Women's experiences of home visits by midwives in the early postnatal period

Recreating the village: the patient experience with a hybrid model of Group Perinatal Care (GPPC) in an academic family health team

BACKGROUND

Group prenatal care (GPC) has been shown to have a positive impact on social support, patient knowledge and preparedness for birth. We developed an interprofessional hybrid model of care whereby the group perinatal care (GPPC) component was co-facilitated by midwives (MW) and family medicine residents (FMR) and alternating individual visits were provided by family physicians (FP's) within our academic family health team (FHT) In this qualitative study, we sought to explore the impact of this program and how it supports patients through pregnancy and the early newborn period.

METHODS

Qualitative study that was conducted using semi-structured telephone interviews with 18 participants who had completed GPPC in the Mount Sinai Academic Family Health Team in Toronto, Canada and delivered between November 2016 and October 2018. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted by team members using grounded theory.

RESULTS

Four over-arching themes emerged from the data: (i) Participants highly valued information they received from multiple trusted sources, (ii) Participants felt well cared for by the collaborative and coordinated interprofessional team, (iii) The design of GPPC enabled a shared experience, allowing for increased support of the pregnant person, and (iv) GPPC facilitated a supportive transition into the community which positively impacted participants' emotional well- being.

CONCLUSIONS

The four constructs of social support (emotional, informational, instrumental and appraisal) were central to the value that participants found in GPPC. This support from the team of healthcare providers, peers and partners had a positive impact on participants' mental health and helped them face the challenges of their transition to parenthood.

Health, social, and dental professionals' experiences of working within an extended home-visit program in the child healthcare: a qualitative interview study in Sweden

BACKGROUND

The goal of the Swedish child healthcare system is to reach all children with health-promotive actions and to create equal health opportunities for all children. In that context, an extended home-visit program - called Grow Safely - for first-time parents, with an interprofessional collaboration between child healthcare nurses, midwives, social workers, and dental assistants, was initiated. The current study aims at illuminating and evaluating the health, social, and dental professionals' experiences of working within this program and how such collaboration could benefit the professions.

METHODS

A qualitative method was chosen, and 13 interviews were carried out with professionals working within child healthcare centers that participated in an extended home-visit program in the southernmost part of Sweden. The interviews were analyzed via Burnard's approach to content analysis.

RESULTS

The results showed that it was satisfying for the health, social, and dental professionals to work with the home-visit program and that they encountered positive feelings among the parents receiving it. The creation of deep conversations and parents opening up about feelings that could otherwise be shameful to express, was a positive aspect of the home visits. A negative aspect was the difficulty of handling the (sometimes necessary) interpretation over the phone during the visits, and another one was the fact that the visits were time-consuming and required logistical planning. Overall, the professionals were positive about the home-visit program in that they felt that they were able to give the families what they needed and to have discussions on sensitive issues. They also appreciated the fact that different professions collaborated in order to reach the same goal.

CONCLUSIONS

This study showed that the health, social, and dental professionals enjoyed working with the home-visit program and that they encountered positive feelings among the parents regarding the collaborative visits being conducted within the home, where the families felt safe and relaxed. The professionals expressed that the home visits, despite the extended time they required and the logistical challenges involved, created a deeper collaboration between the professionals.

"But at home, with the midwife, you are a person": experiences and impact of a new early postpartum home-based midwifery care model in the view of women in vulnerable family situations

BACKGROUND

Postpartum home-based midwifery care is covered by basic health insurance in Switzerland for all families with newborns but must be self-organized. To ensure access for all, Familystart, a network of self-employed midwives, launched a new care model in 2012 by ensuring the transition from hospital to home through cooperation with maternity hospitals in the Basel area. It has particularly improved the access to follow-up care for families in vulnerable situations needing support beyond basic services. In 2018, the SORGSAM (Support at the Start of Life) project was initiated by Familystart to enhance parental resources for better postpartum health outcomes for mothers and children through offering improved assistance to psychosocially and economically disadvantaged families. First, midwives have access to first-line telephone support to discuss challenging situations and required actions. Second, the SORGSAM hardship fund provides financial compensation to midwives for services not covered by basic health insurance. Third, women receive financial emergency support from the hardship fund.

AIM

The aim was to explore how women living in vulnerable family situations experienced the new early postpartum home-based midwifery care model provided in the context of the SORGSAM project, and how they experienced its impact.

METHODS

Findings are reported from the qualitative part of the mixed-methods evaluation of the SORGSAM project. They are based on the results of seven semi-structured interviews with women who, due to a vulnerable family postpartum situation at home, received the SORGSAM support. Data were analyzed following thematic analysis.

RESULTS

Interviewed women experienced the early postpartum care at home, as "relieving and strengthening" in that midwives coordinated patient care that opened up access to appropriate community-based support services. The mothers expressed that they felt a reduction in stress, an increase in resilience, enhanced mothering skills, and greater parental resources. These were attributed to familiar and trusting relationships with their midwives where participants acknowledged deep gratitude.

CONCLUSION

The findings show the high acceptance of the new early postpartum midwifery care model. These indicate how such a care model can improve the well-being of women in vulnerable family situations and may prevent early chronic stress in children.

