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Auger N, Bilodeau-Bertrand M, Lafleur N, Lewin A. Underlying Causes of Ethnocultural Inequality in Pregnancy Outcomes: Role of Hospital Proximity. J Immigr Minor Health 2024; 26:54-62. [PMID: 37733167 DOI: 10.1007/s10903-023-01545-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
We evaluated the contribution of place of birth to ethnocultural inequality in pregnancy outcomes. We analyzed a cohort of 1,487,723 births between 1998 and 2019 among minority Anglophones and majority Francophones in Quebec, Canada. We estimated the association (adjusted risk ratio, RR; 95% confidence interval, CI) of language with preterm birth and stillbirth, and incorporated interaction terms to determine the contribution of place of birth and distance traveled. Compared with Francophones, minority Anglophones had a greater risk of preterm birth (RR 1.03; 95% CI 1.01-1.06) and were less likely to deliver farther from home (RR 0.95; 95% CI 0.94-0.95). Anglophones who delivered close to home had a higher risk of preterm birth (RR 1.07; 95% CI 1.04-1.11), whereas Anglophones who delivered farther had a lower risk (RR 0.69; 95% CI 0.64-0.75). Patterns were similar for stillbirth. Ethnocultural inequality in adverse birth outcomes may be influenced by place of birth.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Canada.
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
| | - Marianne Bilodeau-Bertrand
- University of Montreal Hospital Research Centre, Montreal, Canada
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada
| | - Nahantara Lafleur
- University of Montreal Hospital Research Centre, Montreal, Canada
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada
| | - Antoine Lewin
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Canada
- Medical Affairs and Innovation, Héma-Québec, Saint-Laurent, Canada
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Bizuayehu HM, Harris ML, Chojenta C, Cavenagh D, Forder PM, Loxton D. Patterns of Labour Interventions and Associated Maternal Biopsychosocial Factors in Australia: a Path Analysis. Reprod Sci 2023; 30:2767-2779. [PMID: 36973581 PMCID: PMC10480095 DOI: 10.1007/s43032-023-01219-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
In Australia, nearly half of births involve labour interventions. Prior research in this area has relied on cross-sectional and administrative health data and has not considered biopsychosocial factors. The current study examined direct and indirect associations between biopsychosocial factors and labour interventions using 19 years of population-based prospective data. The study included singleton babies among primiparous women of the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health. Data from 5459 women who started labour were analysed using path analysis. 42.2% of babies were born without intervention (episiotomy, instrumental, or caesarean delivery): Thirty-seven percent reported vaginal birth with episiotomy and instrumental birth interventions, 18% reported an unplanned caesarean section without episiotomy and/or instrumental interventions, and 3% reported unplanned caesarean section after episiotomy and/or instrumental interventions. Vaginal births with episiotomy and/or instrumental interventions were more likely among women with chronic hypertension (RRR(95%-CI):1.50(1.12-2.01)), a perceived length of labour of more than 36 h (RRR(95%-CI):1.86(1.45-2.39)), private health insurance (RRR(95%-CI):1.61(1.41-1.85)) and induced labour (RRR(95%-CI):1.69(1.46-1.94)). Risk factors of unplanned caesarean section without episiotomy and/or instrumental birth intervention included being overweight (RRR(95%-CI):1.30(1.07-1.58)) or obese prepregnancy (RRR(95%-CI):1.63(1.28-2.08)), aged ≥ 35 years (RRR(95%-CI):1.87(1.46-2.41)), having short stature (< 154 cm) (RRR(95%-CI):1.68(1.16-2.42)), a perceived length of labour of more than 36 h (RRR(95%-CI):3.26(2.50-4.24)), private health insurance (RRR(95%-CI):1.38(1.17-1.64)), and induced labour (RRR(95%-CI):2.56(2.16-3.05)). Prevention and management of hypertension, diabetes, and obesity during preconception and/or antenatal care are keys for reducing labour interventions and strengthening the evidence-base around delivery of best practice obstetric care.
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Affiliation(s)
- Habtamu Mellie Bizuayehu
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia.
- Descriptive Epidemiology, Cancer Council Queensland, Brisbane, Australia.
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.
