical decision making, which contributed to women feeling less stressed and anxious during their pregnancy, birth and early parenthood. When developing MCoC models for women with obstetric complexities: access, advocacy and time should be embedded to ensure women can build trusting relationships and reduce anxiety levels.
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Affiliation(s)
- L Brigante
- Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, London, United Kingdom; The Royal College of Midwives, London, United Kingdom.
| | - K Coxon
- School of Education, Midwifery and Social Work. Faculty of Health, Science, Social Care and Education. Kingston University, London, United Kingdom
| | - C Fernandez Turienzo
- Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, London, United Kingdom
| | - J Sandall
- Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, London, United Kingdom
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Sweet L, Wynter K, O'Driscoll K, Blums T, Nenke A, Sommeling M, Kolar R, Teale G. Ten years of a publicly funded homebirth service in Victoria: Maternal and neonatal outcomes. Aust N Z J Obstet Gynaecol 2022; 62:664-673. [PMID: 35318640 PMCID: PMC9790430 DOI: 10.1111/ajo.13518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rates of homebirth in Australia remain low, at less than 0.3% of all births. AIMS To report maternal and neonatal outcomes of ten years of a publicly funded homebirth service, 2009-2019. METHOD Retrospective analysis of clinical outcome data including neonatal outcomes of women who requested a homebirth at a large metropolitan health service in Victoria, Australia. The primary outcomes included: maternal outcomes (mortality, transfer to hospital, place and mode of birth, perineal status, type of third stage of labour, postpartum haemorrhage), and neonatal outcomes (mortality, Apgar score at five minutes, birthweight, breastfeeding initiation, significant morbidity, transfer to hospital). RESULTS Referrals for 827 women were reviewed; 633 remained eligible at 36 weeks gestation, and 473 (57%) birthed at home. Compared to women who did not, women who had a homebirth were significantly more likely to be multiparous, have a normal vaginal birth and an intact perineum, less likely to require suturing and less likely to have blood loss of more than 500 mL. Compared to infants not born at home, infants born at home were significantly less likely to require resuscitation, more likely to be of normal birthweight and exclusively receive breastmilk on discharge. There were no maternal deaths and one neonatal death of a baby born at home before the arrival of a midwife. CONCLUSIONS The outcomes for women accepted into the publicly funded homebirth program suggest appropriate triaging and case selection. A publicly funded homebirth program, with appropriate governance and clinical guidelines, appears to be a safe option for women experiencing low-risk pregnancies.
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Affiliation(s)
- Linda Sweet
- School of Nursing and MidwiferyDeakin UniversityMelbourneVictoriaAustralia,Centre for Quality and Patient Safety ResearchWestern Health PartnershipMelbourneVictoriaAustralia
| | - Karen Wynter
- School of Nursing and MidwiferyDeakin UniversityMelbourneVictoriaAustralia,Centre for Quality and Patient Safety ResearchWestern Health PartnershipMelbourneVictoriaAustralia
| | | | - Tija Blums
- Western HealthMelbourneVictoriaAustralia
| | - Agia Nenke
- Western HealthMelbourneVictoriaAustralia
| | | | | | - Glyn Teale
- Western HealthMelbourneVictoriaAustralia
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Kuipers Y, Degraeve J, Bosmans V, Thaels E, Mestdagh E. Midwifery-led care: A single mixed-methods synthesis. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2070824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yvonne Kuipers
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Antwerp University, Wilrijk, Belgium
| | - Julie Degraeve
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Antwerp University, Wilrijk, Belgium
| | - Valerie Bosmans
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
| | - Ellen Thaels
- Faculty of Health & Wellbeing, School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | - Eveline Mestdagh
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Antwerp University, Wilrijk, Belgium
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Curtin M, Carroll L, Szanfranska M, O’Brien D. Embedding continuity of care into a midwifery curriculum in the Republic of Ireland: A historical context. Eur J Midwifery 2022; 6:20. [PMID: 35515092 PMCID: PMC8998086 DOI: 10.18332/ejm/146232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/29/2022] [Accepted: 01/28/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mary Curtin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lorraine Carroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marcelina Szanfranska
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Denise O’Brien
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Johnsen H, Juhl M, Møller BK, de Lichtenberg V. Adult Daughters of Alcoholic Parents-A Qualitative Study of These Women's Pregnancy Experiences and the Potential Implications for Antenatal Care Provision. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063714. [PMID: 35329401 PMCID: PMC8950929 DOI: 10.3390/ijerph19063714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/10/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
The adult children of alcoholic parents are at increased risk of having health problems compared to the adult children of nonalcoholic parents. Little is known about how growing up with alcoholic parents affects women’s experiences when pregnant. The objectives of this study were to explore how adverse childhood experiences related to parental alcohol abuse affect women during their pregnancy and to assess the potential implications of women’s experiences for antenatal care provision. Twelve in-depth interviews were performed with women who were brought up by an alcoholic mother and/or father. Systematic text condensation was used to analyse the data. Two main categories were identified: ‘establishing relationships and having social support’ and ‘antenatal care encounters and concerns during pregnancy’. Women’s trust in others in adult life was impacted by their upbringing. Strained relationships with their parents and few friends meant that the women primarily relied on their partners for support. Neither antenatal care providers nor women talked about women’s childhood experiences at the visits. The women described concerns related to the baby’s health, lack of predictability and control during the pregnancy, as well as apprehensiveness regarding birth and motherhood. The potential implications for practice include systematic screening for adverse childhood experiences, antenatal preparation classes, parenting courses, and post-graduate training.