Women's experiences of continuity of care from student midwives - A qualitative study from Norway

OBJECTIVE

The study aimed to gain a deeper understanding of women's experience of continuity of care by student midwives during the childbearing process.

METHOD

A qualitative approach was the design used in this study. In-depth interviews were conducted with nine women who had received continuity of care during their childbearing process by student midwives. The interviews were analysed with the help of systematic text condensation. The study was approved by the Norwegian Centre for Research Data (ref. 905085) and the Regional Research Ethics Committee (ref. 2019/608).

FINDINGS

Continuity of care enabled a deep relationship between the woman and the student midwife and made the care provided more individualised, giving the woman emotional support and preparing her for birth. The presence of a student midwife during labour and birth who knew the woman's story made the woman able to focus on the birth process. Even when unexpected events occurred, the woman had a positive birth experience due to the relationship between her and the student midwife. Continuity of care made the women feel safe and taken care of and was the preferred model of care.

CONCLUSION

Continuity of care contributes to individualised and personalised care, enabling all aspects of the woman's needs to be considered throughout the childbearing process. Due to the positive impact on the women in the present study, it is appropriate to implement a continuity of care model in midwifery education programmes. Further research should be conducted to examine how doing so would influence both student midwives and women.

Support during the postnatal period: Evaluating new mothers' and midwives' experiences of a new, coordinated postnatal care model in a midwifery clinic in Sweden

OBJECTIVE

Continuity of care as provided by midwives promoting the health and well-being of new mothers during the postnatal period is critical; thus, access to midwifery services needs to be facilitated. The aim of this study was to describe new mothers' and midwives' experiences and perceptions of a new coordinated postnatal care intervention in a midwifery clinic.

DESIGN

New mothers responded to open-ended questions in a survey, and midwives were interviewed individually about the intervention. A deductive content analysis research related to continuity of care concepts was used.

SETTING AND PARTICIPANTS

The study was carried out at a midwifery clinic in a larger city in Sweden, for an eight-month period in 2019 and 2020. Two hundred and sixteen answers from new mothers and nine interviews with midwives were analysed.

INTERVENTION

All registered pregnant women at the midwifery clinic received enhanced postnatal support based on a new coordinated postnatal care model. The focus was on continuity of care, from pregnancy to the postnatal period and included planning for the first weeks after childbirth at the end of pregnancy, early postnatal contact and several visits to the midwifery clinic.

FINDINGS

New mothers describing the coordinated postnatal care model highlighted continuity and accessibility as empowering factors that made them feel assured and confident. Midwives emphasised the pregnancy to postnatal continuity as crucial to providing care based on individual needs.

KEY CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Using a structured and coordinated care model as a midwife that includes planning for the postnatal period together with the pregnant woman at the end of pregnancy may be a good and relatively easy way to create continuity and thus ensure satisfaction and confidence in expectant and new mothers.

"She was there all the time". A qualitative study exploring how women at higher risk for preterm birth experience midwifery continuity of care

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.

Home-based postnatal midwifery care facilitated a smooth succession into motherhood: A Swedish interview study

INTRODUCTION

If a family is discharged from a hospital earlier after birth, close supervision by a skilled midwife is essential. The aim was to describe mothers' overall experience receiving postnatal care in a Swedish home-based midwifery care model.

METHODS

A descriptive qualitative study was conducted. Mothers meeting the inclusion criteria for a new home-based postnatal care model at a hospital in Stockholm, Sweden, were included. In total, 24 healthy mothers participated in a semi-structured telephone interview, averaging 58 minutes. Data were analyzed using thematic analysis, according to Braun and Clarke.

RESULTS

The main theme explored, 'The home-based postnatal care model facilitated a smooth succession into motherhood', is explained by the themes: 1) Mothers felt 'not left adrift' when cared for by the home-based postnatal midwives; 2) Professional midwives with authority guided the way into motherhood; and 3) The home, a safe and secure space for new mothers.

CONCLUSIONS

Mothers valued the well-structured home-based postnatal midwifery care. Important for mothers was to receive health checks, adequate information, and that midwives have a kind and individual approach to the families. Midwives play an important role for mothers in the early days after the birth of their baby.

Factors that influence uptake of routine postnatal care: Findings on women's perspectives from a qualitative evidence synthesis

BACKGROUND

Effective postnatal care is important for optimal care of women and newborns-to promote health and wellbeing, identify and treat clinical and psychosocial concerns, and to provide support for families. Yet uptake of formal postnatal care services is low and inequitable in many countries. As part of a larger study examining the views of women, partners, and families requiring both routine and specialised care, we analysed a subset of data on the views and experiences of women related to routine postnatal care.

METHODS

We undertook a qualitative evidence synthesis, using a framework analysis approach. We included studies published up to December 2019 with extractable qualitative data, with no language restriction. We focused on women in the general population and their accounts of routine postnatal care utilization. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews, and grey literature. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and scientific quality assessment were carried out using a study-specific extraction form and established quality assessment tools. The analysis framework was developed a priori based on previous knowledge and research on the topic and adapted. Due to the number of included texts, the final synthesis was developed inductively from the initial framework by iterative sampling of the included studies, until data saturation was achieved. Findings are presented by high versus low/middle income country, and by confidence in the finding, applying the GRADE-CERQual approach.

