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Dooley J, Jardine J, Ibrahim B, Mongru R, Pradhan F, Wolstenholme D, Lenguerrand E, Draycott T, Bruce F, Iliodromiti S. A positive deviant approach to examining the impact of Covid-19 on ethnic inequalities in maternal and neonatal outcomes. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100971. [PMID: 38692137 DOI: 10.1016/j.srhc.2024.100971] [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: 11/29/2023] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES During the COVID-19 pandemic, rapid and heterogeneous changes were made to maternity care. Identification of changes that may reduce maternal health inequalities is a national priority. The aim of this project was to use data collected about care and outcomes to identify NHS Trusts in the UK where inequalities in outcomes reduced during the pandemic and explore through interviews how the changes that occurred may have led to a reduction in inequalities. METHODS A Women's Reference Group of public advisors guided the project. Analysis of Hospital Episode Statistics Admitted Patient Care data of 128 organisations in England identified "positive deviant" organisations that reduced inequalities, using maternal and perinatal composite adverse outcome indicators. Positive deviant organisations were identified for investigation, alongside comparators. Senior clinicians, heads of midwifery and representatives of women giving birth were interviewed. Reflexive thematic analysis was employed. RESULTS The change in the inequality gap for the maternal indicator ranged from a reduction of -0.24 to an increase of 0.30 per 1000 births between the pre-pandemic and pandemic period. For the perinatal composite indicator, the change in inequality gap ranged from -0.47 to 0.67 per 1000 births. Nine Trusts were identified as positive deviants and 10 as comparators. We conducted 20 interviews from six positive deviant and four comparator organisations. Positive deviants reported that necessary shifts in roles led to productive and novel use of expert staff; comparators reported senior staff 'stepping in' where needed and no benefits of this. They reported proactivity and quick reactions, increased team working, and rapid implementation of new ideas. Comparators found constant changes overwhelming, and no increase in team working. No specific differences in care processes were identified. CONCLUSIONS Harnessing proactivity, flexibility, staffing resource, and increased team working proves vital in reducing health inequalities.
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Affiliation(s)
- Jemima Dooley
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK.
| | - Jen Jardine
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Buthaina Ibrahim
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Rohan Mongru
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Farrah Pradhan
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Daniel Wolstenholme
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, BS10 5NB, UK
| | - Tim Draycott
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Faye Bruce
- Caribbean and African Health Network, Transformation Community Resource Centre, 1st Floor, Richmond House, 11 Richmond Grove, Manchester, M13 0LN, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Kim S, Kim C, Kim JH. Antenatal care inequalities in South Korea: An analysis of health insurance claims data (2013-2022) in a high-resource, high-use country. Int J Gynaecol Obstet 2024. [PMID: 38494879 DOI: 10.1002/ijgo.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE The aim of the present study was to explore inequalities in antenatal care (ANC) in South Korea. Based on the guidelines of the WHO, we categorized less than eight visits to an obstetrical facility as insufficient ANC. We examined ANC inequalities associated with age, disability, nationality, income, and geographic accessibility. METHODS We extracted delivery event claimed from 2013 to 2022 from the National Health Insurance Service database. By tracing back 270 days from the delivery date, we counted the number of antenatal visits for each childbirth and calculated the proportion of women with insufficient ANC and assessed both absolute and relative inequalities for each population group. The logistic regression analysis for both underuse and overuse of ANC were conducted. RESULTS Out of 3 416 517 childbirths, 104 109 women (3.0%) had fewer than eight ANC visits. Although the average number of ANC visits reached 18.7 in 2022, significant inequalities persisted across different population groups. The insufficient ANC rate was 28.1% for teenage women, 6.4% for disabled women, 10.7% for non-Korean women, and 15.2% for dependents of medical aid households. Women with low income and those living in obstetric care underserved areas also exhibited higher ANC insufficiency. From 2021 to 2022, sufficiency in ANC decreased for teenage, disabled, and non-Korean women, highlighting the effects of the COVID-19 pandemic. CONCLUSION Antenatal care inequalities are evident in South Korea's well-resourced health system. There is a need for further investigation into these disparities and the qualitative aspects of maternity care services.