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Grylka-Baeschlin S, Aeberli R, Guenthard-Uhl B, Meier-Kaeppeli B, Leu-tenegger V, Volken T, Pehlke-Milde J. Job satisfaction of midwives working in a labor ward: A repeat measure mixed-methods study. Eur J Midwifery 2022; 6:8. [PMID: 35233515 PMCID: PMC8842085 DOI: 10.18332/ejm/145494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/26/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Job satisfaction of midwives is important to prevent skill shortage. Those working in midwife-led models of care work more independently and have more responsibility. No previous study investigated if a self-initiated and self-responsible project could enhance job satisfaction of midwives working in a medicalled maternity unit. The aim of this study was therefore to assess job satisfaction before and after the implementation of such a project. METHODS This is longitudinal observational study at three time points using quantitative and qualitative methods. A total of 43 midwives working in a Swiss labor ward participated in the online surveys and in the focus group discussions. The surveys comprised questions from validated instruments to assess job satisfaction. Descriptive and multivariable time series analysis were used for quantitative and content analysis for qualitative data. RESULTS Adjusted predicted scores decreased between t0 and t1, and subsequently increased at t2 without reaching baseline values (e.g. ‘professional support subscales’ between t0 and t1: (0.65; 95% CI: 0.45–0.86 vs 0.26; 95% CI: 0.08–0.45, p=0.005) and between t0 and t2 (0.65; 95% CI: 0.45–0.86 vs 0.29; 95% CI: 0.12–0.47, p=0.004). Focus group discussions revealed four themes: ‘general job satisfaction’, ‘challenges with the implementation’, ‘continuity of care’ and ‘meaning for the mothers’. Midwives perceived the additional tasks as stressors. CONCLUSIONS The implementation of new projects might enhance work-related stress and consequently have negative impacts on job satisfaction in an early phase. Heads of institutions and policy makers should recognize the needs of support and additional resources for staff when implementing new projects.
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Affiliation(s)
- Susanne Grylka-Baeschlin
- Research Institute for Midwifery Science, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Regula Aeberli
- Division of Women’s Health and Newborn Care, Department of Obstetrics, University Hospital of Zurich, Zürich, Switzerland
| | - Barbara Guenthard-Uhl
- Division of Women’s Health and Newborn Care, Department of Obstetrics, University Hospital of Zurich, Zürich, Switzerland
| | - Barbara Meier-Kaeppeli
- Division of Women’s Health and Newborn Care, Department of Obstetrics, University Hospital of Zurich, Zürich, Switzerland
| | - Vanessa Leu-tenegger
- Research Institute for Midwifery Science, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Thomas Volken
- Research Institute for Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Jessica Pehlke-Milde
- Research Institute for Midwifery Science, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
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12
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Küçüktürkmen B, Baskaya Y, Özdemir K. A qualitative study of Turkish midwives' experience of providing care to pregnant women infected with COVID-19. Midwifery 2021; 105:103206. [PMID: 34864325 PMCID: PMC8595251 DOI: 10.1016/j.midw.2021.103206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
Objective To determine the experiences of Turkish midwives who provided care to pregnant women diagnosed with COVID-19 or suspected of having it, during labour and delivery. Methods A phenomenological approach was used. In-depth individual interviews were conducted with 15 midwives from 15 different hospitals in various Turkish cities through video-conferencing. Data analysis was based on Graneheim and Lundman's techniques for extracting themes from qualitative data. Findings Four themes emerged: “Measures against pandemic uncertainty,” “Impairment in postpartum care,” “Emotional burden of the pandemic,” and “Adaptation to the results of the pandemic.” Midwives stated that they tried to reduce the risk of contamination by taking self-protection measures and creating isolated areas. They carried out practices such as separating the mother and baby postpartum and not allowing breastfeeding. They experienced emotional confusion with the difficulties faced in this process, and they became professional in the management of the process. Implications for practice The results of this study reveal the challenges faced by Turkish midwives during the COVID-19 pandemic and the importance of the publication of evidence-based guidelines. Provision of emotional support for midwives is essential in order to sustain the continuity of the quality maintenance of midwifery care.
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Affiliation(s)
- Büşra Küçüktürkmen
- Sakarya University, Faculty of Health Sciences, Department of Midwifery, Sakarya, Turkey.
| | - Yasemin Baskaya
- Sakarya University, Faculty of Health Sciences, Department of Midwifery, Sakarya, Turkey
| | - Kevser Özdemir
- Sakarya University, Faculty of Health Sciences, Department of Nursing, Sakarya, Turkey
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Hanley A, Davis D, Kurz E. Job satisfaction and sustainability of midwives working in caseload models of care: An integrative literature review. Women Birth 2021; 35:e397-e407. [PMID: 34257046 DOI: 10.1016/j.wombi.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Demand for caseload midwifery care continues to outstrip supply. We know little about what sustains midwives working in caseload models of care. AIM This review systematically identifies and synthesises research findings reporting on factors which contribute to job satisfaction, and therefore the sustainability of practice, of midwives working in caseload models of care. METHODS A comprehensive search strategy explored the electronic databases CINAHL Plus with Full Text, MEDLINE, PubMED, Cochrane Database of Systematic Reviews, and Scopus. Articles were assessed using the Crowe Critical Appraisal Tool. Data analysis and synthesis of these publications were conducted using a narrative synthesis approach. FINDINGS Twenty-two articles were reviewed. Factors which contribute to the job satisfaction and sustainability of practice of midwives working in caseload models are: the ability to build relationships with women; flexibility and control over own working arrangements; professional autonomy and identity; and, organisational and practice arrangements. CONCLUSION Insights into the factors which contribute to the job satisfaction and sustainability of practice of midwives in caseload models of care enables both midwives and healthcare administrators to more effectively implement and support midwifery-led caseload models of care which have been shown to improve outcomes for childbearing women.
