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Lai MYK, Wong MM, Kearney L, Lee N. The effect of antenatal hypnosis training on pharmacological analgesia use during labour and birth: A systematic review and meta-analysis. Midwifery 2024; 137:104113. [PMID: 39047320 DOI: 10.1016/j.midw.2024.104113] [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: 03/06/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The use of hypnosis as a means of pain management during labour is becoming increasingly popular. While recent reviews have reported on pain perception, relaxation and other psychological benefits the impact of hypnosis on the use of pharmacological analgesia use has not been specifically examined. QUESTION For women in labour at term, does antenatal hypnosis instruction compared to no instruction result in decreased use of pharmacological analgesia and influence maternal and infant birth outcomes. METHODS Databases such as PubMed, CINAHL, Cochrane Central Register of Controlled Trials and Embase were searched with dates ranging from 1947-2024. We included randomised controlled trials (RCTs) that compared antenatal hypnosis training to no hypnosis control groups, published in English and reported on pharmacological analgesia use. The Cochrane's Risk of Bias 2 for RCTs was used to assess design quality. Study selection, quality assessment, data extraction and analysis were undertaken by two independent researchers. FINDINGS Six RCTs met the inclusion criteria (n=2937). The use of hypnosis did not result in a significant reduction in the risk of epidural use (RR. 0.79 95% CI 0.39-1.61) or other forms of pharmacological analgesia. Factors such as blinding of care providers to the participants allocated group may have reduced the chances of successful use of hypnosis. Variations in the presentation of hypnosis between studies may also impact on outcomes. DISCUSSION AND CONCLUSION This review reports no effect on the use of pharmacological analgesia in women trained in hypnosis antenatally compared with those who were not. Our review does highlight several RCT design characteristics that could impact on the measurement and analysis of the use and efficacy of hypnosis.
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Affiliation(s)
- Ms Yee Kay Lai
- School of Nursing Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Queensland, Australia
| | - Ms Michelle Wong
- School of Nursing Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Queensland, Australia
| | - Lauren Kearney
- School of Nursing Midwifery and Social Work, University of Queensland/Royal Brisbane Women's Hospital, Level 6, Ned Hanlon Building, Queensland, Australia
| | - Nigel Lee
- School of Nursing Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Queensland, Australia.
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Whitburn LY, Cullinane M, Benzie C, Newton MS, McLachlan HL, Forster DA. Women's views and experiences of a new Midwifery Group Practice model in rural Australia. Women Birth 2024; 37:101603. [PMID: 38657332 DOI: 10.1016/j.wombi.2024.101603] [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: 09/14/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Women in rural Australia often have limited maternity care options available, and in Victoria, like many Australian states, numerous small hospitals no longer offer birthing services. AIM To evaluate women's views and experiences of maternity care at a local rural hospital that re-established birthing services with a Midwifery Group Practice (MGP) model of maternity care. METHODS Women who booked into the new MGP model from May 2021 to June 2022 were invited to complete an anonymous online survey and participate in an optional additional semi-structured interview to explore their views and experiences. Descriptive statistics were used for quantitative data, and open-ended survey and interview responses were analysed using a general inductive approach. FINDINGS Sixty-seven percent (44/66) of women completed the survey and five also completed an interview. Women were highly satisfied with the care they received. They felt respected, empowered, and had a sense of agency throughout their pregnancies, labour and birth, and post-birth. They reported low levels of anxiety during labour and birth, and felt that they coped physically and emotionally better than they anticipated. They felt well supported by midwives and highly valued the continuity of care within the MGP model. CONCLUSION Women's voices play a critical role in informing maternity care provision, particularly for those in rural communities who may have limited access to care options. The findings support and expand on existing research regarding the value of midwifery continuity of care models, and can inform other rural maternity services in introducing similar models.
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Affiliation(s)
- Laura Y Whitburn
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Charlie Benzie
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Royal Women's Hospital, Locked Bag 300, Grattan Street & Flemington Road, Parkville, VIC 3052, Australia
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Kuipers YJ. The future of midwife-led continuity of care: Call for a dialogue. DIALOGUES IN HEALTH 2024; 4:100170. [PMID: 38516226 PMCID: PMC10953852 DOI: 10.1016/j.dialog.2024.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 03/23/2024]
Abstract
Background/Purpose Midwife-led continuity of care (MLCC) is an evidence-based care model positively influencing the health and wellbeing of women and their families. Despite the evidence, a sustainable future of the model is uncertain. The aim of this paper is to give an example of a theoretical exercise that enhances the understanding of the trends and developments impacting MLCC's future state. Methods The industrial complex theory scaffolded the theoretical approach. The intuitive logics scenario development methodology was used to structure the key variables that influence the utility of MLCC. Dimensionally structured scenarios representing the probable, possible and probable MLCC futures were written. Results Thirteen key variables that greatly impact the future MLCC, with varying degrees of certainty were identified. A theoretical framework representing two underlying meta dimensions of MLCC was constructed: identity system of midwife-led continuity of care (fixed vs fluid) and embodied orientation to the world (reasoning vs meaning making). Within the framework, four different storylines of possible, plausible prospective futures emerged: Sense & sensibility, The birth of mothers, Too many sisters and One-stop-shop. Conclusion The paper is an example of how to approach the future of MLCC, the method serving as a tool to establish a theoretical truth of how its future state may unfold, the scenarios facilitating a dialogue among stakeholders and informing the public.