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Affiliation(s)
- Saerom Kim
- Department of Preventive Medicine, College of Medicine, Inje University, Busan, Republic of Korea
| | - Chanki Kim
- Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jin-Hwan Kim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Dewart G, Muller J, Phillips JC, Banaszak D, Caine V. Interventions in maternal syphilis care globally: A scoping review. Health Care Women Int 2024:1-20. [PMID: 38180353 DOI: 10.1080/07399332.2023.2294815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024]
Abstract
Infectious and Congenital Syphilis rates continue to rise globally. Current recommendations for syphilis screening and treatment may be insufficient, and there is a pressing need for improved programs and services to address the increase in cases. A scoping review was conducted to examine approaches to maternal syphilis screening and treatment. Theoretical underpinnings and the key characteristics of these interventions were studied to identify gaps in the existing literature to guide future research. Developing a modified version of the socio-ecological model to guide data analysis, we included 33 academic studies spanning 31 years, covering a range of interventions, programs, and policies globally. We highlight key facets of interventions aligning with the five levels of the modified model that include: individual, interpersonal, institutional, community and policy. In this review, we provide valuable insights into the characteristics and principles of maternal syphilis screening and treatment interventions.
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Affiliation(s)
- Georgia Dewart
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Jessica Muller
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - J Craig Phillips
- School of Nursing, Faculty of Health Sciences, Université d'Ottawa | University of Ottawa, Ottawa, Ontario, Canada
| | - Danielle Banaszak
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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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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Faulks F, Shafiei T, McLachlan H, Forster D, Mogren I, Copnell B, Edvardsson K. Perinatal outcomes of socially disadvantaged women in Australia: A population-based retrospective cohort study. BJOG 2023; 130:1380-1393. [PMID: 37077044 DOI: 10.1111/1471-0528.17501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To examine the perinatal outcomes of women who experience social disadvantage using population-based perinatal data collected between 1999 and 2016. DESIGN Population-based, retrospective cohort study. SETTING Victoria, Australia. POPULATION OR SAMPLE A total of 1 188 872 singleton births were included. METHODS Cohort study using routinely collected perinatal data. Multiple logistic regression was performed to determine associations between social disadvantage and adverse maternal and neonatal outcomes with confidence limits set at 99%. Time-trend analysis for perinatal outcomes was performed in relation to area-level disadvantage measures. MAIN OUTCOME MEASURES Incidence of maternal admission to intensive care unit (ICU), postpartum haemorrhage (PPH) and caesarean section, perinatal mortality, preterm birth, low birthweight (LBW), and admission to special care nursery/neonatal intensive care unit (SCN/NICU). RESULTS Social disadvantage was associated with higher odds of adverse perinatal outcomes. Disadvantaged women were more likely to be admitted to ICU, have a PPH or experience perinatal mortality (stillbirth or neonatal death) and their neonates were more likely to be admitted to SCN/NICU, be born preterm and be LBW. A persistent social gradient existed across time for the most disadvantaged women for all outcomes except caesarean section. CONCLUSIONS Social disadvantage has a marked negative impact on perinatal outcomes. This aligns with national and international evidence regarding the impact of disadvantage. Strategies that improve access to, and reduce fragmentation in, maternity care in addition to initiatives that address the social determinants of health may contribute to improving perinatal outcomes for socially disadvantaged women.