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Affiliation(s)
- Andrea Hanley
- Faculty of Health, University of Canberra and ACT Government Health Directorate, ACT, Australia
| | - Deborah Davis
- Faculty of Health, University of Canberra and ACT Government Health Directorate, ACT, Australia
| | - Ella Kurz
- Faculty of Health, University of Canberra, University Drive, Belconnen, ACT 2617, Australia.
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Pace CA, Crowther S, Lau A. Midwife experiences of providing continuity of carer: A qualitative systematic review. Women Birth 2021; 35:e221-e232. [PMID: 34253467 DOI: 10.1016/j.wombi.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Continuity of carer models present positives and challenges for midwives working in them, and are difficult to sustain. BACKGROUND Research shows midwifery continuity of carer improves perinatal outcomes and experiences, and is considered the optimal model of care. AIM To synthesise existing research on midwives' experiences of providing continuity of carer and generate further understanding of what sustains them in practice. METHODS Protocol for the review was developed using PRISMA guidelines and registered with PROSPERO. 22 studies were included with original themes and findings extracted using JBI tools and synthesised using meta-ethnographic techniques. GRADE CERQual assessment of review findings showed high confidence. FINDINGS Midwives identified working in continuity of carer models as both fulfilling and challenging. Professional autonomy and ability to develop meaningful relationships were the most commonly cited positives, while lack of work life balance and conflict with the wider maternity team were the main challenges. 15 studies identified strategies employed by midwives which sustained them in practice. DISCUSSION Midwife experiences of providing continuity are impacted by personal and professional factors. Of paramount importance to sustainability of the model is the support of the wider organisation, and their alignment with principles of person-centred, relational care. CONCLUSION Relational models of care are desired by midwives, service users and are recommended in policy. Relational models of care must be responsive to midwives needs as well as birthing people, and therefore need to be designed and managed by those working in them and supported by the whole organisation to be sustainable.
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Affiliation(s)
- Charlotte Ashley Pace
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK.
| | - Susan Crowther
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK; AUT University, Auckland, New Zealand.
| | - Annie Lau
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
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15
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Larsson B, Thies-Lagergren L, Karlström A, Hildingsson I. Demanding and rewarding: Midwives experiences of starting a continuity of care project in rural Sweden. Eur J Midwifery 2021; 5:8. [PMID: 33768199 PMCID: PMC7983178 DOI: 10.18332/ejm/133573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/22/2020] [Accepted: 02/21/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The closure of a local labor ward enhanced the possibility to initiate a continuity of midwifery care model project. Continuity models of midwifery care are a cornerstone in midwifery and women-centered care, mainly accessible in metropolitan areas. Australian studies have found continuity of midwifery care to work well in rural areas. The aim of this study is to describe midwives' experiences of developing and working in a continuity of midwifery model of care in a rural setting in Sweden. METHODS We used a qualitative longitudinal interview with a participatory action research approach. The project was subjected to changes over time to allow the midwives to provide the best care options and to develop a model suitable for a rural area in northern Sweden. RESULTS The overarching theme, 'Developing a continuity model of midwifery care - demanding and rewarding with new insights', was based on three themes: 1) A challenging but evolving start, 2) Varying views within the midwifery group, and 3) Visions for the future. It was revealed that the midwives had to handle the grief process of the closure of the labor ward alongside their enthusiasm of being part of a continuity of midwifery care model project. CONCLUSIONS The establishment of the model in light of the labor ward closure was associated with conflict within the community and this had implications for the midwives. Midwives who are attracted to work in continuity models need to understand and incorporate the prerequisites of such models. In addition, long commuting to a labor ward requires enough midwives to maintain safety and security for the women at all times.