FINDINGS

Of 12,678 papers, 512 met the inclusion criteria; 59 articles were sampled for analysis. Five themes were identified: access and availability; physical and human resources; external influences; social norms; and experience of care. High confidence study findings included the perceived low value of postnatal care for healthy women and infants; concerns around access and quality of care; and women's desire for more emotional and psychosocial support during the postnatal period. These findings highlight multiple missed opportunities for postnatal care promotion and ensuring continuity of care.

CONCLUSIONS

Factors that influence women's utilization of postnatal care are interlinked, and include access, quality, and social norms. Many women recognised the specific challenges of the postnatal period and emphasised the need for emotional and psychosocial support in this time, in addition to clinical care. While this is likely a universal need, studies on mental health needs have predominantly been conducted in high-income settings. Postnatal care programmes and related research should consider these multiple drivers and multi-faceted needs, and the holistic postpartum needs of women and their families should be studied in a wider range of settings.

REGISTRATION

This protocol is registered in the PROSPERO database for systematic reviews: CRD42019139183.

Midwives’ experiences of an organizational change in early postpartum care services in Norway: A qualitative study

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

Interprofessional Teamwork to Promote Health: First-Time Parents' Experiences of a Combined Home Visit by Midwife and Child Health Care Nurse

BACKGROUND

To achieve the requisites for a child's healthy development and to reduce health inequalities, it is important to promote health initiatives at an early stage in a child's life and to include the parents. Home visits by healthcare professionals have been found to have positive health effects for both the baby and the parents. From an extended home visit programme in Sweden, our aim was to illuminate first-time parents' experience of a home visit conducted by a midwife and a child health care nurse 1-2 weeks postnatal.

METHODS

Data was collected by interviews (n = 13) with first-time parents. The transcribed texts were analyzed using inductive content analysis.

RESULTS

The participants' experiences could be understood from the two themes, A trust in the professionals and Feeling safe as a new parent. The participants experienced that the midwives and the child health care nurses complemented each other and appreciated to get knowledge and information from both professions. In their own home, they felt secured and relaxed, and the professionals could help them provide a safe home environment for the child.

CONCLUSION

By meeting both professionals at the same time and in their own home, the participants experienced that the needs of the baby and their needs and concerns as new parents were included and supported.

Midwifery continuity of care: A scoping review of where, how, by whom and for whom?

Systems of care that provide midwifery care and services through a continuity of care model have positive health outcomes for women and newborns. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? Using a scoping review framework, we searched electronic and grey literature databases for reports in any language between January 2012 and January 2022, which described current and recent trials, implementation or scaling-up of midwifery continuity of care studies or initiatives in high-, middle- and low-income countries. After screening, 175 reports were included, the majority (157, 90%) from high-income countries (HICs) and fewer (18, 10%) from low- to middle-income countries (LMICs). There were 163 unique studies including eight (4.9%) randomised or quasi-randomised trials, 58 (38.5%) qualitative, 53 (32.7%) quantitative (cohort, cross sectional, descriptive, observational), 31 (19.0%) survey studies, and three (1.9%) health economics analyses. There were 10 practice-based accounts that did not include research. Midwives led almost all continuity of care models. In HICs, the most dominant model was where small groups of midwives provided care for designated women, across the antenatal, childbirth and postnatal care continuum. This was mostly known as caseload midwifery or midwifery group practice. There was more diversity of models in low- to middle-income countries. Of the 175 initiatives described, 31 (18%) were implemented for women, newborns and families from priority or vulnerable communities. With the exception of New Zealand, no countries have managed to scale-up continuity of midwifery care at a national level. Further implementation studies are needed to support countries planning to transition to midwifery continuity of care models in all countries to determine optimal model types and strategies to achieve sustainable scale-up at a national level.

Early discharge from hospital after birth:How Norwegian parents experience postnatal home visits by midwives - A qualitative study

BACKGROUND

According to the WHO, the quality of care is not conditioned by the length of stay at the postnatal ward. As long as the postnatal care provided is of high quality, it could be better for the family to stay in their home.

AIM

Firstly, to examine parents' experiences of early discharge and home visits by the postnatal ward midwife, in cases where the mother and baby have been discharged within 24 h after birth. Secondly, to examine participants' motivation for opting for early discharge from the hospital.

METHODS

10 individual interviews were conducted, including five where both parents were present. The interviews were carried out 4-12 weeks after birth. The data were analysed using systematic text condensation.

RESULTS

The choice of early discharge was influenced by external factors like a wish to be together as a family while receiving sufficient support from both family and midwife. Internal factors, like previous experience, were also significant. The presence and attitude of the midwife, both in professional and practical terms, affected how the parents perceived postnatal care. Home visits from the midwife also affected the parents' feeling of security.

CONCLUSION

An offer of home visits from the midwife of the postnatal ward enables parents who wish to leave the hospital shortly after birth to receive the necessary care and support in the early postnatal period. This offer is suitable for healthy women who have given birth to a healthy baby and wish to return home not long after birth.