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Affiliation(s)
- Fiona Faulks
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Helen McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Della Forster
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Ingrid Mogren
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Kristina Edvardsson
- School of Nursing and Midwifery/Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
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Vedeler C, Eri TS, Nilsen RM, Blix E, Downe S, van der Wel KA, Nilsen ABV. Women's negative childbirth experiences and socioeconomic factors: Results from the Babies Born better survey. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100850. [PMID: 37116380 DOI: 10.1016/j.srhc.2023.100850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To investigate the association between women's socioeconomic status and overall childbirth experience and to explore how women reporting an overall negative birth experience describe their experiences of intrapartum care. METHODS We used both quantitative and qualitative data from the Babies Born Better (B3) survey version 2, including a total of 8317 women. First, we performed regression analyses to explore the association between women's socioeconomic status and labour and birth experience, and then a thematic analysis of three open-ended questions from women reporting a negative childbirth experience (n = 917). RESULTS In total 11.7% reported an overall negative labour and birth experience. The adjusted odds ratio (OR) of a negative childbirth experience was elevated for women with non-tertiary education, for unemployed, students and not married or cohabiting. Women with lower subjective living standard had an adjusted OR of 1.70 (95% CI 1.44-2.00) for a negative birth experience, compared with those with average subjective living standard. The qualitative analysis generated three themes: 1) Uncompassionate care: lack of sensitivity and empathy, 2) Impersonal care: feeling objectified, and 3) Critical situations: feeling unsafe and loss of control. CONCLUSION Important socioeconomic disparities in women's childbirth experiences exist even in the Norwegian setting. Women reporting a negative childbirth experience described disrespect and mistreatment as well as experiences of insufficient attention and lack of awareness of individual and emotional needs during childbirth. The study shows that women with lower socioeconomic status are more exposed to these types of experiences during labour and birth. TWEETABLE ABSTRACT Women with lower socioeconomic status are more exposed to negative experiences during labour and birth.
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Affiliation(s)
- Carina Vedeler
- Research Group Midwifery Science, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Tine Schauer Eri
- Research Group Midwifery Science, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Roy Miodini Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ellen Blix
- Research Group Midwifery Science, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Soo Downe
- ReaCH group, School of Community Health and Midwifery University of Central Lancashire, Preston, UK
| | - Kjetil A van der Wel
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne Britt Vika Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Lukin TT, Saidarab S, Bogren M, Premberg Å. Syrian women's experiences of being pregnant and receiving care at antenatal clinics in Sweden for the first time after migration. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100823. [PMID: 36796309 DOI: 10.1016/j.srhc.2023.100823] [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: 05/17/2022] [Revised: 10/20/2022] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To describe Syrian women's experiences of being pregnant and receiving care at antenatal clinics for the first time after migration. METHODS A phenomenological lifeworld approach was used. Eleven women from Syria enrolled at antenatal clinics, who were experiencing their first pregnancy in Sweden but who may have given birth before in other countries, were interviewed in 2020. The interviews were open and based on one initial question. Data were inductively analysed using a phenomenological method. RESULTS The essence of Syrian women's experiences of being pregnant and receiving care at antenatal clinics for the first time after migration was the importance of being met with understanding to create trust to build a sense of confidence. The following four constituents capture the essence of the women's experiences: "It was important to feel welcomed and to be treated like an equal"; "A good relationship with the midwife strengthened self-confidence and trust"; "Good communication despite language difficulties and cultural differences was important"; and "Previous experience of pregnancy and care influenced the experience of the care received". CONCLUSION Syrian women's experiences reveal a heterogeneous group with different experiences and background. The study highlights the first visit and emphasises the importance of this visit for future quality of care. It also points out the negative occurrence of the transferring guilt from the midwife to the migrant woman in case of cultural insensitivity and clashing norm systems.