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Affiliation(s)
- Birgitta Larsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Li Thies-Lagergren
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Helsingborg Lasarett, Helsingborg, Sweden
| | | | - Ingegerd Hildingsson
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Dharni N, Essex H, Bryant MJ, Cronin de Chavez A, Willan K, Farrar D, Bywater T, Dickerson J. The key components of a successful model of midwifery-led continuity of carer, without continuity at birth: findings from a qualitative implementation evaluation. BMC Pregnancy Childbirth 2021; 21:205. [PMID: 33711957 PMCID: PMC7955626 DOI: 10.1186/s12884-021-03671-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent UK maternity policy changes recommend that a named midwife supports women throughout their pregnancy, birth and postnatal care. Whilst many studies report high levels of satisfaction amongst women receiving, and midwives providing, this level of continuity of carer, there are concerns some midwives may experience burnout and stress. In this study, we present a qualitative evaluation of the implementation of a midwife-led continuity of carer model that excluded continuity of carer at the birth. METHODS Underpinned by the Conceptual Model for Implementation Fidelity, our evaluation explored the implementation, fidelity, reach and satisfaction of the continuity of carer model. Semi-structured interviews were undertaken with midwives (n = 7) and women (n = 15) from continuity of carer team. To enable comparisons between care approaches, midwives (n = 7) and women (n = 10) from standard approach teams were also interviewed. Interviews were recorded, transcribed and analysed using thematic analysis. RESULTS For continuity of carer team midwives, manageable caseloads, extended appointment times, increased team stability, and flexible working patterns facilitated both care provided and midwives' job satisfaction. Both continuity of carer and standard approach midwives reported challenges in providing postnatal continuity given the unpredictable timing of labour and birth. Time constraints, inadequate staffing and lack of administrative support were reported as additional barriers to implementing continuity of carer within standard approach teams. Women reported continuity was integral to building trust with midwives, encouraged them to disclose mental health issues and increased their confidence in making birth choices. CONCLUSIONS Our evaluation highlighted the successful implementation of a continuity of carer model for ante and postnatal care. Despite exclusion of the birth element in the model, both women and midwives expressed high levels of satisfaction in comparison to women and midwives within the standard approach. Implementation successes were largely due to structural and resource factors, particularly the combination of additional time and smaller caseloads of women. However, these resources are not widely available within the resources of maternity unit budgets. Future research should further explore whether a continuity of carer model focusing on antenatal and postnatal care delivery is a feasible and sustainable model of care for all women.
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Affiliation(s)
- N. Dharni
- Royal College of Obstetricians & Gynaecologists, London, UK
- Better Start Bradford Innovation Hub, Bradford Institute for Health Research, Bradford, York, UK
| | - H. Essex
- Department of Health Sciences, University of York, York, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M. J. Bryant
- Department of Health Sciences, University of York, York, UK
| | - A. Cronin de Chavez
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - K. Willan
- Better Start Bradford Innovation Hub, Bradford Institute for Health Research, Bradford, York, UK
| | - D. Farrar
- Maternal and Infant Health, Bradford Institute for Health Research, Bradford, UK
| | - T. Bywater
- Department of Health Sciences, University of York, York, UK
| | - J. Dickerson
- Better Start Bradford Innovation Hub, Bradford Institute for Health Research, Bradford, York, UK
| | - on behalf of the Better Start Bradford Innovation Hub
- Royal College of Obstetricians & Gynaecologists, London, UK
- Better Start Bradford Innovation Hub, Bradford Institute for Health Research, Bradford, York, UK
- Department of Health Sciences, University of York, York, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
- Maternal and Infant Health, Bradford Institute for Health Research, Bradford, UK
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Kashani A, Ingberg JL, Hildingsson I. Caseload midwifery in a rural Australian setting: A qualitative descriptive study. Eur J Midwifery 2021; 5:2. [PMID: 33537651 PMCID: PMC7839082 DOI: 10.18332/ejm/131240] [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: 08/07/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Midwifery-led continuity of care models are beneficial to women and babies, but might be challenging for midwives. Several studies have, however, shown that midwives report higher job satisfaction and less burnout when working with caseload. Another challenge is to staff such models in rural areas. The aim of this study was to describe midwives’ experiences of working in a caseload model in a rural region of Australia. METHODS A qualitative descriptive approach using interviews and thematic analysis was undertaken with eleven midwives. RESULTS The overarching theme, ‘A modified caseload model of care in rural Australia creates opportunities for increased job satisfaction despite the challenges involved with being on call’, comprised: two themes, ‘Increased job satisfaction’ and ‘Challenges’; one core theme, ‘Being on call’; and several subthemes. Working with caseload creates job satisfaction and increases vitality and positive feelings about being a midwife. The main difficulty, as well as the necessity with this model, is the challenging aspect of being on call. CONCLUSIONS Caseload midwifery builds partnership between the woman and her midwife, it allows flexible working hours and increased autonomy, even when the work affects the midwife’s social life. Being on call allows the midwife to work on the whole scope of midwifery practice and is a basis for the continuity model of care; however, being on call also represents a challenge to be overcome in order to make caseload work. Continuity models may be a means to attract midwives to work in rural areas.
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Affiliation(s)
- Alia Kashani
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jessica L Ingberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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Dayyani I, Lou S, Jepsen I. Midwives' provision of health promotion in antenatal care: A qualitative explorative study. Women Birth 2021; 35:e75-e83. [PMID: 33509736 DOI: 10.1016/j.wombi.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/15/2022]
Abstract
PROBLEM Studies indicate that health promotion in antenatal care can be improved. Moreover, a schism seems to exist between health promotion and prevention in antenatal care. BACKGROUND Antenatal care to support and improve maternal health is a core midwifery activity in which prevention as well as HP and woman-centeredness are important. AIM To explore how Danish midwives experienced antenatal care and practiced health promotion. METHODS Midwives undertaking antenatal care were interviewed individually (n=8) and two focus groups (n=10) were created. Thematic analysis was performed inductively, and the theoretical models from Piper's health promotion practice Framework for midwives were used to analyse the midwives' health promotion approach. FINDINGS Two major themes were highlighted. Theme 1: 'The antenatal care context for health promotion' described factors contributing to quality in health promotion in antenatal care, such as communication and building relationships with the pregnant women. Theme 2: 'The health promotion approach in antenatal care' described both midwife-focused and woman-focused approaches to pregnant women's health. Barriers to high-quality antenatal care and a holistic health promotion approach were identified, such as shared-care issues, documentation demands and lack of time. DISCUSSION The midwives' experiences were discussed in the context of a health promotion approach. Why midwives practice using a midwife-centred approach has many explanations, but midwives need to learn and help each other understand how they can practice woman-focused care while simultaneously providing prophylactic, evidence-based care. CONCLUSION Midwives mainly had a midwife-focused approach. To further promote women's health, midwives need to focus on a woman-focused approach.
