Report on the midwives' experiences in the Brazilian National Health System: A qualitative research

A global overview of midwives' working conditions: A rapid review of literature on positive practice environment

BACKGROUND

In the United Kingdom (UK), a critical shortage of midwives puts pressure on the already overworked midwives working in maternity services. Considering the challenges that midwives in the UK face, this rapid review was conducted to inform a larger-scale initiative to improve the working conditions of midwives in an acute NHS Trust in the Midlands area of the UK.

OBJECTIVE

To describe midwives' perceptions and experiences of positive practice environments.

METHODS

A search strategy to identify literature about midwives' perceptions and experiences of positive practice environments was conducted in Medline, CINAHL Plus and Embase databases. Literature screening was conducted independently in two steps using an eligibility tool. The articles' quality assessment was conducted using the Mixed Method Appraisal Tool. Data were extracted using the Job Quality framework and managed using NVivo12.

RESULTS

Seventy articles were included in this review. Midwives' working conditions can be improved in all seven areas of the Job Quality framework. Most articles in the review reported the negative aspects of midwives' working environments, making it challenging for the team to define a positive practice environment for midwives. Despite this, authors discuss that a positive practice environment is at least sustained by ensuring midwives' ability to provide care; providing good employment conditions; developing respectful organisations; and increasing team resources, such as those that improve team resilience.

CONCLUSIONS

Midwives' working conditions are universally challenging. Failure to address the situation will compromise recruitment and retention, increasing the shortage of midwives. Provision of safe and respectful care appears to be directly linked to midwives' safe and respectful working conditions.

'No other alternative than to compromise': Experiences of midwives/nurses providing care in the context of scarce resources

Midwives and nurses play a critical role in safeguarding the lives of women in resource-constrained African countries. Working within the context of scarce resources may undermine their moral agency and hinder their ability to care. The purpose of this paper is to understand the influence of resource scarcity on midwifery and nursing care and practice. A critical ethnography was conducted in the obstetric department of three tertiary-level facilities in Ghana. Purposive sampling was used to recruit 30 midwives and nurses and semistructured interviews, field notes and documentary materials were used to generate in-depth understanding. Ethical approval was granted from Canada and Ghana and written, and ongoing informed consent was obtained from the participants. Five conceptual themes depicting the impact of scarce resources on midwifery and nursing care were discovered: compromised care, constrained care, dehumanized care, missed care and disengaged care. Improving the maternal health of women and averting avoidable maternal morbidity and mortality require governments and institutions to invest in health infrastructure that will support the delivery of ethical and safe midwifery care for women in their most vulnerable period.

Apoio contínuo na assistência ao parto para redução das cirurgias cesarianas: síntese de evidências para políticas

Resumo As taxas mundiais de cirurgia cesariana têm crescido há 30 anos, correspondendo a mais de 56% dos nascimentos no Brasil. Considerando os agravos ocasionados por cesáreas eletivas na saúde materna e infantil, esta revisão buscou apresentar uma estratégia para a redução dessas taxas. Para realizar a síntese das melhores evidências, adotou-se a metodologia SUPPORT. Foram incluídas revisões sistemáticas publicadas em inglês, português ou espanhol sobre intervenções não clínicas. As buscas resultaram em quatro estudos, que em metanálise associaram o apoio contínuo durante o parto à redução de 25% a 51% nas taxas de cesárea. Igualmente, o apoio contínuo reduziu a duração e as intervenções clínicas desnecessárias durante o trabalho de parto e a probabilidade de bebê com baixo escore de Apgar aos cinco minutos. Além disso, proporcionou melhoria na amamentação e na recuperação da mulher, aumento da satisfação com o processo de nascimento e maiores chances de parto vaginal espontâneo. O apoio contínuo foi benéfico para a gestante e o recém-nascido. A intervenção garante respeito, segurança e qualidade durante o parto, bem como reduz custos hospitalares. Portanto, é uma estratégia efetiva que deve ser adotada nos serviços de saúde para ampliar o acesso das mulheres aos seus direitos.

A systematic integrative literature review of the factors influencing the professionalization of midwifery in the last decade (2009-2019)

BACKGROUND

The professionalization of midwifery is not only important for midwives themselves, but for women and society in general since professionalism is associated with high-quality services and moral and ethical standards.

AIM

This systematic integrative literature review seeks to investigate the factors that have affected the professionalization of midwifery in the last decade (2009-2019).

METHODS

Systematic searches were conducted in EBSCO, PubMed, ScienceDirect, SAGE and the Web of Science Core Collection. Critical appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). The findings were synthesised through a thematic analysis. The PRISMA statement was used to guide the reporting.

FINDINGS

Analysis of the 20 studies included detected two main themes: professionalization barriers and professionalization opportunities. The first theme includes issues concerning power imbalance, social recognition, conflicting perspectives on childbirth, professional autonomy, work characteristics, midwifery associations, and regulation. The second theme includes opportunity issues related to woman-centred care, expansion of professional competency, interprofessional collaboration, and education.

KEY CONCLUSIONS

Over the last decade, the midwifery profession has faced several barriers that seem to be historically entrenched in the professionalization of midwifery, yet changes in the professionalization process are visible in the shift towards elements of the 'new professionalism' that is rising to the surface during this process.

IMPLICATIONS FOR PRACTICE

The findings suggest the socialisation process of midwifery candidates must focus on raising their self-awareness, self-esteem and confidence in their professional role; woman-centred care needs to be further promoted and implemented; and interprofessional collaboration should be addressed in educational programmes for all health professionals.

CD, de Bortoli MC, Toma TS, Chapman EMG, Barreto JOM. Barriers to implementing guideline recommendations to improve childbirth care: a rapid review of evidence

OBJECTIVE

To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence.

METHOD

A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved.

RESULTS

Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests.

CONCLUSIONS

The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities.

CD, de Bortoli MC, Toma TS, Chapman EMG, Barreto EJOM. [Barriers to implementing guideline recommendations to improve childbirth care: rapid review of evidenceObstáculos a la aplicación de las recomendaciones para la atención del parto normal: revisión rápida de evidencia]

OBJECTIVE

To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence.

METHOD

A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved.

RESULTS

Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests.

CONCLUSIONS

The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities.

Reasons for Increased Caesarean Section Rate in Vietnam: A Qualitative Study among Vietnamese Mothers and Health Care Professionals

The Caesarean section rate in urban Vietnam is 43% in 2014, which is more than twice the recommended rate (10%-15%) by the World Health Organization. This qualitative study aims to identify the perceptions of pregnant mothers and health care professionals on the medical and social factors related to the increased Caesarean section rate in Vietnam. A qualitative descriptive study was conducted among pregnant mothers and healthcare professionals at two public hospitals in Nha Trang city. A content analysis was adopted in order to identify social and medical factors. As a result, 29 pregnant women and 19 health care professionals were invited to participate in the qualitative interviews. Private interviews were conducted with 10 women who wished to have a Caesarean section, and the others participated in focus group interviews. The main themes of the social factors were 'request for Caesarean section,' 'mental strain of obstetricians,' and 'decision-making process.' To conclude, this qualitative study suggests that there were unnecessary caesarean sections without a clear medical indication, which were requested by women and family members. Psychological fear occurred among women and family, and doctors were the main determinants for driving the requests for Caesarean section, which implies that education and emotional encouragement is necessary by midwives. In addition, a multi-faced approach including a mandatory reporting system in clinical fields and involving family members in antenatal education is important.