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Affiliation(s)
- Tanja-Tatiana Lukin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Bergsjöns Antenatal Clinic, Gothenburg, Sweden
| | - Sahra Saidarab
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Maternity care, Gothenburg, Sweden
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Åsa Premberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
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Della PR, Huang H, Roberts PA, Porter P, Adams E, Zhou H. Risk factors associated with 31-day unplanned hospital readmission in newborns: a systematic review. Eur J Pediatr 2023; 182:1469-1482. [PMID: 36705723 PMCID: PMC10167195 DOI: 10.1007/s00431-023-04819-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
UNLABELLED The purpose of this study is to synthesize evidence on risk factors associated with newborn 31-day unplanned hospital readmissions (UHRs). A systematic review was conducted searching CINAHL, EMBASE (Ovid), and MEDLINE from January 1st 2000 to 30th June 2021. Studies examining unplanned readmissions of newborns within 31 days of discharge following the initial hospitalization at the time of their birth were included. Characteristics of the included studies examined variables and statistically significant risk factors were extracted from the inclusion studies. Extracted risk factors could not be pooled statistically due to the heterogeneity of the included studies. Data were synthesized using content analysis and presented in narrative and tabular form. Twenty-eight studies met the eligibility criteria, and 17 significant risk factors were extracted from the included studies. The most frequently cited risk factors associated with newborn readmissions were gestational age, postnatal length of stay, neonatal comorbidity, and feeding methods. The most frequently cited maternal-related risk factors which contributed to newborn readmissions were parity, race/ethnicity, and complications in pregnancy and/or perinatal period. CONCLUSION This systematic review identified a complex and diverse range of risk factors associated with 31-day UHR in newborn. Six of the 17 extracted risk factors were consistently cited by studies. Four factors were maternal (primiparous, mother being Asian, vaginal delivery, maternal complications), and two factors were neonatal (male infant and neonatal comorbidities). Implementation of evidence-based clinical practice guidelines for inpatient care and individualized hospital-to-home transition plans, including transition checklists and discharge readiness assessments, are recommended to reduce newborn UHRs. WHAT IS KNOWN • Attempts have been made to identify risk factors associated with newborn UHRs; however, the results are inconsistent. WHAT IS NEW • Six consistently cited risk factors related to newborn 31-day UHRs. Four maternal factors (primiparous, mother being Asian, vaginal delivery, maternal complications) and 2 neonatal factors (male infant and neonatal comorbidities). • The importance of discharge readiness assessment, including newborn clinical fitness for discharge and parental readiness for discharge. Future research is warranted to establish standardised maternal and newborn-related variables which healthcare providers can utilize to identify newborns at greater risk of UHRs and enable comparison of research findings.
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Affiliation(s)
- Phillip R Della
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia
| | - Haichao Huang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Pamela A Roberts
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia
| | - Paul Porter
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia.,Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Elizabeth Adams
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia.,European Federation of Nurses Associations, Clos du Parnasse, Brussels, 11A B-1050, Belgium
| | - Huaqiong Zhou
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia. .,General Surgical Ward, Perth Children's Hospital, Nedlands, Western Australia, Australia.
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van den Berg LMM, Akooji N, Thomson G, de Jonge A, Balaam MC, Topalidou A, Downe S. Making maternity and neonatal care personalised in the COVID-19 pandemic: Results from the Babies Born Better survey in the UK and the Netherlands. PLoS One 2022; 17:e0267415. [PMID: 36449488 PMCID: PMC9710753 DOI: 10.1371/journal.pone.0267415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/24/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic had a severe impact on women's birth experiences. To date, there are no studies that use both quantitative and qualitative data to compare women's birth experiences before and during the pandemic, across more than one country. AIM To examine women's birth experiences during the COVID-19 pandemic and to compare the experiences of women who gave birth in the United Kingdom (UK) or the Netherlands (NL) either before or during the pandemic. METHOD This study is based on analyses of quantitative and qualitative data from the online Babies Born Better survey. Responses recorded by women giving birth in the UK and the NL between June and December 2020 have been used, encompassing women who gave birth between 2017 and 2020. Quantitative data were analysed descriptively, and chi-squared tests were performed to compare women who gave birth pre- versus during pandemic and separately by country. Qualitative data was analysed by inductive thematic analysis. FINDINGS Respondents in both the UK and the NL who gave birth during the pandemic were as likely, or, if they had a self-reported above average standard of life, more likely to rate their labour and birth experience positively when compared to women who gave birth pre-pandemic. This was despite the fact that those labouring in the pandemic reported a lack of support and limits placed on freedom of choice. Two potential explanatory themes were identified in the qualitative data: respondents had lower expectations of care during the pandemic, and they appreciated the efforts of staff to give individualised care, despite the rules. CONCLUSION Our study implies that many women labouring during the COVID-19 pandemic experienced restrictions, but their experience was mitigated by staff actions. However, personalised care should not be maintained by the good will of care providers, but should be a priority in maternity care policy to benefit all service users equitably.