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Affiliation(s)
- Ida Dayyani
- University College of Northern Denmark, Department of Midwifery, Selma Lagerløfs Vej 2, 9220 Aalborg Øst, Denmark.
| | - Stina Lou
- Defactum - Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.
| | - Ingrid Jepsen
- University College of Northern Denmark, Department of Midwifery, Selma Lagerløfs Vej 2, 9220 Aalborg Øst, Denmark.
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Vasilevski V, Sweet L, Smith L, Dell M. Part-time positions in Caseload Midwifery Group Practice: Impact on satisfaction and quality of care. Women Birth 2020; 34:e567-e574. [DOI: 10.1016/j.wombi.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
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Lewis M. Midwives' Experience of Providing Continuity of Care in a Pilot Project: Findings of a Prospective Qualitative Research Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-20-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTIONThere has been a strategic drive for several years in midwifery to improve models of care and enable women to receive care from a known midwife. However over the past decade new models of care to achieve this have not been sustained and some midwives have expressed opinions that such models can never be sustainable for the staff working them. This study was designed to explore the midwives experience of working a continuity of care model, develop understanding of the lived experience of midwives, and provide insight into how such models can be sustainable from the midwives perspective. A local trust initiative to pilot a small team continuity of care model in one geographical area was introduced and a group of midwives interested in working differently were recruited onto the study to share their experiences. This article details the process and themes identified through a small qualitative research study to explore midwives' experiences of working in a new way to provide increased continuity of care for women. The study results are written in response to a local drive for change and within the context of a small group of midwives taking part in a service improvement project. The article specifically identifies themes in the midwives' experiences and lessons learnt for sustainable change in relation to continuity of care within midwifery services.METHODThe study was a qualitative descriptive study. The main purpose of the study was to gain further understanding of the personal experiences of midwives. Data was collected over a 12-month period from eight midwives who took part; reflective diaries, notes from team meetings and data from the team's “WhatsApp” group chat were used to capture the data over time. Themes identified were then verified with the participants through one to one semi structured interviews.FINDINGSThe research data has been organized into four overarching themes related to May's (2009) normalization process theory: Coherence—same difference, cognitive participation—operational workability, collective action—relationships and reflexive monitoring—personal sustainability.DISCUSSIONA key theme running throughout the data was the importance of autonomy, flexibility, and trust, enabling midwives and women to build effective therapeutic relationships. This is important to note when developing systems for care. Staff needed to feel trusted in order to work flexibly and take control over their own work/life balance. The findings indicate that where staff felt enabled to organize their own workloads they did in fact work harder to meet the needs of the women. A shift in culture in maternity systems would need to be embraced for this level of control to be afforded all midwives. It should be noted that the study was conducted in one specific area and with a small number of midwives. Hence the findings cannot be generalized and will need to be explored further across different cultures.
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A continuity of care project with two on-call schedules: Findings from a rural area in Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 26:100551. [PMID: 32950811 DOI: 10.1016/j.srhc.2020.100551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In many countries, various continuity models of midwifery care arrangements have been developed to benefit women and babies. In Sweden, such models are rare. AIM To evaluate two on-call schedules for enabling continuity of midwifery care during labour and birth, in a rural area of Sweden. METHOD A participatory action research project where the project was discussed, planned and implemented in collaboration between researchers, midwives and the project leader, and refined during the project period. Questionnaires were collected from participating women, in mid pregnancy and two months after birth. RESULT One of the models resulted in a higher degree of continuity, especially for women with fear of birth. Having a known midwife was associated with higher satisfaction in the medical (aOR 2.02 (95% CI 1.14-4.22) and the emotional (aOR 2.05; 1.09-3.86) aspects of intrapartum care, regardless of the model. CONCLUSION This study presented and evaluated two models of continuity with different on-call schedules and different possibilities for women to have access to a known midwife during labour and birth. Women were satisfied with the intrapartum care, and those who had had a known midwife were the most satisfied. Introducing a new model of care in a rural area where the labour ward recently closed challenged both the midwives' working conditions and women's access to evidence-based care.