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Affiliation(s)
- Yvonne J. Kuipers
- Edinburgh Napier University, School of Health & Social Care, Sighthill Campus, Edinburgh EH11 4BN, Scotland, UK
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McCalman P, Forster D, Newton M, McLardie-Hore F, McLachlan H. "Safe, connected, supported in a complex system." Exploring the views of women who had a First Nations baby at one of three maternity services offering culturally tailored continuity of midwife care in Victoria, Australia. A qualitative analysis of free-text survey responses. Women Birth 2024; 37:101583. [PMID: 38302389 DOI: 10.1016/j.wombi.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND In Australia, continuity of midwife care is recommended for First Nations women to address the burden of inequitable perinatal outcomes experienced by First Nations women and newborns. AIMS This study aimed to explore the experiences of women having a First Nations baby who received care at one of three maternity services in Naarm (Melbourne), Victoria, where culturally tailored midwife continuity models had been implemented. METHODS Women having a First Nations baby who were booked for care at one of three study sites were invited to participate in an evaluation of care. Thematic analysis was used to analyse qualitative data from responses to free-text, open ended questions that were included in a follow-up questionnaire at 3-6 months after the birth. RESULTS In total, 213 women (of whom 186 had continuity of midwife care) participated. The global theme for what women liked about their care was 'Safe, connected, supported' including emotional and clinical safety, having a known midwife and being supported 'my way'. The global theme for what women did not like about their care was 'A complex, fragmented and unsupportive system' including not being listened to, things not being explained, and a lack of cultural safety. CONCLUSIONS Culturally tailored caseload midwifery models appear to make maternity care feel safer for women having a First Nations baby, however, the mainstream maternity care system remained challenging for some. These models should be implemented for First Nations women, and evidence-based frameworks, such as the RISE framework, should be used to facilitate change.
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Affiliation(s)
- P McCalman
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3052, Australia.
| | - D Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - M Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3052, Australia
| | - F McLardie-Hore
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - H McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3052, Australia
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Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024; 4:CD004667. [PMID: 38597126 PMCID: PMC11005019 DOI: 10.1002/14651858.cd004667.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016. OBJECTIVES To compare the effects of midwife continuity of care models with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (17 August 2022), as well as the reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife continuity of care models or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion criteria, scientific integrity, and risk of bias, and carried out data extraction and entry. Primary outcomes were spontaneous vaginal birth, caesarean section, regional anaesthesia, intact perineum, fetal loss after 24 weeks gestation, preterm birth, and neonatal death. We used GRADE to rate the certainty of evidence. MAIN RESULTS We included 17 studies involving 18,533 randomised women. We assessed all studies as being at low risk of scientific integrity/trustworthiness concerns. Studies were conducted in Australia, Canada, China, Ireland, and the United Kingdom. The majority of the included studies did not include women at high risk of complications. There are three ongoing studies targeting disadvantaged women. Primary outcomes Based on control group risks observed in the studies, midwife continuity of care models, as compared to other models of care, likely increase spontaneous vaginal birth from 66% to 70% (risk ratio (RR) 1.05, 95% confidence interval (CI) 1.03 to 1.07; 15 studies, 17,864 participants; moderate-certainty evidence), likelyreduce caesarean sections from 16% to 15% (RR 0.91, 95% CI 0.84 to 0.99; 16 studies, 18,037 participants; moderate-certainty evidence), and likely result in little to no difference in intact perineum (29% in other care models and 31% in midwife continuity of care models, average RR 1.05, 95% CI 0.98 to 1.12; 12 studies, 14,268 participants; moderate-certainty evidence). There may belittle or no difference in preterm birth (< 37 weeks) (6% under both care models, average RR 0.95, 95% CI 0.78 to 1.16; 10 studies, 13,850 participants; low-certainty evidence). We arevery uncertain about the effect of midwife continuity of care models on regional analgesia (average RR 0.85, 95% CI 0.79 to 0.92; 15 studies, 17,754 participants, very low-certainty evidence), fetal loss at or after 24 weeks gestation (average RR 1.24, 95% CI 0.73 to 2.13; 12 studies, 16,122 participants; very low-certainty evidence), and neonatal death (average RR 0.85, 95% CI 0.43 to 1.71; 10 studies, 14,718 participants; very low-certainty evidence). Secondary outcomes When compared to other models of care, midwife continuity of care models likely reduce instrumental vaginal birth (forceps/vacuum) from 14% to 13% (average RR 0.89, 95% CI 0.83 to 0.96; 14 studies, 17,769 participants; moderate-certainty evidence), and may reduceepisiotomy 23% to 19% (average RR 0.83, 95% CI 0.77 to 0.91; 15 studies, 17,839 participants; low-certainty evidence). When compared to other models of care, midwife continuity of care models likelyresult in little to no difference inpostpartum haemorrhage (average RR 0.92, 95% CI 0.82 to 1.03; 11 studies, 14,407 participants; moderate-certainty evidence) and admission to special care nursery/neonatal intensive care unit (average RR 0.89, 95% CI 0.77 to 1.03; 13 studies, 16,260 participants; moderate-certainty evidence). There may be little or no difference in induction of labour (average RR 0.92, 95% CI 0.85 to 1.00; 14 studies, 17,666 participants; low-certainty evidence), breastfeeding initiation (average RR 1.06, 95% CI 1.00 to 1.12; 8 studies, 8575 participants; low-certainty evidence), and birth weight less than 2500 g (average RR 0.92, 95% CI 0.79 to 1.08; 9 studies, 12,420 participants; low-certainty evidence). We are very uncertain about the effect of midwife continuity of care models compared to other models of care onthird or fourth-degree tear (average RR 1.10, 95% CI 0.81 to 1.49; 7 studies, 9437 participants; very low-certainty evidence), maternal readmission within 28 days (average RR 1.52, 95% CI 0.78 to 2.96; 1 study, 1195 participants; very low-certainty evidence), attendance at birth by a known midwife (average RR 9.13, 95% CI 5.87 to 14.21; 11 studies, 9273 participants; very low-certainty evidence), Apgar score less than or equal to seven at five minutes (average RR 0.95, 95% CI 0.72 to 1.24; 13 studies, 12,806 participants; very low-certainty evidence) andfetal loss before 24 weeks gestation (average RR 0.82, 95% CI 0.67 to 1.01; 12 studies, 15,913 participants; very low-certainty evidence). No maternal deaths were reported across three studies. Although the observed risk of adverse events was similar between midwifery continuity of care models and other models, our confidence in the findings was limited. Our confidence in the findings was lowered by possible risks of bias, inconsistency, and imprecision of some estimates. There were no available data for the outcomes: maternal health status, neonatal readmission within 28 days, infant health status, and birth weight of 4000 g or more. Maternal experiences and cost implications are described narratively. Women receiving care from midwife continuity of care models, as opposed to other care models, generally reported more positive experiences during pregnancy, labour, and postpartum. Cost savings were noted in the antenatal and intrapartum periods in midwife continuity of care models. AUTHORS' CONCLUSIONS Women receiving midwife continuity of care models were less likely to experience a caesarean section and instrumental birth, and may be less likely to experience episiotomy. They were more likely to experience spontaneous vaginal birth and report a positive experience. The certainty of some findings varies due to possible risks of bias, inconsistencies, and imprecision of some estimates. Future research should focus on the impact on women with social risk factors, and those at higher risk of complications, and implementation and scaling up of midwife continuity of care models, with emphasis on low- and middle-income countries.