- The First Nations Cancer & Wellbeing Research (FNCWR) Program, School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Melissa L Harris
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
| | - Catherine Chojenta
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
| | - Dominic Cavenagh
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
| | - Peta M Forder
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
| | - Deborah Loxton
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
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Bizuayehu HM, Harris ML, Chojenta C, Kiross GT, Loxton D. Maternal residential area effects on preterm birth, low birth weight and caesarean section in Australia: A systematic review. Midwifery 2023; 123:103704. [PMID: 37196576 DOI: 10.1016/j.midw.2023.103704] [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: 06/07/2022] [Revised: 03/11/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION In Australia, area of residence is an important health policy focus and has been suggested as a key risk factor for preterm birth (PTB), low birth weight (LBW) and cesarian section (CS) due to its influence on socioeconomic status, access to health services, and its relationship with medical conditions. However, there is inconsistent evidence about the relationship of maternal residential areas (rural and urban areas) with PTB, LBW, and CS. Synthesising the evidence on the issue will help to identify the relationships and mechanisms for underlying inequality and potential interventions to reduce such inequalities in pregnancy outcomes (PTB, LBW and CS) in rural and remote areas. METHODS Electronic databases, including MEDLINE, Embase, CINAHL, and Maternity & Infant Care, were systematically searched for peer-reviewed studies which were conducted in Australia and compared PTB, LBW or CS by maternal area of residence. Articles were appraised for quality using JBI critical appraisal tools. RESULTS Ten articles met the eligibility criteria. Women who lived in rural and remote areas had higher rates of PTB and LBW and lower rate of CS compared to their urban and city counterparts. Two articles fulfilled JBI's critical appraisal checklist for observational studies. Compared to women living in urban and city areas, women living in rural and remote areas were also more likely to give birth at a younger age (<20 years) and have chronic diseases such as hypertension and diabetes. They were also less likely to have higher levels of completing university degree education, private health insurance and births in private hospitals. CONCLUSIONS Addressing the high rate of pre-existing and/or gestational hypertension and diabetes, limited access of health services and a shortage of experienced health staff in remote and rural areas are keys to early identification and intervention of risk factors of PTB, LBW, and CS.
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Affiliation(s)
- Habtamu Mellie Bizuayehu
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia; The First Nations Cancer & Wellbeing Research (FNCWR) Program, School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.
| | - Melissa L Harris
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
| | - Catherine Chojenta
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
| | - Girmay Tsegay Kiross
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia; Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Deborah Loxton
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
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Miller YD, Tone J, Talukdar S, Martin E. A direct comparison of patient-reported outcomes and experiences in alternative models of maternity care in Queensland, Australia. PLoS One 2022; 17:e0271105. [PMID: 35819947 PMCID: PMC9275696 DOI: 10.1371/journal.pone.0271105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
We aimed to directly compare women’s pregnancy to postpartum outcomes and experiences across the major maternity models of care offered in Queensland, Australia. We conducted secondary analyses of self-reported data collected in 2012 from a state-wide sample of women who had recently given birth in Queensland (response rate = 30.4%). Logistic regression was used to estimate the odds of outcomes and experiences associated with three models (GP Shared Care, Public Midwifery Continuity Care, Private Obstetric Care) compared with Standard Public Care, adjusting for relevant maternal characteristics and clinical covariates. Of 2,802 women, 18.2% received Standard Public Care, 21.7% received GP Shared Care, 12.9% received Public Midwifery Continuity Care, and 47.1% received Private Obstetric Care. There were minimal differences for women in GP Shared Care. Women in Public Midwifery Continuity Care were less likely to have a scheduled caesarean and more likely to have an unassisted vaginal birth, experience freedom of mobility during labour and informed consent processes for inducing labour, vaginal examinations, fetal monitoring and receiving Syntocinon to birth their placenta, and report highest quality interpersonal care. They had fewer vaginal examinations, lower odds of perineal trauma requiring sutures and anxiety after birth, shorter postpartum hospital stays, and higher odds of a home postpartum care visit. Women in Private Obstetric Care were more likely to have their labour induced, a scheduled caesarean birth, experience informed consent processes for caesarean, and report highest quality interpersonal care, but less likely to experience unassisted vaginal birth and informed consent for Syntocinon to birth their placenta. There is an urgent need to communicate variations between maternity models across the range of outcome and experiential measures that are important to women; build more rigorous comparative evidence for Private Midwifery Care; and prioritise experiential and out-of-pocket cost comparisons in further research to enable woman-centred informed decision-making.