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Hildingsson I, Karlström A, Larsson B. Childbirth experience in women participating in a continuity of midwifery care project. Women Birth 2020; 34:e255-e261. [PMID: 32595033 DOI: 10.1016/j.wombi.2020.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuity models of care are rare in Sweden, despite the evidence of their benefit to women and babies. Previous studies have shown certain factors are associated with a positive birth experience, including continuity of midwifery care. AIM The aim was to investigate women's childbirth experiences in relation to background data, birth outcome and continuity with a known midwife, in a rural area of Sweden. METHODS An experimental cohort study. Participating women were offered continuity of midwifery care in pregnancy and birth, during selected time periods. Data were collected in mid-pregnancy and two months after birth. The Childbirth Experience Questionnaire was used to determine women's birth experiences. RESULT A total of 226 women responded to the follow-up questionnaire. Not living with a partner, fear of giving birth, and a birth preference other than vaginal were associated with a less positive birth experience. Having had a vaginal birth with no epidural, no augmentation and no birth complication all yield a better birth experience. Women who had had a known midwife were more likely to have had a positive birth experience overall, predominantly in the domain Professional support. CONCLUSIONS The results of this study showed that women who received care from a known midwife in labour were more likely to have a positive birth experience. The results also pointed out the benefits of a less medicalized birth as important for a good birth experience, and that some women may need extra support to avoid a less positive birth experience.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
| | | | - Birgitta Larsson
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden; Sophiahemmet University College, Stockholm, Sweden
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McInnes RJ, Aitken-Arbuckle A, Lake S, Hollins Martin C, MacArthur J. Implementing continuity of midwife carer - just a friendly face? A realist evaluation. BMC Health Serv Res 2020; 20:304. [PMID: 32293422 PMCID: PMC7158105 DOI: 10.1186/s12913-020-05159-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background Good quality midwifery care saves the lives of women and babies. Continuity of midwife carer (CMC), a key component of good quality midwifery care, results in better clinical outcomes, higher care satisfaction and enhanced caregiver experience. However, CMC uptake has tended to be small scale or transient. We used realist evaluation in one Scottish health board to explore implementation of CMC as part of the Scottish Government 2017 maternity plan. Methods Participatory research, quality improvement and iterative data collection methods were used to collect data from a range of sources including facilitated team meetings, local and national meetings, quality improvement and service evaluation surveys, audits, interviews and published literature. Data analysis developed context-mechanism-outcome configurations to explore and inform three initial programme theories, which were refined into an overarching theory of what works for whom and in what context. Results Trusting relationships across all organisational levels are the context in which CMC works. However, building these relationships during implementation requires good leadership and effective change management to drive whole system change and foster trust across all practice and organisational boundaries. Trusting relationships between midwives and women were valued and triggered a commitment to provide high quality care; CMC team relationships supported improvements in ways of working and sustained practice, and relationships between midwives and providers in different care models either sustained or constrained implementation. Continuity enabled midwives to work to full skillset and across women’s care journey, which in turn changed their perspective of how they provided care and of women’s care needs. In addition to building positive relationships, visible and supportive leadership encourages engagement by ensuring midwives feel safe, valued and informed. Conclusion Leadership that builds trusting relationships across all practice and organisational boundaries develops the context for successful implementation of CMC. These relationships then become the context that enables CMC to grow and flourish. Trusting relationships, working to full skill set and across women’s care journey trigger changes in midwifery practice. Implementing and sustaining CMC within NHS organisational settings requires significant reconfiguration of services at all levels, which requires effective leadership and cannot rely solely on ground-up change.
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Affiliation(s)
- Rhona J McInnes
- School of Nursing & Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia.
| | - Alix Aitken-Arbuckle
- School of Health, Edinburgh Napier University, Sighthill Campus, Edinburgh, Scotland
| | - Suzanne Lake
- Nursing, Midwifery & Allied Health Professions, NHS Education for Scotland, Westport, Edinburgh, Scotland
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A modified caseload midwifery model for women with fear of birth, women's and midwives' experiences: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 24:100504. [PMID: 32120329 DOI: 10.1016/j.srhc.2020.100504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/10/2020] [Accepted: 02/23/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Although fear of birth is common during pregnancy and childbirth, the best treatment for fear of birth in clinical care remain unclear. Strong evidence suggests that continuity models of midwifery care can benefit women and birth outcomes, though such models are rare in Sweden. Because women with fear of birth could benefit from such models, the aim of this qualitative study was to examine how women with fear of birth and their midwives experienced care in a modified caseload midwifery model. METHODS A qualitative interview study using thematic analysis. Participants were recruited from a pilot study in which women assessed to have fear of birth received antenatal and intrapartum care, from a midwife whom they knew. Eight women and four midwives were interviewed. RESULTS An overarching theme-"A mutual relationship instilled a sense of peace and security"-and three themes-"Closeness, continuity, and trust," "Preparation and counselling," and "Security, confidence, and reduced fear"-reflect the views and experiences of women with fear of birth and their midwives after participating in a modified caseload midwifery model. CONCLUSIONS For both women with fear of birth and their midwives, the caseload midwifery model generated trustful woman-midwife relationships, which increased women's confidence, reduced their fear, and contributed to their positive birth experiences. Moreover, the midwives felt better equipped to address women's needs, and their way of working with the women became more holistic. Altogether, offering a continuity model of midwifery care could be an option to support women with fear of birth.
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Corrigan AE, Lake S, McInnes RJ. Normalisation process theory as a conceptual framework for continuity of carer implementation. Women Birth 2020; 34:e204-e209. [PMID: 32139185 DOI: 10.1016/j.wombi.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Abstract
PROBLEM Despite long standing strategic level ambitions to increase access to continuity of carer (CoC) models in maternity services, implementation of CoC in the United Kingdom (UK) has been generally small-scale and short lived. This indicates problems in implementing and sustaining CoC as the main model of care provision, and as such a need to better understand the process of implementation itself. AIM To use normalisation process theory (NPT) to underpin development of a conceptual implementation framework for CoC in order to improve understanding of the implementation process. METHODS Literature review on CoC implementation and NPT development and use, combined with immersion in the implementation of CoC context. RESULTS AND DISCUSSION A conceptual framework for the implementation of CoC is developed and individual components discussed, with a view to better understanding the implementation process for CoC models. The will of a critical mass of midwives to work in a CoC model and the provision and maintenance of the 'organisational space' required for CoC within the National Health Service (NHS) emerge as key barriers to mainstreaming CoC in the UK. CONCLUSION There is utility in NPT as a means of understanding and conceptualising large scale implementation of CoC. With testing and further development into a practical tool, the conceptual framework developed here could become a useful aid to those involved in implementing and evaluating CoC in the context of renewed strategic direction and Governmental level support in the UK.