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Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Declan Devane
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, School of Business and Economics, Institute for Lifecourse and Society, University of Galway, Galway, Ireland
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Leanne V Jones
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Hannah Rayment-Jones
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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O'Dea B, Roe Y, Gao Y, Kruske S, Nelson C, Hickey S, Carson A, Watego K, Currie J, Blackman R, Reynolds M, Wilson K, Costello J, Kildea S. Breaking the cycle: Effect of a multi-agency maternity service redesign on reducing the over-representation of Aboriginal and Torres Strait Islander newborns in out-of-home care: A prospective, non-randomised, intervention study in urban Australia. CHILD ABUSE & NEGLECT 2024; 149:106664. [PMID: 38354600 DOI: 10.1016/j.chiabu.2024.106664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Strategies to reduce over-representation of Indigenous children in out-of-home care must start in pregnancy given Indigenous babies are 6 % of infants (<1 year), yet 43 % of infants in out-of-home care. OBJECTIVE To determine if an Indigenous-led, multi-agency, partnership redesign of maternity services decreases the likelihood of babies being removed at birth. PARTICIPANTS AND SETTING Women carrying an Indigenous baby/babies who gave birth at the Mater Mothers' Public Hospital, Brisbane (2013-2019). METHODS A prospective, non-randomised, intervention trial evaluated a multi-agency service redesign. Women pregnant with an Indigenous baby birthing at a tertiary hospital were offered standard care or Birthing in Our Community (BiOC) service. We compared likelihood of babies being removed by Child Protection Services (CPS) at birth by model of care. Inverse probability of treatment propensity score weighting controlled baseline confounders and calculated treatment effect. Standardized differences were calculated to assess balance of risk factors for each copy of multiple imputation. Australian New Zealand Clinical Trial Registry, ACTRN12618001365257. RESULTS In 2013-2019, 1988 women gave birth to 2044 Indigenous babies, with 40 women having babies removed at birth (9 BiOC, 31 standard care). Adjusted odds of baby removal were significantly lower for mothers in BiOC compared to standard care (AOR 0.37, 95 % CI 0.16, 0.84). In total, 2.0 % of Indigenous babies were removed by CPS; eight times higher than non-Indigenous babies at the same hospital (0.25 %). CONCLUSIONS BiOC reduced removals of newborn Indigenous babies likely disrupting generational cycles of CPS contact, trauma, and maltreatment, and contributing to short and long-term health and wellbeing benefits for mothers and babies.
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Affiliation(s)
- Birri O'Dea
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Yvette Roe
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sue Kruske
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, 22 Cox Rd, Windsor, Queensland 4030, Australia
| | - Sophie Hickey
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Adrian Carson
- Institute for Urban Indigenous Health, 22 Cox Rd, Windsor, Queensland 4030, Australia
| | - Kristie Watego
- Institute for Urban Indigenous Health, 22 Cox Rd, Windsor, Queensland 4030, Australia
| | - Jody Currie
- Aboriginal and Torres Strait Islander Community Health Service Brisbane Limited, 55 Annerley Rd, Woolloongabba, Queensland 4103, Australia
| | - Renee Blackman
- Aboriginal and Torres Strait Islander Community Health Service Brisbane Limited, 55 Annerley Rd, Woolloongabba, Queensland 4103, Australia
| | - Maree Reynolds
- Mater Hospital, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Kay Wilson
- Mater Hospital, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Jo Costello
- Institute for Urban Indigenous Health, 22 Cox Rd, Windsor, Queensland 4030, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia.
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Dube M, Ireland S, Bromley A, Steel M, Gao Y, Kildea S. "It's all about cultural understanding": A reflexive thematic analysis of women's experiences at a dedicated refugee midwifery group practice service. Women Birth 2024; 37:410-418. [PMID: 38158322 DOI: 10.1016/j.wombi.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/27/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Inequitable maternity care provision in high-income countries contributes to ongoing poor outcomes for women of refugee backgrounds. To address barriers to quality maternity care and improve health equity, a co-designed maternity service incorporating community-based group antenatal care, onsite social worker and interpreters, continuity of midwifery carer through a caseload design with 24/7 phone access was implemented for women of refugee background. OBJECTIVE To explore and describe women's experiences and perceptions of care from a dedicated Refugee Midwifery Group Practice service. DESIGN Qualitative exploratory descriptive study using focus group discussions and interpreters. SETTING The study was conducted at a community-based Refugee Midwifery Group Practice service in a tertiary maternity hospital in Brisbane, Australia. METHODS We conducted three focus group discussions (June - December 2020) with 16 women, born in six different countries, in three language groups: Sudanese Arabic, Somali, and English. We used reflexive thematic analysis to interpret women's perspectives and generate informed meanings of experiences of care. RESULTS We generated four themes 1) accessibility of care, 2) women feeling accepted, 3) value of relationality, and 4), service expansion and promotion. Results demonstrate positive experiences and acceptability due to easy access, strong woman-midwife relationships, and culturally safe care. CONCLUSION The service addressed concerns raised in an early evaluation and provides evidence that redesigning maternity services to meet the needs of women with a refugee background speaking multiple languages from many countries is possible and promotes access, use, and satisfaction with care, contributing to improved health equity and perinatal outcomes.
