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Stewart S. Maternal postnatal care in general practice: steps forward. Br J Gen Pract 2024; 74:392-393. [PMID: 39209714 PMCID: PMC11349367 DOI: 10.3399/bjgp24x739161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Affiliation(s)
- Stuart Stewart
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester; Doctoral Research Fellow, Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford; Research Ambassador, Rochdale Care Organisation, Northern Care Alliance NHS Group, Rochdale
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Lambermon FJ, van Duijnhoven NTL, Dedding C, Kremer JAM. Client-centered flexible planning of home-based postpartum care: A randomized controlled trial on the quality of care. Birth 2024; 51:649-658. [PMID: 38716628 DOI: 10.1111/birt.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 02/28/2024] [Accepted: 04/12/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Standardization of health systems often hinders client-centered care. This study investigates whether allowing more flexibility in the planning range of the Dutch home-based postpartum care service improves its quality of care, as innovative approach to client-centered care. METHODS A randomized controlled trial was conducted (2017-2019), in which pregnant women who intended to breastfeed were assigned into two groups (1:1). The intervention group was allowed to receive care up to the 14th-day postpartum, instead of the first 8-10 consecutive days ("usual care"). Primary outcome measure was the proportion of newborns still receiving exclusively breastmilk on final caring day of the service. This so-called successful breastfeeding rate is currently used by the Dutch health sector to measure the quality of care. Secondary outcome measures were self-care experience, overall care experience, and exclusive breastfeeding duration rate. RESULTS Based on data from 1275 participants, there was no difference in exclusive breastfeeding on final caring day (86,7% intervention group vs. 88,9% control group, RR: 1.03, 95% CI: 0.98-1.07). Both groups showed similar self-care experiences. Women in the intervention group had slightly poorer overall care experience and lower exclusive breastfeeding duration rates. CONCLUSIONS This study found no effect on the quality of care when allowing more flexibility in the planning range of home-based postpartum care. Women can, therefore, be offered more flexibility to suit them. Given the confusion in interpreting the sector's current main quality indicator, we call for an inclusive dialogue on how to best measure the quality of home-based postpartum care.
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Affiliation(s)
- Fleur J Lambermon
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Jan A M Kremer
- IQ Healthcare, Radboud university medical center, Nijmegen, The Netherlands
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Cross-Sudworth F, Taylor B, Kenyon S. Community postnatal care delivery in England since Covid-19: A qualitative study of midwifery leaders' perspectives and strategies. Women Birth 2024; 37:240-247. [PMID: 37903683 DOI: 10.1016/j.wombi.2023.10.006] [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: 06/22/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023]
Abstract
PROBLEM COVID-19 impacted negatively on maternity care experiences of women and staff. Understanding the emergency response is key to inform future plans. BACKGROUND Before the COVID-19 pandemic, experts highlighted concerns about UK community postnatal care, and its impact on long-term health, wellbeing, and inequalities. These appear to have been exacerbated by the pandemic. AIM To explore community postnatal care provision during and since the pandemic across a large diverse UK region. METHODS A descriptive qualitative approach. Virtual semi-structured interviews conducted November 2022-February 2023. All regional midwifery community postnatal care leaders were invited to participate. FINDINGS 11/13 midwifery leaders participated. Three main themes were identified: Changes to postnatal care (strategic response, care on the ground); Impact of postnatal care changes (staff and women's experiences); and Drivers of postnatal care changes (COVID-19, workforce issues). DISCUSSION Changes to postnatal care during the pandemic included introduction of virtual care, increased role of Maternity Support Workers, and moving away from home visits to clinic appointments. This has largely continued without evaluation. The number of care episodes provided for low and high-risk families appears to have changed little. Those requiring additional support but not deemed highest risk appear to have been most impacted. Staffing levels influenced amount and type of care provided. There was little inter-organisation collaboration in the postnatal pandemic response. CONCLUSION Changes to postnatal care provision introduced more efficient working practices. However, evaluation is needed to ensure ongoing safe, equitable and individualised care provision post pandemic within limited resources.