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Affiliation(s)
- Amy E Corrigan
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, 9 Sighthill Court, Midlothian, EH11 4BN, United Kingdom.
| | - Suzanne Lake
- NHS Education for Scotland, Stirling Community Hospital, PDU/ Admin Block Level 1, Livilands Gate, Stirling, FK8 2AU, United Kingdom
| | - Rhona J McInnes
- Professor of Maternal and Child Health and Clinical Chair, Gold Coast University Hospital, School of Nursing and Midwifery, Griffith University, Gold Coast Campus, QLD 4222, Australia
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Allen J, Parratt JA, Rolfe MI, Hastie CR, Saxton A, Fahy KM. Immediate, uninterrupted skin-to-skin contact and breastfeeding after birth: A cross-sectional electronic survey. Midwifery 2019; 79:102535. [DOI: 10.1016/j.midw.2019.102535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
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Ricchi A, Rossi F, Borgognoni P, Bassi MC, Artioli G, Foa C, Neri I. The midwifery-led care model: a continuity of care model in the birth path. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:41-52. [PMID: 31292414 PMCID: PMC6776178 DOI: 10.23750/abm.v90i6-s.8621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The birth path is affected by a fragmentation in the patient care process, creating a discontinuity of this last one. The pregnant woman has to interface with many professionals, both during the pregnancy, the childbirth and the puerperium. However, during the last ten years, there has been an increasing of the pregnancy care operated by the midwife, who is considered to be the operator with the right competences, who can take care of every pregnancy and may avail herself of other professionals' contributions in order to improve the outcomes of maternal and neonatal health. AIM To verify whether there are proofs of effectiveness that support the caseload midwifery care model, and if it is possible to apply this model in the birth path in Italy. METHODS A revision of literature has been done using some search engine (Google, Bing) and specific databases (MEDLINE, CINAHL, Embase, Home - ClinicalTrials.gov). There has also been a consultation of the Italian regulations, the national guidelines and the recommendations of WHO. RESULTS The search string, properly adapted to the three databases, has given the following results: MEDLINE 64 articles, CINAHL 94 articles, Embase 88 articles. From this selection, 14 articles have been extracted: 1 systematic review, 3 controlled random trial, 7 observational studies, 3 qualitative studies. CONCLUSIONS The caseload midwifery care seems to be an effective and reliable organisational/caring method. It responds to the criterions of quality and security, to the needs of women not only during the pregnancy but also during the post-partum phase. For these reasons, it seems very useful also for the birth path in the Italian reality.
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Taylor B, Cross-Sudworth F, Goodwin L, Kenyon S, MacArthur C. Midwives' perspectives of continuity based working in the UK: A cross-sectional survey. Midwifery 2019; 75:127-137. [PMID: 31100484 DOI: 10.1016/j.midw.2019.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE UK policy is advocating continuity of midwife throughout the antenatal, intrapartum and postnatal period in order to improve outcomes. We explored the working patterns that midwives are willing and able to adopt, barriers to change, and what would help midwives to work in continuity models of care. DESIGN A cross-sectional survey. SETTING 27 English maternity providers in the seven geographically-based 'Early Adopter' sites, which have been chosen to fast-track national policy implementation. PARTICIPANTS All midwives working in the 'Early Adopter' sites were eligible to take part. METHOD Anonymous online survey disseminated by local and national leaders, and social media, in October 2017. Descriptive statistics were calculated for quantitative survey responses. Qualitative free text responses were analysed thematically. FINDINGS 798 midwives participated (estimated response rate 20% calculated using local and national NHS workforce headcount data for participating sites). Being willing or able to work in a continuity model (caseloading and/or team) was lowest where this included intrapartum care in both hospital and home settings (35%, n = 279). Willingness to work in a continuity model of care increased as the range of intrapartum care settings covered decreased (home births only 45%, n = 359; no intrapartum care at all 54%, n = 426). A need to work on the same day each week was reported by 24% (n = 188). 31% (n = 246) were currently working 12 h shifts only, while 37% (n = 295) reported being unable to work any on-calls and/or nights. Qualitative analysis revealed multiple barriers to working in continuity models: the most prominent was caring responsibilities for children and others. Midwives suggested a range of approaches to facilitate working differently including concessions in the way midwife roles are organised, such as greater autonomy and choice in working patterns. CONCLUSIONS Findings suggest that many midwives are not currently able or willing to work in continuity models, which includes care across antenatal, intrapartum and postnatal periods as recommended by UK policy. IMPLICATIONS FOR PRACTICE A range of approaches to providing continuity models should be explored as the implementation of 'Better Births' takes place across England. This should include studies of the impact of the different models on women, babies and midwives, along with their practical scalability and cost.
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Affiliation(s)
- Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Laura Goodwin
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Christine MacArthur
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
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Jepsen I, Juul S, Foureur MJ, Sørensen EE, Nohr EA. Labour outcomes in caseload midwifery and standard care: a register-based cohort study. BMC Pregnancy Childbirth 2018; 18:481. [PMID: 30522453 DOI: 10.1186/s12884-018-2090-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 11/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care. METHODS A historical register-based cohort study was carried out using routinely collected data about all singleton births 2013-2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses. RESULTS Compared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06-1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13-1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03-1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84-1.28). Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11-2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital. For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06-1.29). CONCLUSIONS For most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.