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Affiliation(s)
- Lauri M. M. van den Berg
- Department of Midwifery Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Naseerah Akooji
- Lancashire Clinical Trials Units, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Faculty of Health and Care, School of Community Health & Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Ank de Jonge
- Department of Midwifery Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Amsterdam Reproduction and Development, Quality of Care, Amsterdam, The Netherlands
| | - Marie-Clare Balaam
- Faculty of Health and Care, School of Community Health & Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Anastasia Topalidou
- Faculty of Health and Care, School of Community Health & Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Soo Downe
- Faculty of Health and Care, School of Community Health & Midwifery, University of Central Lancashire, Preston, United Kingdom
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Heys S, Downe S, McKeown M, Thomson G. The design, delivery and evaluation of 'Human Perspectives VR': An immersive educational programme designed to raise awareness of contributory factors for a traumatic childbirth experience and PTSD. PLoS One 2022; 17:e0276263. [PMID: 36322586 PMCID: PMC9629609 DOI: 10.1371/journal.pone.0276263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A traumatic childbirth experience affects ~30% of women each year, with negative impacts on maternal, infant, and family wellbeing. Women classified as vulnerable or marginalised are those more likely to experience a psychologically traumatising birth. A key contributory factor for a traumatic childbirth experience is women's relationships with maternity care providers. AIMS To develop, design and evaluate an immersive educational programme for maternity care providers to raise awareness of traumatic childbirth experiences amongst vulnerable groups, and ultimately to improve women's experiences of childbirth. METHODS A critical pedagogical approach that utilised virtual reality (VR) underpinned the design and development of the educational programme. This involved: a) collecting vulnerable/disadvantaged women's experiences of birth via interviews; b) analysing data collected to identify key hotspots for traumatic experiences within interpersonal patient-provider relationships to develop a script; c) filming the script with professional actors creating a first person perspective via VR technology; d) using existing literature to inform the theoretical and reflective aspects of the programme; e) conducting an evaluation of the education programme using pre-and post-evaluation questionnaires and a follow-up focus group. FINDINGS Human Perspective VR was very well received. Participants considered the content to have enhanced their reflective practice and increased their knowledge base regarding contributory factors associated with a traumatic childbirth experience. A need for further work to implement learning into practice was highlighted. CONCLUSION While further research is needed to evaluate the impact of the programme, Human Perspective VR programme offers an innovative approach to reflective education and to enhance participants' care practices.
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Affiliation(s)
- Stephanie Heys
- Maternity Learning and Development Lead, Consultant Midwife, The Northwest Ambulance Service, The University of Central Lancashire, Preston, United Kingdom
- * E-mail:
| | - Soo Downe
- Professor of Midwifery Studies, The University of Central Lancashire, Preston, United Kingdom
| | - Mick McKeown
- Professor of Democratic Mental Health, The University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Professor of Perinatal Health, The University of Central Lancashire, Preston, United Kingdom
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Marques MJP, Zangão O, Miranda L, Sim-Sim M. Childbirth Experience Questionnaire: Cross-cultural validation and psychometric evaluation for European Portuguese. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221128121. [PMID: 36255072 PMCID: PMC9583229 DOI: 10.1177/17455057221128121] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Self-reported measures are relevant both for the clinic and for health evaluation because they provide an interpretation of quality parameters. Women who experience labour can express themselves through these measures, identifying indicators that need improvement. OBJECTIVE The objective of this study is to adapt the Childbirth Experience Questionnaire to the Portuguese context and to determine its psychometric properties. METHOD A methodological study carried out with a convenience sample where the participants were 161 female users of a hospital in southern Portugal. They were aged between 20 and 43 years (M = 31.05, SD = 4.87) and answered a questionnaire approximately 48 h postpartum, preserving the ethical principles. The original instrument, with 22 items, underwent the linguistic and cultural adequacy process. RESULTS Factor analysis with Varimax rotation was performed, revealing a set of 19 items with factor weights above .400. The set of items remained four-dimensional as the original, explaining 62.517% of the variance. In the retest, the reliability results showed that similar characteristics to the original study are maintained in the two subscales that express 'Participation' (three items) and 'Professional Support' (four items), with internal consistency values of .807 and .782. The 'Own Performance' and 'Own Threshold' subscales were elaborated from the results of the Varimax rotation, presenting Cronbach's alpha coefficients of .840 and 714, respectively. The total scale showed alpha values of .873 and .823 in the test and retest, respectively. Time stability showed a positive association, with r = .659 (p < .001). Accuracy through the split-half method reached an alpha value of .880 with Spearman-Brown correction. The floor effect was high in the 'Participation' subscale, both in the test and in the retest. Convergent validity between the instrument and the 'Index of Strategies for Pain Relief in Labour' discrete variable showed a Spearman's rho value of .209 (p = .011) in the total scale. In discriminating validity, the Mann-Whitney test reveals that the women who recognize interactions with the midwife have more favourable scores in Childbirth Experience Questionnaire (U = 2748.000; Z = 2.905; p = .004). CONCLUSION The current version in European Portuguese suggests that it is a valid and reliable measure. This study may facilitate other validation processes in Lusophony countries.