Identification of quality indicators of public health nursing practice: "modified Delphi" approach

OBJECTIVE

Identify process indicators to measure public health nursing practice during first postnatal visits in Ireland.

DESIGN

Using a RAND/UCLA appropriateness- "modified Delphi" method, a two-round rating and ranking process was completed in 2016. Fifty-nine statements were reviewed for consensus and priority ranking.

SAMPLE

The sample comprised a panel of 21 national and international experts.

RESULTS

Fifty-nine indicators were identified and subsequently reduced across two rounds of consensus testing. Fifty-six indicators achieved consensus and priority ranking identified 13 indicators to measure care for mothers and 15 indicators to measure care for newborns resulting in 28 process indicators to enable Public Health Nurses (PHNs) to measure care during the first postnatal visit.

CONCLUSIONS

Measurement of care using quality indicators plays an integral role in quality improvement. Developing quality indicators is important in improving care outcomes. This two round "modified Delphi" study combined with literature and previous qualitative findings identified process indicators to measure public health nursing practice at first postnatal visits and enables benchmarking. Developing quality indicators for public health nursing practice using a "modified Delphi" technique has enabled a platform to provide consensus amongst a panel of experts and identified key processes of care by PHNs and mothers.

Work environment challenging Irish public health nurses' care quality: First postnatal visit

OBJECTIVES

Exploring views and experiences of public health nurses of their work environment and measurement of care practices at first postnatal visits.

DESIGN

An exploratory qualitative design. Data collected using four focus groups and analyzed using thematic analysis.

SAMPLE

Nineteen public health nurses from four health service regions in Ireland participated.

RESULTS

Two themes emerged. Theme one identified "challenges of providing a quality service." Public health nurses identified workload demands and that the working environment can detract from the ability to provide a quality service. Challenges within the home, language barriers, and lack of support from management were key issues. Theme two identified "challenges of measuring quality of public health nursing practice." While Measuring practice through quantitative outcomes such as key performance indicators were viewed as inadequate to measure the quality of care provided, positive views of using quality process indicators to measure the quality of their practice emerged.

CONCLUSIONS

Key issues concern the working environment of public health nurses and challenges of providing and measuring care practices. Absence of appropriate supports and resources means public health nurses work hard to provide quality care. Public health nurses were confident they would score high on quality process measurements of their practice.

Experiences of women discharged early following vaginal birth: a qualitative systematic review

OBJECTIVE

The objective of this qualitative review was to evaluate the meaningfulness of early hospital discharge for women following a normal vaginal birth.

INTRODUCTION

A challenge for maternity services nationally and internationally is to identify what services may be restructured or reduced to enable cost savings while not compromising safe, quality care. Many different models of care have emerged across maternity services in relation to facilitating early hospital discharge. Different models of care complicate evaluation of early discharge programs because of the different staffing components, professional collaborative arrangements, and approaches to antenatal and postnatal care.

METHODS

Databases searched included: CINAHL, PubMed, Scopus, Embase and ProQuest Dissertations and Theses. The search was conducted between March and May 2018 and repeated again in March 2019. Only qualitative research written in English since 1970, when publications on the topic first started to appear, were considered for inclusion in this review. Critical appraisal of identified manuscripts and qualitative data extraction occurred. Findings were assembled according to their quality, and categorized on the basis of similarity in meaning. These categories were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings.

RESULTS

A search of the literature identified seven papers for final inclusion. The meta-synthesis resulted in 22 findings, 9 categories, and the following five synthesized findings: i) Women who committed to early discharge had a positive experience; ii) Women recognized that supportive family and friends were an important resource when experiencing early discharge; iii) Women found that supportive midwives enabled a positive transition at home following early discharge; iv) Women who were ready for discharge gained control of their lives more quickly when they went home early and commenced their own routine; v) Early discharge may not be suitable for some women. Synthesized findings were used to construct a theory that comprehensively explained the women's experience.

CONCLUSIONS

This qualitative systematic review resulted in seven moderate-quality studies that explored women's experiences of early postnatal discharge. Women who commit to, are prepared for, and have access to partner, family, and midwife support are most likely to have positive experiences when they arrive home from hospital with a new infant. Each woman, however, has a unique personality, life story, and support network that must be considered when identifying whether early discharge is appropriate. Early discharge following birth should be determined on an individual basis and in consultation with the woman. There is no agreed definition of early discharge from hospital. The different approaches to models of maternity care can complicate evaluation attempts to understand women's experiences of early discharge because of different staffing components and approaches to antenatal and postnatal care provision. There was a gap in the literature around women without partners or whose partners were unable or unwilling to provide emotional and practical support following early discharge.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42017084024.

Community-based assessment of postnatal care in Puducherry-A cross-sectional study

Introduction:

Postnatal period is a neglected period compared to the antenatal period. Providing adequate care to infant and mother during this vital period is essential.

Objectives:

To assess the postnatal care (PNC) received by the mothers and newborn children in Puducherry.

Materials and Methods:

Community-based cross-sectional study done among the postnatal mothers under the care of two urban Primary Health Centers (PHC A and PHC B) in Puducherry in 2015–2016. Eligible mothers were contacted at their houses within 4 weeks of completion of their postnatal period to assess the postnatal care.