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Affiliation(s)
- Yvette D. Miller
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
- * E-mail:
| | - Jessica Tone
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Sutapa Talukdar
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Elizabeth Martin
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
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Roxburgh C, Moore S, McCulloch C, Valli K, Zuidersma D, Pikora T, Ngo H. Satisfaction with general practitioner obstetrician-led maternity care in rural Western Australia. Aust J Rural Health 2021; 30:135-148. [PMID: 34514661 DOI: 10.1111/ajr.12783] [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: 01/27/2021] [Revised: 06/07/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To measure satisfaction with general practitioner obstetrician-led maternity care in Western Australia and to explore perspectives of maternity service users DESIGN: Women were recruited at antenatal visits with their general practitioner obstetrician. Participants completed a validated three-part survey about their satisfaction with antenatal, intrapartum and postpartum care. They were all offered a semi-structured interview. SETTING Nine general practitioner obstetrician practices located in regional Western Australia. PARTICIPANTS 155 women receiving general practitioner obstetrician-led maternity care within the South West or Great Southern regions of Western Australia. 13 of these women also participated in an interview. MAIN OUTCOME MEASURES We quantified satisfaction with aspects of antenatal, intrapartum and postpartum care using a Likert scale. Descriptive variables included demographic information and birth outcomes. Qualitative data described valued aspects of maternity care. RESULTS 116 women completed all 3 surveys. General practitioner obstetrician-led care resulted in high rates of satisfaction across all 3 stages of care, with 78%-100% agreement with positively worded satisfaction statements. Thematic analysis identified four key aspects of care women valued when receiving maternity care: the woman-centred care experience, the skills of the general practitioner obstetrician, support from the health care team and the health care environment. CONCLUSION General practitioner obstetrician-led maternity care is a highly regarded model of maternity care, valued by rural women with high rates of satisfaction.
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Affiliation(s)
- Carly Roxburgh
- Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Sarah Moore
- Rural Clinical School of Western Australia, University of Western Australia, Busselton, WA, Australia
| | - Claudia McCulloch
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, WA, Australia
| | - Kelsey Valli
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, WA, Australia
| | - Danika Zuidersma
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, WA, Australia
| | - Terri Pikora
- Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Hanh Ngo
- Rural Clinical School of Western Australia, University of Western Australia, Perth, WA, Australia
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Pollock D, Cooper M, McArthur A, Barker T, Munn Z. Women's experiences of their interactions with health care providers during the postnatal period in Australia: a qualitative systematic review protocol. JBI Evid Synth 2021; 19:622-628. [PMID: 33074985 DOI: 10.11124/jbies-20-00182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the review is to explore and evaluate women's experiences of interactions with health care providers during their postnatal period. INTRODUCTION The postnatal period is a transformative time for women. Women experience significant change and adaptation, which could impact upon parenting confidence, health, and psychological outcomes during this time. The interaction women have with their health care providers during the postnatal period plays an integral role in improving these health outcomes. INCLUSION CRITERIA This qualitative review will explore the experiences of primiparous and multiparous women during the postnatal period with a key focus on evaluating the interactions they have with health care providers. It will include all studies that utilize qualitative methods (such as interviews and focus groups). Articles that explore the postnatal care experiences of women who have endured a pregnancy loss, given birth to a baby with complex needs, or those that solely focus on describing the neonatal and intensive care experiences, will not be included. METHODS PubMed, CINAHL, Embase, Emcare, and PsycINFO will be searched. Studies published from 2000 onwards and written in English will be assessed for inclusion. Studies that are selected initially will be assessed for methodological quality by two independent reviewers utilizing the JBI critical appraisal instrument for qualitative research. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020186384.