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Affiliation(s)
- Mpho Dube
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sarah Ireland
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Angela Bromley
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Michelle Steel
- Mater Mothers Hospital, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia.
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Watkins V, Kavanagh SA, Macdonald JA, Rasmussen B, Maindal HT, Hosking S, Wynter K. "I always felt like I wasn't supposed to be there". An international qualitative study of fathers' engagement in family healthcare during transition to fatherhood. Midwifery 2024; 130:103928. [PMID: 38290320 DOI: 10.1016/j.midw.2024.103928] [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: 02/19/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Engagement of fathers in family health services confers benefits for the health and wellbeing of the whole family. The childbirth continuum is traditionally considered a feminine event, however, commensurate with the changing paradigm of gender equity in family healthcare worldwide, the role of fathers is in transformation. The aim of the study is to explore father's perceptions and experiences of healthcare engagement during pregnancy and early infant care. DESIGN Qualitative free-text questions were embedded in a large multi-country, cross-sectional survey, to explored fathers' attendance, participation, and experience of health care during appointments with their pregnant partner and/or baby. SETTING AND PARTICIPANTS Expectant and new fathers were recruited through Prolific®, an international paid online survey platform. FINDINGS Qualitative responses (n=889) were provided by fathers from 28 countries, with experiences of a range of contexts and models of care; 46.8% of whose partners were pregnant and 53.2% had given birth since 2020. The findings suggest that although most fathers wanted to attend and participate in maternity and early parenting-related healthcare, multiple barriers were identified at the individual father, organisational context, and societal levels. Fathers reported negative social factors such as gender bias and restrictive gender norms as barriers to their healthcare engagement. In contrast, factors that enabled fathers to overcome barriers included the fathers' feelings of confidence in their partner's autonomy and decision-making skills, trusted professional relationships with clinicians, and clinicians with good interpersonal skills. KEY CONCLUSIONS Multiple barriers restrict the participation of fathers in healthcare for childbearing and early parenting. Knowledge of these barriers can inform healthcare redesign to include more successful engagement strategies for fathers, to benefit fathers, mothers, and infants alike. IMPLICATIONS FOR PRACTICE Health professionals consulting with the mother, father and infant triad are ideally placed to address the healthcare needs of both parents. Early engagement of fathers in family health care by use of inclusive interpersonal skills and the development of a trusted relationship has potential to improve paternal mental health, and may be associated with benefits for the health, wellbeing and safety of the whole family.
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Affiliation(s)
- Vanessa Watkins
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Geelong, Victoria, Australia; Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, Australia.
| | - Shane A Kavanagh
- Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, Australia; Deakin University, School of Health and Social Development, Faculty of Health, Geelong, Victoria, Australia
| | - Jacqui A Macdonald
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health; Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia; University of Melbourne, Department of Paediatrics, Melbourne, Australia
| | - Bodil Rasmussen
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Geelong, Victoria, Australia; Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, Australia; Deakin University Centre for Quality and Patient Safety Research - Western Health Partnership, St Albans, Victoria, Australia; University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark.; University of Southern Denmark, Faculty of Health Sciences and Steno Diabetes Center, Odense, Denmark; Aarhus University, Department of Public Health, Aarhus, Denmark
| | - Helle Terkildsen Maindal
- Deakin University, School of Health and Social Development, Faculty of Health, Geelong, Victoria, Australia; Aarhus University, Department of Public Health, Aarhus, Denmark; Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Sarah Hosking
- Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, Australia
| | - Karen Wynter
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Geelong, Victoria, Australia; Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, Australia; Deakin University Centre for Quality and Patient Safety Research - Western Health Partnership, St Albans, Victoria, Australia; Monash University, Department of Psychiatry, School of Clinical Sciences, Clayton, Victoria, Australia
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Penman SV, Beatson RM, Walker EH, Goldfeld S, Molloy CS. Barriers to accessing and receiving antenatal care: Findings from interviews with Australian women experiencing disadvantage. J Adv Nurs 2023; 79:4672-4686. [PMID: 37366583 PMCID: PMC10952242 DOI: 10.1111/jan.15724] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
AIM To identify the barriers associated with inadequate antenatal attendance by disadvantaged women in Australia and to further explore how these barriers are experienced by this population group. DESIGN A qualitative descriptive study utilizing semi-structured interviews and thematic analysis. METHODS Interviews were conducted with 11 pregnant women who self-identified as experiencing disadvantage, purposively sampled from a local government area of Victoria, Australia, characterized by socio-economic disadvantage. Data were collected from February to July 2019. RESULTS Study participants reported a range of barriers to receiving timely and adequate antenatal care (ANC). For several women, a combination of personal (e.g., emotions, knowledge), health service provision (e.g., limited access to continuity of care provider and continuity of information, inflexible scheduling, difficulty travelling, staff attitudes), and broader social-contextual factors (e.g., financial situation, language, cultural norms) were ultimately insurmountable. Whereas some barriers were experienced as hassles or annoyances, others were unacceptable, overwhelming, or humiliating. CONCLUSION Women experiencing disadvantage