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Affiliation(s)
- Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Beck Taylor
- Warwick Medical School, University of Warwick, University Road, Coventry CV4 7AL, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Hannon S, Newnham E, Hannon K, Wuytack F, Johnson L, McEvoy E, Daly D. Positive postpartum well‐being: What works for women. Health Expect 2022; 25:2971-2981. [DOI: 10.1111/hex.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Susan Hannon
- School of Nursing and Midwifery, Trinity College Dublin The University of Dublin Dublin Ireland
- School of Nursing and Midwifery, Trinity Centre for Maternity Care Research (TCMCR) Trinity College Dublin Dublin Ireland
| | - Elizabeth Newnham
- School of Nursing and Midwifery University of Newcastle Callaghan New South Wales Australia
| | - Kathleen Hannon
- School of Nursing and Midwifery, Trinity College Dublin The University of Dublin Dublin Ireland
- School of Nursing and Midwifery, Trinity Centre for Maternity Care Research (TCMCR) Trinity College Dublin Dublin Ireland
| | - Francesca Wuytack
- School of Nursing and Midwifery, Trinity College Dublin The University of Dublin Dublin Ireland
- ESTER Team—Epidemiology in Occupational Health and Ergonomics, Department of Medicine, Research Institute for Environmental and Occupational Health (IRSET—Inserm UMR 1085) University of Angers Angers France
| | - Louise Johnson
- Study Participant, c/o Susan Hannon, School of Nursing and Midwifery Trinity College Dublin Dublin Ireland
| | - Ellen McEvoy
- Study Participant, c/o Susan Hannon, School of Nursing and Midwifery Trinity College Dublin Dublin Ireland
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin The University of Dublin Dublin Ireland
- School of Nursing and Midwifery, Trinity Centre for Maternity Care Research (TCMCR) Trinity College Dublin Dublin Ireland
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How many more reviews are needed? Joined-up policy and investment in England's maternity units is needed now to improve postnatal and inter-pregnancy care. Midwifery 2022; 113:103469. [PMID: 36045018 DOI: 10.1016/j.midw.2022.103469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Turner L, Ball J, Culliford D, Kitson-Reynolds E, Griffiths P. Exploring the relationship between women’s experience of postnatal care and reported staffing measures: An observational study. PLoS One 2022; 17:e0266638. [PMID: 35917338 PMCID: PMC9345482 DOI: 10.1371/journal.pone.0266638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Women have reported dissatisfaction with care received on postnatal wards and this area has been highlighted for improvement. Studies have shown an association between midwifery staffing levels and postnatal care experiences, but so far, the influence of registered and support staff deployed in postnatal wards has not been studied. This work is timely as the number of support workers has increased in the workforce and there has been little research on skill mix to date. Methods Cross sectional secondary analysis including 13,264 women from 123 postnatal wards within 93 hospital Trusts. Staffing was measured in each organisation as Full Time Equivalent staff employed per 100 births, and on postnatal wards, using Hours Per Patient Day. Women’s experiences were assessed using four items from the 2019 national maternity survey. Multilevel logistic regression models were used to examine relationships and adjust for maternal age, parity, ethnicity, type of birth, and medical staff. Results Trusts with higher levels of midwifery staffing had higher rates of women reporting positive experiences of postnatal care. However, looking at staffing on postnatal wards, there was no evidence of an association between registered nurses and midwives hours per patient day and patient experience. Wards with higher levels of support worker staffing were associated with higher rates of women reporting they had help when they needed it and were treated with kindness and understanding. Conclusion The relationship between reported registered staffing levels on postnatal wards and women’s experience is uncertain. Further work should be carried out to examine why relationships observed using whole Trust staffing were not replicated closer to the patient, with reported postnatal ward staffing. It is possible that recorded staffing levels on postnatal wards do not actually reflect staff deployment if midwives are floated to cover delivery units. This study highlights the potential contribution of support workers in providing quality care on postnatal wards.
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Affiliation(s)
- Lesley Turner
- School of Health Sciences, University of Southampton, Southampton, England
- * E-mail:
| | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, England
| | - David Culliford
- NIHR Applied Research Collaboration Wessex, School of Health Sciences, University of Southampton, Southampton, England
| | | | - Peter Griffiths
- National Institute for Health Research Applied Research Centre (Wessex), School of Health Sciences, University of Southampton, Southampton, England
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Kokab F, Jones E, Goodwin L, Taylor B, Kenyon S. Community midwives views of postnatal care in the UK; A descriptive qualitative study. Midwifery 2021; 104:103183. [PMID: 34808526 DOI: 10.1016/j.midw.2021.103183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore views and experiences of community midwives delivering postnatal care. DESIGN A descriptive qualitative study design undertaking focus groups with community midwives and community midwifery team leaders. SETTING All focus groups were carried out in community midwifery care settings, across four hospitals in two NHS organisations, April to June 2018 in the West Midlands, UK. PARTICIPANTS 47 midwives: 34 community midwives and 13 community midwifery team leaders took part in 7 focus groups. FINDINGS Inductive framework analysis of data led to the development of themes and sub-themes relating to factors influencing discharge from hospital, strategies to address increases in discharge and the broader challenges to providing care. Conditions on the postnatal ward and women's experiences of care in the hospital were factors influencing timing of discharge from hospital that resulted in community midwives managing women and babies with more complex needs. In order to manage increased workloads, there was growing but varied use of flexible approaches to providing care such as telephone consultations, postnatal clinics, and maternity support workers. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE In a context of short postnatal hospital stays, community midwives appear to be responding to women's needs and service pressures in the postnatal period. Wider implementation of specific strategies to organise and deliver support to women and babies may further improve care and outcomes.