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Affiliation(s)
| | - Otília Zangão
- Comprehensive Health Research Centre
(CHRC), University of Évora, Évora, Portugal,Nursing Department, University of
Évora, Évora, Portugal,Otília Zangão, Nursing Department,
University of Évora, 7000-811 Évora, Portugal.
| | - Luis Miranda
- Centro Hospitalar Barreiro Montijo
(CHBM), Hospital do Barreiro, Barreiro, Portugal
| | - Margarida Sim-Sim
- Comprehensive Health Research Centre
(CHRC), University of Évora, Évora, Portugal,Nursing Department, University of
Évora, Évora, Portugal
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Puthussery S, Tseng PC, Sharma E, Harden A, Griffiths M, Bamfo J, Li L. Disparities in the timing of antenatal care initiation and associated factors in an ethnically dense maternal cohort with high levels of area deprivation. BMC Pregnancy Childbirth 2022; 22:713. [PMID: 36123628 PMCID: PMC9484064 DOI: 10.1186/s12884-022-04984-6] [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: 07/27/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late access to antenatal care is a contributor to excess mortality and morbidity among ethnic minority mothers compared to White British in the UK. While individual ethnicity and socioeconomic disadvantage are linked to late antenatal care initiation, studies have seldom explored patterns of late initiation and associated factors in ethnically dense socially disadvantaged settings. This study investigated disparities in the timing of antenatal care initiation, and associated factors in an ethnically dense socially disadvantaged maternal cohort. METHODS A retrospective cross-sectional study using routinely collected anonymous data on all births between April 2007-March 2016 in Luton and Dunstable hospital, UK (N = 46,307). Late initiation was defined as first antenatal appointment attended at > 12 weeks of gestation and further classified into moderately late (13-19 weeks) and extremely late initiation (≥ 20 weeks). We applied logistic and multinomial models to examine associations of late initiation with maternal and sociodemographic factors. RESULTS Overall, one fifth of mothers (20.8%) started antenatal care at > 12 weeks of gestation. Prevalence of late initiation varied across ethnic groups, from 16.3% (White British) to 34.2% (Black African). Late initiation was strongly associated with non-White British ethnicity. Compared to White British mothers, the odds of late initiation and relative risk of extremely late initiation were highest for Black African mothers [adjusted OR = 3.37 (3.05, 3.73) for late initiation and RRR = 4.03 (3.51, 4.64) for extremely late initiation]. The odds did not increase with increasing area deprivation, but the relative risk of moderately late initiation increased in the most deprived ([RRR = 1.53 (1.37, 1.72)] and second most deprived areas [RRR = 1.23 (1.10, 1.38)]. Late initiation was associated with younger mothers and to a lesser extent, older mothers aged > 35 years. Mothers who smoked during pregnancy were at higher odds of late initiation compared to mothers who did not smoke. CONCLUSIONS There is a need to intensify universal and targeted programmes/services to support mothers in ethnically dense socially disadvantaged areas to start antenatal care on time. Local variations in ethnic diversity and levels of social disadvantage are essential aspects to consider while planning services and programmes to ensure equity in maternity care provision.