in Australia value ANC but face multiple and complex barriers that undermine timely and regular access. IMPLICATIONS FOR THE PROFESSION AND/PATIENT CARE A wide range of strategies targeting barriers across multiple levels of the social-ecological environment are required if ANC attendance rates are to improve and ultimately redress existing health disparities. Various continuity of care models are well-placed to address many of the identified barriers and should be made more accessible to women, and particularly those women experiencing disadvantage. IMPACT Antenatal care appointments promote the health of women and their babies during pregnancy, but for many women, particularly those experiencing disadvantage, access is delayed or inadequate. ANC providers play a critical role in facilitating timely and adequate care. Health service practitioners and management, and health services policymakers need to understand the complexity of the barriers women encounter. These stakeholders can utilize the findings reported herein to develop more effective strategies for overcoming multiple and multi-level barriers. REPORTING METHOD The study is reported in accordance with the relevant EQUATOR guidelines: the standards for reporting qualitative research (SRQR) and consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sarah V. Penman
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
| | - Ruth M. Beatson
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Elizabeth H. Walker
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
| | - Sharon Goldfeld
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
| | - Carly S. Molloy
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
- North Western Melbourne Public Health NetworkParkvilleVictoriaAustralia
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Brady S, Bogossian F, Gibbons KS. Achieving international consensus on the concept of woman-centred care: A Delphi study. Women Birth 2023; 36:e631-e640. [PMID: 37308353 DOI: 10.1016/j.wombi.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
PROBLEM There is no internationally-informed understanding of how midwives perceive woman-centred care and use it in practice. BACKGROUND Woman-centred care is integral to the role of the midwife and to determining standards of practice. Few empirical studies have explored the meaning of woman-centred care, and those that have are limited to country specific research. AIM To gain an in-depth understanding and consensus on the concept of woman-centred care from an international perspective. METHODS A three round Delphi study was conducted, with surveys distributed online to a group of international expert midwives to draw consensus on the topic of woman-centred care. FINDINGS A panel of 59 expert midwives representing 22 countries participated. Fifty-nine statements about woman-centred care, of which 63% of statements reached the 75% a priori agreement level, were developed and categorised under four emergent themes: defining characteristics of woman-centred care (n = 17), the role of the midwife in woman-centred care (n = 19), woman-centred care and systems of care (n = 18), woman-centred care in education and research (n = 5). DISCUSSION Participants agreed that woman-centred care should be provided by any health care professional in any health care setting. Systems of maternity care should provide holistic care tailored for the individual woman rather than subject her to routine practices and policies. Although continuity of care is important to midwifery practice, it was not reported as a core characteristic of woman-centred care. CONCLUSION This is the first study to investigate the concept of woman-centred care as it is experienced globally by midwives. The findings of this study will be used to contribute to the development of an internationally informed evidence-based definition of woman-centred care.
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Affiliation(s)
- Susannah Brady
- School of Nursing, Midwifery & Social Work, The University of Queensland, St Lucia, Australia.
| | - Fiona Bogossian
- School of Nursing, Midwifery & Social Work, The University of Queensland, St Lucia, Australia; School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Kristen S Gibbons
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Dawson K, Wallace H, Bayes S. "I believe…" - graduating midwifery students' midwifery philosophies and intentions for their graduate year: A longitudinal descriptive study. Midwifery 2023; 125:103807. [PMID: 37660539 DOI: 10.1016/j.midw.2023.103807] [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: 09/20/2022] [Revised: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Midwifery graduates may experience transition shock that makes them question their fit for their workplace and the profession and in extreme cases, may lead to them leaving. Understanding graduate midwives' worldviews, job intentions and work experiences is important to inform retention strategies. Factors such as having a strong professional identity and experiencing strong job satisfaction are important for midwife retention. Conversely, stress, trauma and work-life imbalances are examples of factors that lead to attrition from midwifery. Transition shock experienced by some graduates can exacerbate these factors if not managed effectively. This study aimed to identify causes and impact of any changes in graduate and early career midwives' philosophy, practice, and intention to stay in the profession. DESIGN, SETTING AND PARTICIPANTS We invited the 2021 and 2022 cohorts of graduating midwifery students from all educational pathways in Victoria, Australia to participate in a longitudinal descriptive study using a questionnaire with both closed and open -ended questions. This paper reports the findings from 16 participants that completed the first survey of a five-year longitudinal descriptive study. FINDINGS The sixteen participants predominantly held a woman centred philosophy and ideally wanted to work in a midwife-led model of care. Although excited about moving into practice, they also disclosed a sense of needing to 'survive' in a maternity care system that their beliefs were not fully in alignment with. KEY CONCLUSIONS The hopes, expectations and concerns of midwifery students who are anticipating moving into practice in this study resonate with those previously reported and demonstrate the need to consider personality-job fit in supporting this vulnerable group to transition. IMPLICATIONS FOR PRACTICE This study provides insights into graduating midwives' hopes for, expectations of, and concerns about transitioning into practice that may inform the design of transition programs and support expansion of midwifery led models of care.