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Affiliation(s)
- Farina Kokab
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Eleanor Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Laura Goodwin
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
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Daly D, Moran P, Wuytack F, Hannon S, Hannon K, Martin Y, Peoples M, Begley C, Newnham E. The maternal health-related issues that matter most to women in Ireland as they transition to motherhood - A qualitative study. Women Birth 2021; 35:e10-e18. [PMID: 33582046 DOI: 10.1016/j.wombi.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many studies on women's maternity care experiences reveal recurring issues that are poor or less than optimal. Women's opinions on the maternal health-related issues that matter most to them are essential if care and services are to be improved. AIMS To identify the maternal health-related issues that matter most to women in Ireland, based on their own experiences of maternity care, services and motherhood. METHODS A qualitative exploratory study with 24 women. Following university ethical approval, audio-recorded one-to-one telephone interviews were conducted and thematically analysed. FINDINGS We identified two themes, each with four subthemes, connected to a central concept of the invisible woman. Pendulum of care, and subthemes Inconsistent services, All about the baby, Induced anxiety and Information seesaw, illustrated the extremes of care and services that women experienced. Magnitude of motherhood, and subthemes Weight of responsibility, Real-time reassurance, Change of identity and Growth into advocacy, depicted the intensity of their new role while transitioning to motherhood. DISCUSSION Findings articulate the issues that mattered most to women in Ireland as they transitioned to motherhood. Some women identified specific research topics/areas, but all of the issues identified can be translated into researchable topics that seek to improve local care and service provision. CONCLUSION Given the recurring nature of women's less than satisfactory experiences of aspects of maternity care in many countries, it is likely that conducting research on issues that matters most to women will have the greatest impact on their health, wellbeing and lives as they transition to motherhood.
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Affiliation(s)
- Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland.
| | - Patrick Moran
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Francesca Wuytack
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Susan Hannon
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Kathleen Hannon
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Yvonne Martin
- Study participant, c/o Deirdre Daly, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Maeve Peoples
- Study participant, c/o Deirdre Daly, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Elizabeth Newnham
- School of Nursing and Midwifery, Griffith University, L05 Room 1.46, Logan Campus, University Drive, Meadowbrook, Queensland 4131, Australia
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Falling through the cracks: the impact of COVID-19 on postnatal care in primary care. Br J Gen Pract 2020; 70:578-579. [PMID: 33199295 DOI: 10.3399/bjgp20x713573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Aston M, Price S, Hunter A, Sim M, Etowa J, Monaghan J, Paynter M. Second Opinions: Negotiating Agency in Online Mothering Forums. Can J Nurs Res 2020; 53:327-339. [DOI: 10.1177/0844562120940554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Study background Online forums and other virtual communities are an increasing source of postpartum support and information for first-time mothers. However, there is little evidence about how new mothers in Canada access and use online resources. Purpose The purpose of this study was to examine how first-time mothers accessed information and support both online and off-line during the first six months postpartum and how their experiences were constructed through social and institutional discourses. Methods A qualitative feminist poststructuralist approach was used to analyze an online discussion board with first-time mothers in Nova Scotia. Results Mothers who used the online discussion board experienced a sense of community with other mothers where empathy and encouragement were integral to the ways in which information and support were shared. “Weak ties” (with strangers) were important and led to the following themes: (a) empathy, encouragement, and information; (b) socialization; (c) blurring the boundaries of online and off-line networks; and (d) Developing community. Conclusions These online forums offer insight for health professionals looking to improve mothers’ care postpartum and point to a need to foster spaces for new mothers to talk to each other.
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Affiliation(s)
- Megan Aston
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheri Price
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Meaghan Sim
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Joelle Monaghan
- Public Health, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Martha Paynter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Bick D, Cheyne H, Chang YS, Fisher J. Maternal postnatal health during the COVID-19 pandemic: Vigilance is needed. Midwifery 2020; 88:102781. [PMID: 32546397 PMCID: PMC7276131 DOI: 10.1016/j.midw.2020.102781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom.
| | - Helen Cheyne
- Professor of Maternal and Child Health Research & RCM (Scotland) Professor of Midwifery Research,NMAHP Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Yan-Shing Chang
- Child and Family Health Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, United Kingdom
| | - Joanne Fisher
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
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Shakespeare J, Adams C, deGiorgio S, Duff E, Hillman S, Stephenson J. We need to improve postnatal care, starting with the maternal six week postnatal check. BMJ 2020; 368:m252. [PMID: 31980425 DOI: 10.1136/bmj.m252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | | | | | | | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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