Results:

Out of 227 postnatal mothers in the study, only 37.4% (85) (95%CI 31.3–43.9) of the mothers had received adequate counselling services on topics of nutrition, hygiene, contraception, essential newborn care, breastfeeding, and immunization. Cord care was given for 99.1% of the babies and breastfeeding position was checked for 88.5% of the babies. Among the mothers who had normal deliveries, 48.1% (76) (95% CI 40.4–55.9) of the mothers had initiated breastfeeding within 1 h of normal delivery and within 4 h of delivery for 72.4% (50) (95% CI 61.1–82.0) among the mothers who had a cesarean section. Only 20.7% (47) (95%CI 15.8–26.3) of the mothers and newborns had received at least one postnatal home visit and none of the mothers had received adequate postnatal home visits as per Indian Public Health Standards guidelines. Out of the 126 eligible mothers for JSY benefits, only 46% (58) (95% CI 37.5–54.8) of them had registered. Among those who were not registered, 20.6% had reported that they were unaware of the scheme. Out of 227 births, 14.1% (32) of them were of low birth weight (<2.5 kg) and 1.3% (3) were of very low birth weight (<1.5 kg) category.

Conclusion:

Although the antenatal care is satisfactory in the study setting, implementation of PNC needed further attention and active guidance via health system strengthening.

The maternal health-related issues that matter most to women in Ireland as they transition to motherhood - A qualitative study

BACKGROUND

Many studies on women's maternity care experiences reveal recurring issues that are poor or less than optimal. Women's opinions on the maternal health-related issues that matter most to them are essential if care and services are to be improved.

AIMS

To identify the maternal health-related issues that matter most to women in Ireland, based on their own experiences of maternity care, services and motherhood.

METHODS

A qualitative exploratory study with 24 women. Following university ethical approval, audio-recorded one-to-one telephone interviews were conducted and thematically analysed.

FINDINGS

We identified two themes, each with four subthemes, connected to a central concept of the invisible woman. Pendulum of care, and subthemes Inconsistent services, All about the baby, Induced anxiety and Information seesaw, illustrated the extremes of care and services that women experienced. Magnitude of motherhood, and subthemes Weight of responsibility, Real-time reassurance, Change of identity and Growth into advocacy, depicted the intensity of their new role while transitioning to motherhood.

DISCUSSION

Findings articulate the issues that mattered most to women in Ireland as they transitioned to motherhood. Some women identified specific research topics/areas, but all of the issues identified can be translated into researchable topics that seek to improve local care and service provision.

CONCLUSION

Given the recurring nature of women's less than satisfactory experiences of aspects of maternity care in many countries, it is likely that conducting research on issues that matters most to women will have the greatest impact on their health, wellbeing and lives as they transition to motherhood.

Quality improvement in postnatal care: Findings from two cohorts of women in Sweden

INTRODUCTION

Postnatal care is an important area of midwifery practice. Changes in the length of postnatal stay, models of postnatal care, and the content of care have influenced women's satisfaction. The aim of this study was to describe women's assessment of postnatal care in a Swedish hospital in 2017, and to compare this with women who gave birth in 2006 in the same hospital.

METHODS

A comparative study was conducted of two cohorts of women who gave birth in 2006 and 2017 in a hospital in the middle-north part of Sweden with 1700 annual births. Data were collected by questionnaires, where data from 2017 were compared with data from 2006.

RESULTS

In all, 366 women who gave birth in 2006 and 342 in 2017 responded. There was a reduction in time of discharge in 2017 and more women went home directly from the labour ward and fewer women had their postnatal stay in the hotel ward, compared to postnatal women in 2006. A higher percentage of women were 'Very satisfied' with the overall aspects of postnatal care in 2017 compared to women in 2006. The content of postnatal care showed statistically significant improvements over time for the majority of variables studied, but some women reported not receiving information/help with specific postnatal aspects. Multiparous women, women older than 35 years, and women who had had a caesarean section received less information and practical help.

CONCLUSIONS

The study showed an increase in overall satisfaction with postnatal care over time and most areas were improved. Continuous work is therefore needed in order to improve postnatal care and put the women and their families at the centre of care. More research is needed to try new models of care that will increase satisfaction with postnatal care.

A qualitative study of first time mothers' experiences of postnatal social support from health professionals in England

PROBLEM

Many women experience the transition to motherhood as stressful and find it challenging to cope, contributing to poor emotional wellbeing.

BACKGROUND

Postnatal social support from health professionals can support new mothers in coping with this transition, but their social support role during the postnatal period is poorly defined.

AIM

To explore how first time mothers in England experienced social support from health professionals involved in their postnatal care.

METHODS

A qualitative descriptive study, theoretically informed by phenomenological social psychology, based on semi-structured, in-depth interviews with 32 mothers from diverse backgrounds. These were analysed using inductive thematic analysis, with themes subsequently mapped on to the four dimensional model of social support (emotional, appraisal, informational, practical).

FINDINGS

There were nine themes connected to social support, with the strongest mapping to appraisal and informational support: for appraisal support, 'Praise and validation', 'Criticism and undermining', and 'Made to feel powerless'; for informational support, 'Is this normal?', 'Need for proactive information', and 'Confusion about postnatal care'; for emotional support, 'Treated as an individual and heard' and 'Impersonal care and being ignored'; for practical support, 'Enabling partners to provide practical support'.