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Affiliation(s)
- Kate Dawson
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Australia.
| | - Heather Wallace
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Australia
| | - Sara Bayes
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Australia; Centre for Nursing, Midwifery and Health Services Research, Edith Cowan University, Joondalup, Australia
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Allen J, Creedy DK, Mills K, Gamble J. Health engagement: a systematic review of tools modifiable for use with vulnerable pregnant women. BMJ Open 2023; 13:e065720. [PMID: 36898741 PMCID: PMC10008331 DOI: 10.1136/bmjopen-2022-065720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE To examine available health engagement tools suitable to, or modifiable for, vulnerable pregnant populations. DESIGN Systematic review. ELIGIBILITY CRITERIA Original studies of tool development and validation related to health engagement, with abstract available in English, published between 2000 and 2022, sampling people receiving outpatient healthcare including pregnant women. DATA SOURCES CINAHL Complete, Medline, EMBASE and PubMed were searched in April 2022. RISK OF BIAS Study quality was independently assessed by two reviewers using an adapted COSMIN risk of bias quality appraisal checklist. Tools were also mapped against the Synergistic Health Engagement model, which centres on women's buy-in to maternity care. INCLUDED STUDIES Nineteen studies were included from Canada, Germany, Italy, the Netherlands, Sweden, the UK and the USA. Four tools were used with pregnant populations, two tools with vulnerable non-pregnant populations, six tools measured patient-provider relationship, four measured patient activation, and three tools measured both relationship and activation. RESULTS Tools that measured engagement in maternity care assessed some of the following constructs: communication or information sharing, woman-centred care, health guidance, shared decision-making, sufficient time, availability, provider attributes, discriminatory or respectful care. None of the maternity engagement tools assessed the key construct of buy-in. While non-maternity health engagement tools measured some elements of buy-in (self-care, feeling hopeful about treatment), other elements (disclosing risks to healthcare providers and acting on health advice), which are significant for vulnerable populations, were rarely measured. CONCLUSIONS AND IMPLICATIONS Health engagement is hypothesised as the mechanism by which midwifery-led care reduces the risk of perinatal morbidity for vulnerable women. To test this hypothesis, a new assessment tool is required that addresses all the relevant constructs of the Synergistic Health Engagement model, developed for and psychometrically assessed in the target group. PROSPERO REGISTRATION NUMBER CRD42020214102.
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Affiliation(s)
- Jyai Allen
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Kyly Mills
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Jenny Gamble
- School of Nursing, Midwifery and Health, Coventry University Faculty of Health and Life Sciences, Coventry, UK
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Women's experiences of continuity of care from student midwives - A qualitative study from Norway. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100814. [PMID: 36701927 DOI: 10.1016/j.srhc.2023.100814] [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: 05/19/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
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.
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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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Kildea S, Roe Y. Utilising the RISE Framework to implement birthing services for First Nations families. Women Birth 2022; 35:521-523. [DOI: 10.1016/j.wombi.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Labouring Together: Women's Experiences of “Getting the Care that I Want and Need” in Maternity Care. Midwifery 2022; 113:103420. [DOI: 10.1016/j.midw.2022.103420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/24/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
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Fahlbeck H, Johansson M, Hildingsson I, Larsson B. ‘A longing for a sense of security’ – women’s experiences of continuity of midwifery care in rural Sweden: a qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100759. [DOI: 10.1016/j.srhc.2022.100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/08/2022] [Accepted: 07/27/2022] [Indexed: 10/16/2022]
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18
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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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Salutogenic qualities of midwifery care: A best-fit framework synthesis. Women Birth 2021; 34:266-277. [DOI: 10.1016/j.wombi.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/08/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
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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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Allen J, Small K, Lee N. How a perineal care bundle impacts midwifery practice in Australian maternity hospitals: A critical, reflexive thematic analysis. Women Birth 2021; 35:e1-e9. [PMID: 33485817 DOI: 10.1016/j.wombi.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A care bundle to reduce severe perineal trauma (the bundle) was introduced in 28 Australian maternity hospitals in 2018. The bundle includes five components of which only one - warm perineal compresses - has highest level evidence. There is scant published research about the impact of implementation of perineal bundles. QUESTION How does a perineal care bundle impact midwifery practice in Australian maternity hospitals? METHODS Purposively sampled midwives who worked in hospitals where the bundle had been implemented. Interested midwives were recruited to participate in one-to-one, semi-structured interviews. The researchers conducted critical, reflexive thematic analysis informed by Foucauldian concepts of power. FINDINGS We interviewed 12 midwives from five hospitals in one state of Australia. Participants varied by age, clinical role, experience, and education. Three themes were generated: 1) bundle design and implementation 2) changing midwifery practice: obedience, subversion, and compliance; and 3) obstetric dominance and midwifery submission. DISCUSSION The bundle exemplifies tensions between obstetric and midwifery constructs of safety in normal birth. Participants' responses appear consistent with oppressed group behaviour previously reported in nurses and midwives. Women expect midwives to facilitate maternal autonomy yet decision-making in maternity care is commonly geared towards obtaining consent. In our study midwives encouraged women to consent or decline depending on their personal preferences. CONCLUSION The introduction of the perineal bundle acts as an exemplar of obstetric dominance in Australian maternity care. We recommend midwives advocate autonomy - women's and their own - by using clinical judgement, evidence, and woman-centred care.
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Affiliation(s)
- Jyai Allen
- Transforming Maternity Care Collaborative & School of Nursing and Midwifery, Griffith University, Australia(1).
