What do we know about sibling attended birth? An integrative literature review

A systematic integrative review examining the impact of Australian rural and remote maternity unit closures

BACKGROUND

Rural and remote Australian women are less able to access locally situated maternity care and birthing facilities, largely due to the gradual closures of rural and remote birthing services. Closures have occurred due to workforce issues, safety and quality issues and economic rationalisation of services to offset rising health system costs. An examination of the published literature to gain a deeper understanding of this phenomenon is warranted.

QUESTION

What are the impacts of rural and remote maternity unit closures in Australia?

METHODS

A systematic integrative review of published literature on Australian maternity unit closures was undertaken using Whittemore and Knafl's (2005) framework. A database search was conducted with date limiters of 2010 to 2020 on papers within the search parameters "maternity unit*" AND closure* AND women AND (midwife OR midwives) AND Australia, also with "birth unit", "labour ward" and "rural" in varying combinations. This search resulted in 348 papers. After applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process and the Crowe Critical Appraisal Tool (CCAT) and discarding those non-relevant, seven papers remained.

FINDINGS

A methodological analysis of seven papers occurred, three qualitative studies, three quantitative studies and one mixed methods study. Two main stakeholders were identified, the woman, and the health service. Women identified risks associated with travel, lack of access to services, costs or financial issues, safety, and emotional burdens. Women explicitly stated that access to local maternity services would negate many of their concerns. Health services indicated closures were due to safety and quality considerations and workforce issues.

CONCLUSION

Conflict exists in trying to meet the perceived needs of both stakeholder groups. Published evidence supports midwifery models for low-risk women. National policy also supports woman-centred care; however, local service uptake is minimal due to organisational barriers.

What's wrong with using the F word? A systematic integrative review of how the fetus is talked about in situations of fetal demise or high risk of fetal loss

BACKGROUND

Limited research exists that investigates the language parents and health professionals use when faced with a high-risk likelihood of fetal demise or an instance of fetal loss. This review examines the language used when referring to the 'fetus' in these cases to better understand the meaning different groups might ascribe to the fetus and how their word choice may reflect their strategies for managing in these situations.

METHODS

An integrative review of primary, peer-reviewed research was conducted. A systematic search of seven databases was undertaken, articles critiqued and summarised using the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA). The comprehensive process of data analysis and synthesis followed a constant comparison approach.

RESULTS

The 23 included studies represented the voices of women, their partners, obstetricians, nurses, midwives and allied health professionals. Five major themes emerged with the main finding being that the term 'Baby' is the most widely recognised word used in instances of fetal loss and high risk of fetal demise.

CONCLUSION

History, science and law all influence how the fetus is understood and discussed within society. This review contributes new insights into our understanding of the term 'fetus' emphasizing the need for further research into the way the fetus is addressed and dealt with in instances of fetal loss or high risk of fetal loss within Maternity care practices.