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Affiliation(s)
- Ingrid Jepsen
- University College of Northern Denmark, Selma Lagerløfs Vej 2, 9220, Aalborg Øst, Denmark. .,Clinical Nursing Research, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
| | - Svend Juul
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus C, Denmark
| | - Maralyn Jean Foureur
- Research unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Sdr Boulevard 29, 5000, Odense C, Denmark.,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Erik Elgaard Sørensen
- Clinical Nursing Research, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Ellen Aagaard Nohr
- Research unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Sdr Boulevard 29, 5000, Odense C, Denmark.,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Centre of Women's, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
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Midwifery continuity of carer: Developing a realist evaluation framework to evaluate the implementation of strategic change in Scotland. Midwifery 2018; 66:103-110. [DOI: 10.1016/j.midw.2018.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 11/21/2022]
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Comparing caseload and non-caseload midwives’ burnout levels and professional attitudes: A national, cross-sectional survey of Australian midwives working in the public maternity system. Midwifery 2018; 63:60-67. [DOI: 10.1016/j.midw.2018.04.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/29/2018] [Accepted: 04/30/2018] [Indexed: 11/15/2022]
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Larsson M. Caseload midwifery - A way forward for a model of care with historical roots. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:224. [PMID: 29793799 DOI: 10.1016/j.srhc.2018.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Caseload midwifery for women with fear of birth is a feasible option. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:50-55. [PMID: 29804775 DOI: 10.1016/j.srhc.2018.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/16/2018] [Accepted: 02/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Continuity with a known midwife might benefit women with fear of birth, but is rare in Sweden. The aim was to test a modified caseload midwifery model of care to provide continuity of caregiver to women with fear of birth. METHODS A feasibility study where women received antenatal and intrapartum care from a known midwife who focused on women's fear during all antenatal visits. The study was performed in one antenatal clinic in central Sweden and one university hospital labor ward. Data was collected with questionnaires in mid and late pregnancy and two months after birth. The main outcome was fear of childbirth. RESULT Eight out of ten women received all antenatal and intrapartum care from a known midwife. The majority had a normal vaginal birth with non-pharmacological pain relief. Satisfaction was high and most women reported that their fear of birth alleviated or disappeared. CONCLUSION Offering a modified caseload midwifery model of care seems to be a feasible option for women with elevated levels of childbirth fear as well as for midwives working in antenatal clinics as it reduces fear of childbirth for most women. Women were satisfied with the model of care and with the care provided.
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Fenwick J, Sidebotham M, Gamble J, Creedy DK. The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity. Women Birth 2018; 31:38-43. [DOI: 10.1016/j.wombi.2017.06.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 11/26/2022]
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Fenwick J, Lubomski A, Creedy DK, Sidebotham M. Personal, professional and workplace factors that contribute to burnout in Australian midwives. J Adv Nurs 2017; 74:852-863. [PMID: 29105143 DOI: 10.1111/jan.13491] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to identify personal, professional and workplace factors that contribute to burnout in midwives. BACKGROUND Burnout is prevalent in the midwifery workforce. Burnout adversely affects the well-being of midwives, diminishes the quality of care they provide and can shorten career duration. DESIGN Self-administered online survey. The survey included the Copenhagen Burnout Inventory and personal and professional variables related to age, children, years of experience, role, model of care and satisfaction with work life. Midwives were invited to participate via an email sent from the Australian College of Midwives and through professional networks between June and July 2014. Variables associated with burnout were entered in a multinomial logistic regression. RESULTS A total of 1,037 responses were received and 990 analysed. The prevalence of moderate to severe personal (N = 643; 64.9%) and work-related burnout (N = 428; 43.8%) were high. Having children, providing caseload midwifery care and working in a regional area were associated with low burnout. However, midwives registered for 5-10 years were more likely to report work and client-related burnout. Similarly, midwives reporting a lack of satisfaction with work-life balance were also more likely to report personal and work-related burnout. CONCLUSIONS Family-friendly work environments that facilitate work-life balance can help to reduce the personal and organizational costs of burnout. Similarly, providing continuity of midwifery care in a caseload model can facilitate work-life balance and provide significant mental health benefits to participating midwives.
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Affiliation(s)
- Jennifer Fenwick
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Qld, Australia.,Maternity, Newborn and Families Research Collaborative, Menzies Health Institute, Griffith University, Qld, Australia.,Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Qld, Australia
| | - Anna Lubomski
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Qld, Australia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Qld, Australia.,Maternity, Newborn and Families Research Collaborative, Menzies Health Institute, Griffith University, Qld, Australia
| | - Mary Sidebotham
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Qld, Australia.,Maternity, Newborn and Families Research Collaborative, Menzies Health Institute, Griffith University, Qld, Australia
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Allen J, Kildea S, Hartz DL, Tracy M, Tracy S. The motivation and capacity to go ‘above and beyond’: Qualitative analysis of free-text survey responses in the M@NGO randomised controlled trial of caseload midwifery. Midwifery 2017; 50:148-156. [DOI: 10.1016/j.midw.2017.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/07/2017] [Accepted: 03/24/2017] [Indexed: 12/16/2022]
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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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