| | - Kirsten Small
- Transforming Maternity Care Collaborative & School of Nursing and Midwifery, Griffith University, Australia(1). https://twitter.com/@birthsmalltalk
| | - Nigel Lee
- School of Nursing, Midwifery and Social Work, University of Queensland, Australia. https://twitter.com/@Nigel_Lee01
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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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Styles C, Kearney L, George K. Implementation and upscaling of midwifery continuity of care: The experience of midwives and obstetricians. Women Birth 2020; 33:343-351. [DOI: 10.1016/j.wombi.2019.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022]
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Allen J, Jenkinson B, Tracy SK, Hartz DL, Tracy M, Kildea S. Women's unmet needs in early labour: Qualitative analysis of free-text survey responses in the M@NGO trial of caseload midwifery. Midwifery 2020; 88:102751. [PMID: 32512314 DOI: 10.1016/j.midw.2020.102751] [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: 02/04/2020] [Revised: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to analyse women's experiences of early labour care in caseload midwifery in Australia. DESIGN this study sits within a multi-site randomised controlled trial of caseload midwifery versus standard care. Participant surveys were conducted at 6-weeks and 6-months after birth. Free-text responses about experiences of care were subject to critical thematic analysis in NVivo 11 software. SETTING two urban Australian hospitals in different states. PARTICIPANTS women 18 years and over, with a singleton pregnancy, less than 24 weeks' pregnant, not planning a caesarean section or already booked with a care provider; were eligible to participate in the trial. INTERVENTIONS participants were randomised to caseload midwifery or standard care for antenatal, labour and birth and postpartum care. MEASUREMENTS AND FINDINGS The 6-week survey response rate was 58% (n = 1,019). The survey included five open questions about women's experiences of pregnancy, labour and birth, and postnatal care. Nine-hundred and one respondents (88%) provided free text comments which were coded to generate 10 categories. The category of early labour contained data from 84 individual participants (caseload care n = 44; standard care n = 40). Descriptive themes were: (1) needing permission; (2) doing the 'wrong' thing; and (3) being dismissed. Analytic themes were: (1) Seeking: women wanting to be "close to those who know what's going on"; and (2) Shielding: midwives defending resources and normal birth. KEY CONCLUSIONS Regardless of model of care, early labour care was primarily described in negative terms. This could be attributed to reporting bias, because women who were neutral about early labour care may not comment. Nevertheless, the findings demonstrate a gap in knowledge about early labour care in caseload midwifery models. IMPLICATIONS FOR PRACTICE Maternity services that offer caseload midwifery are ideally placed to evaluate how early labour home visiting impacts women's experiences of early labour.
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Affiliation(s)
- Jyai Allen
- Mater Research Institute-The University of Queensland, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia.
| | - Bec Jenkinson
- Mater Research Institute-The University of Queensland, Brisbane, Queensland, Australia.
| | - Sally K Tracy
- Midwifery and Women's Health Research Unit, University of Sydney, Royal Hospital for Women, Randwick, New South Wales, Australia.
| | - Donna L Hartz
- Midwifery and Women's Health Research Unit, University of Sydney, Royal Hospital for Women, Randwick, New South Wales, Australia; College of Nursing and Midwifery, Charles Darwin University, Sydney Campus, New South Wales, Australia.
| | - Mark Tracy
- Department of Paediatrics and Child health Westmead Children's Clinical School, The University of Sydney, Westmead, New South Wales, Australia; Westmead Neonatal Intensive Care Unit, Westmead Hospital, Western Sydney Local Health District, New South Wales, Australia.
| | - Sue Kildea
- Mater Research Institute-The University of Queensland, Brisbane, Queensland, Australia; Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Queensland, Australia.
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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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Kildea S, Hickey S, Barclay L, Kruske S, Nelson C, Sherwood J, Allen J, Gao Y, Blackman R, Roe YL. Implementing Birthing on Country services for Aboriginal and Torres Strait Islander families: RISE Framework. Women Birth 2019; 32:466-475. [DOI: 10.1016/j.wombi.2019.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 01/31/2023]
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27
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Hartz DL, Blain J, Caplice S, Allende T, Anderson S, Hall B, McGrath L, Williams K, Jarman H, Tracy SK. Evaluation of an Australian Aboriginal model of maternity care: The Malabar Community Midwifery Link Service. Women Birth 2019; 32:427-436. [DOI: 10.1016/j.wombi.2019.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022]
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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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Bradfield Z, Hauck Y, Kelly M, Duggan R. "It's what midwifery is all about": Western Australian midwives' experiences of being 'with woman' during labour and birth in the known midwife model. BMC Pregnancy Childbirth 2019; 19:29. [PMID: 30642287 PMCID: PMC6332887 DOI: 10.1186/s12884-018-2144-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/11/2018] [Indexed: 11/12/2022] Open
Abstract
Background The phenomenon of being ‘with woman’ is fundamental to midwifery as it underpins its philosophy, relationships and practices. There is an identified gap in knowledge around the ‘with woman’ phenomenon from the perspective of midwives providing care in a variety of contexts. As such, the aim of this study was to explore the experiences of being ‘with woman’ during labour and birth from the perspective of midwives’ working in a model where care is provided by a known midwife. Methods A descriptive phenomenological design was employed with ten midwives working in a ‘known midwife’ model who described their experiences of being ‘with woman’ during labour and birth. The method was informed by Husserlian philosophy which seeks to explore the same phenomenon through rich descriptions by individuals revealing commonalities of the experience. Results Five themes emerged 1) Building relationships; 2) Woman centred care; 3) Impact on the midwife; 4) Impact on the woman; and 5) Challenges in the Known Midwife model. Midwives emphasised the importance of trusting relationships while being ‘with woman’, confirming that this relationship extends beyond the woman – midwife relationship to include the woman’s support people and family. Being ‘with woman’ during labour and birth in the context of the relationship facilitates woman-centred care. Being ‘with woman’ influences midwives, and, it is noted, the women that midwives are working with. Finally, challenges that impact being ‘with woman’ in the known midwife model are shared by midwives. Conclusions Findings offer valuable insight into midwives’ experiences of being ‘with woman’ in the context of models that provide care by a known midwife. In this model, the trusting relationship is the conduit for being ‘with woman’ which influences the midwife, the profession of midwifery, as well as women and their families. Descriptions of challenges to being ‘with woman’ provide opportunities for professional development and service review. Rich descriptions from the unique voice of midwives, provided insight into the applied practices of being ‘with woman’ in a known midwife model which adds important knowledge concerning a phenomenon so deeply embedded in the philosophy and practices of the profession of midwifery.