CONCLUSIONS

Health professionals can play an important role postnatally in helping first time mothers to cope, develop confidence and to thrive, by taking every opportunity to give appropriate and personalised appraisal, informational and emotional social support alongside clinical care. Training and professional leadership may help to ensure that all health professionals are able and expected to offer the positive social support already offered by some.

Parents' experiences of early discharge after a planned caesarean section: A qualitative interpretive study

OBJECTIVE

The birth rate in Denmark is increasing, and the rate of births by caesarean section has increased to more than 20%. Thus, the obstetric departments have been put under pressure to identify new solutions to optimize the maternity care system, in which early discharge might be considered. The aim of this study was to explore parents' experiences of the postnatal care after planned caesarean section with focus on factors that support or hinder early discharge.

DESIGN

An interpretive, hermeneutic approach was chosen, using qualitative interviews with multiparous women and their partners. Data analysis was performed using thematic analysis.

PARTICIPANTS AND SETTING

Twelve women and partners were recruited from two hospital-based maternity units in Denmark. The inclusion criteria were low-risk Danish-speaking multiparous women having a planned caesarean section with a singleton pregnancy (gestational age between 37+0 and 41+6 weeks). Seven sets of parents were discharged before 28 h and five were discharged after 48 h.

FINDINGS

Three main themes were identified as important for timing of discharge: (1) Setting for recovery (2) Views on length of stay, and (3) Preparation and individual planning. All parents valued the safe and supportive environment at the hospital, but several preferred early discharge as they felt more comfortable in their home environment and wanted to be together as a family with all siblings. When considering appropriate time of discharge, the main issues were that pain was manageable, that breastfeeding was initiated successfully and that professional support was available after discharge. Finally, early discharge required preparation and planning and the parents stressed the importance of knowing that they would not be discharged unless they felt ready.

CONCLUSION AND IMPLICATION FOR PRACTICE

A clear link was observed between the care package the parents received and their views on the optimal time of discharge. Based on our findings it seems likely that a significant proportion of parents will accept and feel confident about early discharge if individual circumstances are taken into account in the antenatal planning of a caesarean section.

Three perspectives on the co-location of maternity services: qualitative interviews with mothers, midwives and health visitors

Maternity policy in England has recommended the establishment of Community Hubs, where health-care professionals who care for women during and after pregnancy are co-located and can provide care collaboratively. The aim this paper is to explore midwives,' health visitors' and postnatal women's experiences and views of co-location of midwifery and health visiting services and collaborative practice. In total 15 midwives, 17 health visitors, and 29 mothers participated in a semi-structured interview, either via phone or face-to-face. Transcripts were analyzed thematically. Participants reported how care is currently provided in numerous settings, with home visits especially well liked. Co-location was perceived to be of benefit, however some mothers were not convinced of its necessity, suggesting that integrated services are more important than co-located services. Health-care professionals recognized that co-location aids but does not automatically improve interprofessional collaboration. These findings highlight the need for careful consideration before implementing co-located maternity services. Community Hubs may be apromising strategy to improve care for women and their families but to provide interprofessional care and collaboration appropriate managerial and organizational support is needed. With this support, midwives and health visitors have the potential to deliver the best care possible for women and their families.

A theory of the aims and objectives of midwifery practice: A theory synthesis

INTRODUCTION

Every discipline has a dichotomous objective by which it recognizes whether its work has been successful (Vogd, 2011). For midwifery care, no objective has been set in this way so far. This also has implications for measuring quality, because quality of care is only measurable if objectives have been identified. This paper aims to contribute to theory formation in midwifery science by analysing existing concepts and theories and preferences of women to midwifery care to answer the question of the dichotomous objective of midwifery.

METHOD AND FINDINGS

The method of theory synthesis (Walker and Avant, 2011) was used to analyse existing theories and concepts of midwifery care and literature-based preferences of women to midwifery care and synthesize them with regard to the objectives of midwifery care. The synthesis took place in the form of a means-end chain to extract the dichotomous target of midwifery care. In this way, the objectives of midwifery could be compared and linked from both the scientific and from women's perspective. The resulting means-end chain model of the process of midwifery describes the aims and objectives of midwifery from the point of view of women on three levels.

DISCUSSION

The hierarchical model of the process of midwifery presented here is a first attempt to illustrate the aims and objectives of midwifery practice in a means-end chain model in order to facilitate discussion on the topic and to make the quality of midwifery care measurable. Measurement is a first step towards improving quality of midwifery care and thereby improving women's reproductive capabilities.

Women's successful transition to motherhood during the early postnatal period: A qualitative systematic review of postnatal and midwifery home care literature

OBJECTIVE

To undertake a systematic review of available qualitative research literature to determine what women need to successfully transition to motherhood during the early postnatal period and whether postnatal home care delivered by midwives supports this process.