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Affiliation(s)
- Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK.
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK
| | - Esther Sharma
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK
| | - Angela Harden
- School of Health Sciences, Division of Health Services Research and Management, City, University of London, Northampton Square, EC1V 0HB, London, England
| | - Malcolm Griffiths
- Department of Obstetrics and Gynaecology, The Luton and Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, Bedford, UK
| | - Jacqueline Bamfo
- Department of Obstetrics and Gynaecology, The Luton and Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, Bedford, UK
| | - Leah Li
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
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Hassan SM. Religious practices of Muslim women in the UK during maternity: evidence-based professional practice recommendations. BMC Pregnancy Childbirth 2022; 22:335. [PMID: 35440069 PMCID: PMC9020041 DOI: 10.1186/s12884-022-04664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 04/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Muslim women commonly observe certain religious practices during their maternity journey and research in this area suggests that more could be done from a service provision perspective to support Muslim women in the UK through this significant life event. Aim This study identifies Muslim women’s religious practices during maternity, needs and challenges of religious practice while engaging with maternity services, and support needs from healthcare professionals. Method Qualitative mixed method study; that includes eight longitudinal interviews with first-time pregnant Muslim women, five focus groups with 23 Muslim mothers experiencing childbirth in last three years in UK, and 12 one-to-one interviews with Health care Professionals (HCPs) with previous experience working with Minority Ethnic groups. Participants recruited from local Muslim community groups and Maternity Care Provider, North West Coast, England. Data analysed using thematic analysis. Result Qualitative findings indicate common religious practices that Muslim women exercise at different stages of their maternity journey. These practices can be divided into two categories of common religious practices for Muslim women that 1) require only healthcare professionals’ awareness of these practices and 2) require awareness and active involvement of healthcare professionals. Findings highlight key recommendations for healthcare professionals when addressing Muslim women’s religious needs in the UK. Discussion/Conclusion This study provides evidence-based recommendations for professional practice to assist healthcare professionals in developing understanding and addressing Muslim women’s religious practice needs in the UK. Further research is required to explore the impact of these recommendations for professional practice.
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Affiliation(s)
- Shaima M Hassan
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, L69 3GL, UK. .,NIHR Applied Research Collaboration NWC, Liverpool, England.
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"You're a 'high-risk' customer": A qualitative study of women's experiences of receiving information from health professionals regarding health problems or complications in pregnancy. Women Birth 2021; 35:e477-e486. [PMID: 34974953 DOI: 10.1016/j.wombi.2021.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Experiencing complications in pregnancy is stressful for women and can impact on fetal and maternal outcomes. Supportive encounters with health professionals can reduce the worry women experience. Further research is needed to understand women's perspectives on communicating with their healthcare providers about their concerns. AIM This study explored women's experiences of receiving information about pregnancy complications from healthcare providers and their interactions with multiple professionals and services during pregnancy. METHODS This was a qualitative interpretive study. Semi-structured interviews were conducted with 20 women experiencing pregnancy complications recruited from antenatal services at two hospitals in Sydney. Inductive thematic analysis was used to analyse the data. FINDINGS Women had a range of reactions to their diagnoses, including concern for their baby, for themselves and for their labour. Most women reported that communication with healthcare providers was distressing, they were not listened to and staff used insensitive, abrupt language. Women were also distressed by delays in education, receiving contradictory information and having to repeatedly share their stories with different health professionals. In some cases, this damaged the therapeutic relationship and reduced trust towards healthcare providers. Midwives were generally preferred over doctors because they had a more woman-centred approach. CONCLUSION To improve women's experiences of care for pregnancy complications, it is critical to improve the communication skills of maternity service providers. Women's need for information, resources and support can best be provided by continuity of care with a named health professional, for example, a midwife working within an integrated multidisciplinary antenatal service model.
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