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Affiliation(s)
- Danielle Pollock
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Megan Cooper
- Australian College of Midwives, Adelaide, SA, Australia.,UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Alexa McArthur
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Timothy Barker
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Bizuayehu HM, Harris ML, Chojenta C, Forder PM, Loxton D. Low birth weight and its associated biopsychosocial factors over a 19-year period: findings from a national cohort study. Eur J Public Health 2021; 31:776-783. [PMID: 33755156 DOI: 10.1093/eurpub/ckab033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In Australia, 6.7% of babies (5.2% for singletons) are born low birth weight (LBW), and over the past decade, this figure has increased by 8%. Evidence regarding LBW has largely come from hospital-based cross-sectional studies, which are not representative, lack temporality and do not examine the potential predictors of LBW using a comprehensive theoretical framework. This study, therefore, examined predictors of LBW within a biopsychosocial framework, using a community-based representative prospective cohort with 19 years of data. METHODS The study included 11 854 singleton babies born to 5622 women from the 1973 to 1978 cohort of the Australian Longitudinal Study on Women's Health. RESULTS Among 5622 first births, 310 (5.5%) were reported as LBW. Maternal risk factors included pre-pregnancy underweight (aOR = 2.27, 95% CI: 1.43-3.62), chronic diabetes (aOR = 2.38, 95% CI: 1.14-4.95), gestational diabetes (aOR = 1.93, 95% CI: 1.27-2.94), chronic hypertension (aOR = 2.23, 95% CI: 1.50-3.33) and gestational hypertension (aOR = 2.44, 95% CI: 1.78-3.36). Among all births (N = 11 854), the overall LBW rate was 3.8% with a recurrence rate of 4.8%. Identified risk factors included menarche before 12 years (aOR = 1.57; 95% CI: 1.17-2.11), pre-pregnancy underweight (aOR = 2.25, 95% CI: 1.46-3.45), gestational diabetes (aOR = 1.74, 95% CI: 1.16-2.59), chronic hypertension (aOR = 2.01, 95% CI: 1.40-2.90) and gestational hypertension (aOR = 2.81, 95% CI: 2.05-3.84). LBW was less likely for second births (aOR = 0.39, 95% CI: 0.31-0.50) and third/above births (aOR = 0.49, 95% CI: 0.35-0.67) compared with the first births. CONCLUSION Increased nutrition counselling/supplementation for underweight women and interventions aimed at chronic disease prevention and management by using a multi-sectoral approach may be the key to the prevention of LBW.
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Affiliation(s)
- Habtamu Mellie Bizuayehu
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia.,Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Melissa L Harris
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Peta M Forder
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
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Alderdice F, McLeish J, Henderson J, Malouf R, Harvey M, Redshaw M. Women's ideal and real expectations of postnatal care during their first pregnancy: An online survey in England. Midwifery 2020; 89:102815. [PMID: 32829965 DOI: 10.1016/j.midw.2020.102815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 05/11/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND There are many studies of women's experiences of care during the postnatal period, however little is known about women's expectations of postnatal care. OBJECTIVE This study explores first-time pregnant women's expectations, both ideal and real life, of postnatal care in England. DESIGN a descriptive, cross-sectional online survey design was used. The questionnaire took approximately 10 minutes to complete and was developed specifically for this survey. It included an informed consent section, socio-demographic questions and closed tick-box questions on where they had received information on postnatal care, and real and ideal expectations of postnatal care in hospital/birth centre and at home. SETTING The survey was hosted on the National Perinatal Epidemiology Unit website and advertised through a number of third sector and commercial organisations in 2017. PARTICIPANTS Women who were pregnant, had not given birth before, were aged 16 years and over, and living in England were eligible to participate. ANALYSIS Survey data were analysed using descriptive statistics and, where appropriate, chi square test using SPSS Version 23. Data from open ended questions were analysed by two researchers separately then codes and themes were discussed until consensus was reached. RESULTS 283 women responded to the survey of whom 200 were eligible and included in the analysis. Most had received information on postnatal care from multiple sources, with pregnancy classes and midwives being most common. Most expected to stay one day or less in hospital or birth centre after normal delivery. Real life expectations were lower than ideal expectations, and hospital/birth centre real life expectations were higher than home real life expectations for physical health advice/checks and information/help with feeding. Categories developed from the open text answers were 'Respect, compassion and individualised care at a vulnerable time', 'The ward environment', 'Feeling ready for hospital discharge' and 'Help to find support in the community'. KEY CONCLUSIONS Women in this survey had high ideal world expectations of their postnatal care but in real life expected more focus on checking on their health and that of their baby and on giving information about the new challenges of how to breastfeed and look after a baby. While women valued checks of their health and that of their baby, ideally they wanted easy access to reassurance that they were feeding and looking after their baby well, that they were 'doing it right', and that what was happening to them was normal. IMPLICATIONS FOR PRACTICE As well as the necessary checks in the immediate postpartum period, consideration also needs to be given to the best way to meet the informational and support needs of women to optimise their wellbeing and transition to parenthood. A number of resources are used by women that could be enhanced to inform expectations of postnatal care and to provide valuable information to support their postnatal care.