DESIGN

The transition from woman to mother is a significant occurrence, one that requires adjustments on physical, psychological and social levels. A qualitative systematic review design was chosen to ensure both humanistic and interactive concepts related to what women need to successfully transition to motherhood during the early postnatal period were identified. The systematic and structured search uncovered 33 research articles for detailed review. Two team members, using the qualitative research checklist from the Critical Appraisal Skills Programme, appraised the quality of the research articles. A total of 19 articles met the quality criteria and were included in the data evaluation process.

SETTING AND PARTICIPANTS

Research teams from Asia-Pacific, Europe, Middle East and North America generated the 19 qualitative journal articles.

MEASUREMENTS AND FINDINGS

Data evaluation included identification of research aim, presence of a research question, type of methodology, data collection processes, sample information, data analysis techniques and study outcomes. Data was analysed using an inductive content analysis approach. Four themes were identified from the qualitative systematic review process including: women and midwives connecting, identification and meeting of women's individual needs, family and cultural influences and, education and support.

KEY CONCLUSIONS

The ability of women to connect with midwives during the early postnatal period assisted them overcome barriers and to successfully transitioning to motherhood. Although all four themes were determined to be key to effective postnatal transition, overwhelmingly the findings showed postnatal midwifery home care to be important in women's successful transition to motherhood in the early postnatal period.

IMPLICATIONS FOR PRACTICE

Strategies are needed ensure women have access to midwives in the early postnatal period.

Pregnant Women in Turkey Experience Severe Fear of Childbirth: A Systematic Review and Meta-Analysis

Background: Culture is an important factor to determine fear of childbirth which is shaped by social learning processes. The purpose of this study is to determine the level of fear of childbirth among Turkish healthy pregnant women. Method: The researchers reviewed the eight databases considering inclusion criteria and 14 studies were included. The data analysis was conducted using meta-analysis. Results: Pregnant women experienced severe levels of fear, 67.26 ± 4.08, 95% confidence interval [59.26, 75.26], and 21 out of every 100 women experienced clinical level of fear. Between study variance was significant for parity (Qb = 6.40, p = .04) and region (Qb = 19.14, p = .00) moderators. Conclusions: The high level of FOC, particularly in the Eastern region, suggests that some of the cultural factors in the Eastern region in Turkey negatively affect the birth expectations. In a country like Turkey with a multicultural population, the health care professional should provide culturally sensitive care.

Fathers' experiences during the first postnatal week at home after early discharge of mother and baby from the maternity unit: A meta-synthesis

Aim: The aim of this study was to explore and describe fathers' experiences during the first postnatal week after early discharge of mother and baby from the maternity unit. Methods: A meta-synthesis. Inclusion criteria: peer-reviewed qualitative single studies of fathers' experiences during the first week after early discharge (defined as less than 72 hours postpartum) from hospital after the birth of a healthy singleton baby born between weeks 37 and 40. Databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Maternity and Infant Care, Joanna Briggs, SweMed+ and PsycInfo were searched in May 2015 and May 2018. Of the 940 titles scanned for eligibility, three articles met the inclusion criteria. The consolidated criteria for reporting qualitative research checklist was used. Findings: All included studies were conducted in Sweden during the period 2002-2012. The total sample of participants in the meta-synthesis comprised 35 fathers. Analysis of the included studies generated two themes: building confidence and coping with responsibility. Conclusions: The fathers' experiences were affected by the emotional support of midwives, which boosted their confidence. This seems to be a premise for taking and coping with responsibility during the first days at home. Good cooperation between hospitals and municipalities is vital, and midwives must be available and present in order to ensure continuity in maternity care.

How Tanzanian Nurse-Midwives and Obstetricians Develop Postpartum Relationships With Women

Nurse-midwives and obstetricians are the primary postpartum health-care providers for mothers and babies in Tanzania. It is imperative that mothers and babies receive adequate information and support in order to save lives. Feminist poststructuralism and discourse analysis were used to conduct and analyze 13 semi-structured interviews from nurse-midwives and obstetricians at three clinics in Dar es Salaam, Tanzania. Establishing friendly supportive relationships enabled nurse-midwives and obstetricians to work effectively with mothers postpartum. Participants explained the importance of including family members in postpartum care and about the strategies they used in a clinic environment that was not always supportive of including family. Effective relational maternity care focused on families during the postpartum period can facilitate the delivery of information and save lives.

The Effectiveness and Cost-Effectiveness of Web-Based and Home-Based Postnatal Psychoeducational Interventions for First-Time Mothers: Randomized Controlled Trial Protocol

BACKGROUND

In addition to recuperating from the physical and emotional demands of childbirth, first-time mothers are met with demands of adapting to their social roles while picking up new skills to take care of their newborn. Mothers may not feel adequately prepared for parenthood if they are situated in an unsupported environment. Postnatal psychoeducational interventions have been shown to be useful and can offer a cost-effective solution for improving maternal outcomes.

OBJECTIVE

The objective of this study was to examine the effectiveness and cost-effectiveness of Web-based and home-based postnatal psychoeducational programs for first-time mothers on maternal outcomes.

METHODS

A randomized controlled three-group pre- and posttests experimental design is proposed. This study plans to recruit 204 first-time mothers on their day of discharge from a public tertiary hospital in Singapore. Eligible first-time mothers will be randomly allocated to either a Web-based psychoeducation group, a home-based psychoeducation group, or a control group receiving standard care. The outcomes include maternal parental self-efficacy, social support, psychological well-being (anxiety and postnatal depression), and cost evaluation. Data will be collected at baseline, 1 month, 3 months, and 6 months post-delivery.