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Affiliation(s)
- Zoe Bradfield
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Bentley, WA, 6845, Australia.
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Bentley, WA, 6845, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University King Edward Memorial Hospital, Subiaco, Australia
| | - Michelle Kelly
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Bentley, WA, 6845, Australia
| | - Ravani Duggan
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Bentley, WA, 6845, Australia
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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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Simcock G, Kildea S, Kruske S, Laplante DP, Elgbeili G, King S. Disaster in pregnancy: midwifery continuity positively impacts infant neurodevelopment, QF2011 study. BMC Pregnancy Childbirth 2018; 18:309. [PMID: 30053853 PMCID: PMC6062998 DOI: 10.1186/s12884-018-1944-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research shows that continuity of midwifery carer in pregnancy improves maternal and neonatal outcomes. This study examines whether midwifery group practice (MGP) care during pregnancy affects infant neurodevelopment at 6-months of age compared to women receiving standard hospital maternity care (SC) in the context of a natural disaster. METHODS This prospective cohort study included 115 women who were affected by a sudden-onset flood during pregnancy. They received one of two models of maternity care: MGP or SC. The women's flood-related objective stress, subjective reactions, and cognitive appraisal of the disaster were assessed at recruitment into the study. At 6-months postpartum they completed the Ages and Stages Questionnaire (ASQ-3) on their infants' communication, fine and gross motor, problem solving, and personal-social skills. RESULTS Greater maternal objective and subjective stress predicted worse infant outcomes. Even when controlling for maternal stress from the flood, infants of mothers who were in the MGP model of maternity care performed better than infants of mothers in SC on two of the five ASQ-3 domains (fine motor and problem solving) at 6-months of age. Furthermore, infants in the SC model were more likely to be identified as at risk for delayed development on these domains than infants in the MGP model of care. CONCLUSIONS Continuity of midwifery care has positive effects on infant neurodevelopment when mothers experience disaster-related stress in pregnancy, with significantly better outcomes on two developmental domains at 6 months compared to infants whose mothers received standard hospital care.
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Affiliation(s)
- Gabrielle Simcock
- Mater Research Institute-University of Queensland, Brisbane, QLD Australia
- School of Psychology, The University of Queensland, Brisbane, QLD Australia
| | - Sue Kildea
- Mater Research Institute-University of Queensland, Brisbane, QLD Australia
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, QLD Australia
| | - Sue Kruske
- Institute of Urban Indigenous Health, Brisbane, QLD Australia
| | - David P. Laplante
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health Institute, 6875 LaSalle Boulevard, Verdun, Quebec, H4H 1R3 Canada
| | - Guillaume Elgbeili
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health Institute, 6875 LaSalle Boulevard, Verdun, Quebec, H4H 1R3 Canada
| | - Suzanne King
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health Institute, 6875 LaSalle Boulevard, Verdun, Quebec, H4H 1R3 Canada
- Department of Psychiatry, McGill University, Montreal, QC Canada
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32
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Walker S, Parker P, Scamell M. Expertise in physiological breech birth: A mixed-methods study. Birth 2018; 45:202-209. [PMID: 29205469 DOI: 10.1111/birt.12326] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/21/2017] [Accepted: 10/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The safety of vaginal breech birth depends on the expertise of birth attendants, yet the meaning of "expertise" remains unclear and subjectively defined. The objective of this study was to define expertise and the roles experts may play in expanding access to this service. METHODS We performed an integrative analysis of two strands of data concerning expertise in physiological breech birth, including the following: survey data from a Delphi study involving 26 very experienced clinicians (mean experience = 135 breech births) and 2 service user representatives, and interviews from a grounded theory study of 14 clinicians more moderately experienced with physiological methods (5-30 upright breech births). Data were pooled and analyzed using constant comparative methods. RESULTS Expertise is defined by its ongoing function, the generation of comparatively good outcomes, and confidence and competence among colleagues. Although clinical experience is important, expertise is developed and expressed in social clinical roles, which expand as experience grows: clinician, mentor, specialist, and expert. To develop expertise within a service, clinicians who have an interest in breech birth should be supported to perform these roles within specialist teams. CONCLUSIONS Specialist breech teams may facilitate the development of expertise within maternity care settings. Evaluation of expertise based on enablement of women and colleagues, as well as outcomes, will potentially avoid the pitfalls of alienation produced by some forms of specialist authority.
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Affiliation(s)
- Shawn Walker
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Pam Parker
- Department for Learning Enhancement and Development, City, University of London, Northampton Square, London, UK
| | - Mandie Scamell
- Centre for Maternal and Child Health Research, City, University of London, Northampton Square, London, UK
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Kildea S, Simcock G, Liu A, Elgbeili G, Laplante DP, Kahler A, Austin MP, Tracy S, Kruske S, Tracy M, O'Hara MW, King S. Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study. Arch Womens Ment Health 2018; 21:203-214. [PMID: 28956168 DOI: 10.1007/s00737-017-0781-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 09/19/2017] [Indexed: 01/05/2023]
Abstract
Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women's depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health.
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Affiliation(s)
- Sue Kildea
- Mater Research, Brisbane, QLD, Australia.,The University of Queensland, Brisbane, QLD, Australia
| | | | - Aihua Liu
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada
| | - Guillaume Elgbeili
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada
| | - David P Laplante
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada
| | - Adele Kahler
- The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Sue Kruske
- The University of Queensland, Brisbane, QLD, Australia.,Institute of Urban Indigenous Health, Bowen Hills, Queensland, Australia
| | - Mark Tracy
- Sydney University, Sydney, NSW, Australia
| | - Michael W O'Hara
- Institute of Urban Indigenous Health, Bowen Hills, Queensland, Australia.,Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - Suzanne King
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada. .,McGill University, Montreal, QC, Canada.
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