RESULTS

The recruitment (n=204) commenced in October 2016 and was completed in February 2017, with 68 mothers in each group. The 6-month follow-up data collection was completed in August 2017.

CONCLUSIONS

This study may identify an effective and cost-effective Web-based postnatal psychoeducational program to improve first-time mothers' health outcomes. The provision of a widely-accessed Web-based postnatal psychoeducational program will eventually lead to more positive postnatal experiences for first-time mothers and positively influence their future birth plans.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): 45202278; http://www.isrctn.com/ISRCTN45202278 (Archived by WebCite at http://www.webcitation.org/6whx0pQ2F).

[Evaluation of the perception of postpartum stressors at the Marseille Gynepole]

INTRODUCTION

Maternity stay following childbirth corresponds to the early postpartum period. Birth-related events may be perceived as a major source of stress by women and these events can cause certain disorders during this period, such as anxiety and postnatal depression. The aim of this study was to investigate women's perception of post-delivery stress factors.

METHODS

An overall descriptive study of the target population (n = 206) was carried out and primiparous (n = 96) and multiparous (n = 110) women were then compared in two level III public maternity units in the Marseille Gynépole. The Post-Delivery Perceived Stress Inventory (PDPSI) was the psychometric scale used to collect data. A correlation between the various items of the PDPSI was investigated.

RESULTS

The experience of childbirth is perceived as the main stress factor by 45% of mothers. This factor was significantly correlated (p < 0.05) with 3 items of the PDPSI and very significantly correlated (p < 0.001) with 11 of the 16 items constituting the other 4 factors of the PDPSI. Primiparous women significantly perceived (p < 0.05) childbirth as being more stressful than multiparous women. They also felt very significantly (p < 0.001) more stressed by care activities (bathing, changing) related to the relationship with the newborn factor.

CONCLUSION

These results encourage implementation of guidelines and the organization of informal ?conversations? in the maternity unit, and to conduct an early postnatal consultation at home for these mothers concerning their childbirth experience, which could be ensured by adequate social support based on empathic listening and reassuring actions about parenting.

The care needs of postpartum women taking their first time of doing the month: a qualitative study

BACKGROUND

In contemporary Taiwan, after giving birth, many women undertake a traditional postpartum practice called 'doing the month', which occurs in the medical context of postpartum nursing centres instead of at home. Thus, healthcare workers must identify and address the care needs of new mothers in this setting to improve the care of new mothers and their baby and family.

AIM

To explore new mothers' care needs from their own perspectives during the period of doing the month.

METHODS

A qualitative study was performed. Eligible participants recruited through purposive sampling were interviewed comprehensively.

RESULTS

Twenty-seven primiparous women participated (mean age: 32 years; mean marriage length: 3.4 years). Four themes were identified: the need to increase energy to gain more yang force, the need to internalise mothering, the need to be supported by the family and friends, and the need to be understood.

CONCLUSIONS

For effective care, sufficient support and guidance must be provided to first-time mothers and their families, especially when mother-baby rooming-in is the standard of care.

Barriers to utilization of postnatal care at village level in Klaten district, central Java Province, Indonesia

BACKGROUND

Maternal health remains a persisting public health challenge in Indonesia. Postnatal complications, in particular, are considered as maternal health problems priority that should be addressed. Conducting adequate care for postnatal complications will improve the quality of life of mothers and babies. With the universal health coverage implementation, the Indonesian government provides free maternal and child health services close to clients at the village level, which include postnatal care. Our study aimed to explore barriers to utilization of postnatal care at the village level in Klaten district, Central Java Province, Indonesia.

METHODS

A qualitative study was conducted in March 2015 - June 2016 in Klaten district, Central Java, Indonesia. We selected a total of 19 study participants, including eight mothers with postnatal complications, six family members, and five village midwives for in-depth interviews. We conducted a content analysis technique on verbatim transcripts of the interviews using open code software.

RESULTS

This study found three categories of barriers to postnatal care utilization in villages: mother and family members' health literacy on postnatal care, sociocultural beliefs and practices, and health service responses. Most mothers did not have adequate knowledge and skills regarding postnatal care that reflected how they lacked awareness and practice of postnatal care. Inter-generational norms and myths hindered mothers from utilizing postnatal care and from having adequate nutritional intake during the postnatal period. Mothers and family members conducted unsafe self-treatment to address perceived minor postnatal complication. Furthermore, social power from extended family influenced the postnatal care health literacy for mother and family members. Postnatal care in the village lacked patient-centered care practices. Additionally, midwives' workloads and capacities to conduct postnatal information, education and counseling were also issues.

CONCLUSIONS

Despite the government's efforts to provide free postnatal care closer to mothers' homes, other barriers to postnatal care utilization remained. Specifically, among mothers, community, and health services. An innovative approach to increase the health literacy on postnatal care is required. In particular, improving the capacity of midwives to conduct patient-centered care. In addition, village midwives' tasks should be evaluated and reoriented.