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Affiliation(s)
- Fiona Alderdice
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK.
| | - Jenny McLeish
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Reem Malouf
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Merryl Harvey
- Faculty of Health, Education and Life Science, Birmingham City University, Birmingham, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
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Wapau H, Jans D, Hapea E, Mein J, Curnow V, McDonald M. Coming to town: Reaching agreement on a thorny issue. Aust J Rural Health 2018; 26:416-421. [PMID: 30450678 DOI: 10.1111/ajr.12430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the process of gaining consensus across regional organisations in formulating measures to improve coordination of care for people from remote Far North Queensland communities coming to town (Cairns) to access health care. DESIGN This is a descriptive study that includes survey data from workshop participants. SETTING Coming to town for health care poses great challenges, especially for Indigenous Australians from remote communities. Numerous organisations are involved, communications are fragmented and there is no central coordinating body. The system frequently fails to deliver necessary services. This generates preventable cost burdens through missed flights, missed appointments, missed treatment opportunities and extra administration. Workshop organisers invited key service providers from across Far North Queensland. MAIN OUTCOME MEASURES Using real-case scenarios, the task was to identify and prioritise the central issues and explore ways to address them. Participants jointly crafted the final recommendations and also posted suggestions on a 'wish-list' board. A participant assessment survey was conducted at the end of the workshop, followed by an online survey 6 weeks later. RESULTS There were 32 participants. The concluding survey indicated the workshop was well received and people valued the collaboration. There were six primary recommendations plus numerous wish-list suggestions. The best-supported recommendation was establishment of a coming to town Hub with a local coordinating team and community-based representatives. CONCLUSION Implementation of the workshop recommendations and support of all key service providers should be culturally acceptable and resource-efficient with better health outcomes for travellers, their families and communities.
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Affiliation(s)
- Hylda Wapau
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Diana Jans
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Emily Hapea
- Mookai Rosie Bi-Bayan Aboriginal and Torres Strait Islander Corporation, Edmonton, Queensland, Australia
| | - Jacki Mein
- Wuchopperen Health Service, Manoora, Queensland, Australia
| | - Venessa Curnow
- Aboriginal and Torres Strait Islander Health Management Unit, Cairns and Hinterland Hospital and Health Services, Queensland Health, Cairns, Queensland, Australia
| | - Malcolm McDonald
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia.,Centre for Chronic Disease Prevention, James Cook University, Smithfield, Queensland, Australia
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McCarthy EA, Williamson R, Shub A. Pregnancy outcomes for women with pre‐pregnancy diabetes mellitus in Australian populations, rural and metropolitan: A review. Aust N Z J Obstet Gynaecol 2018; 59:183-194. [DOI: 10.1111/ajo.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Elizabeth A. McCarthy
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
- Department of Perinatal MedicineMercy Hospital for Women Melbourne Victoria Australia
| | - Rebecca Williamson
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
| | - Alexis Shub
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
- Mercy Hospital for Women Melbourne Victoria Australia
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Zhang X, Zhou L, Antwi HA. The impact of China's latest population policy changes on maternity insurance-a case study in Jiangsu Province. Int J Health Plann Manage 2018; 34:e617-e633. [PMID: 30295341 DOI: 10.1002/hpm.2677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/12/2022] Open
Abstract
This study aims to examine the impact of China's population policy changes on social insurance. Nearly 4 decades ago, China ushered in the 1-child policy as a family planning policy to control the adverse effect of high population growth. The current maternity insurance system in China is designed to fit the operations of the 1-child policy. However, the implementation of the comprehensive 2-child policy can pose a challenge to the sustainability of the current maternity insurance scheme hence the call for reform. The study empanels a novel and comprehensive system dynamic model that incorporates all the related factors that influence the income and expenditure of maternity insurance in the Jiangsu Province. Data are mainly derived from the historical data of the Statistical Yearbook of Jiangsu Province and the National Bureau of Statistics of China. These are used to construct and simulate a system dynamic model to determine a sustainable contribution rate for maternity insurance. In conclusion, if the rate of contribution of the current maternity insurance policy is not increased, the burden of implementing the comprehensive 2-child policy will exacerbate the current deficit balance of the maternity insurance fund. The existing maternity insurance benefits thus cannot be maintained, and women's health will be threatened. In the short term, the study proposes an increase in the rate of premium payment to prolong the life of the maternity insurance. In the long term, there is a need to improve the level of coordination and expand the coverage of maternity insurance.
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Affiliation(s)
- Xiaotian Zhang
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Lvlin Zhou
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Henry Asante Antwi
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China
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Rodríguez-Franco R, Serván-Mori E, Gómez-Dantés O, Contreras-Loya D, Pineda-Antúnez C. Old principles, persisting challenges: Maternal health care market alignment in Mexico in the search for UHC. PLoS One 2018; 13:e0199543. [PMID: 29966002 PMCID: PMC6028103 DOI: 10.1371/journal.pone.0199543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/08/2018] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study is to analyze the alignment of supply and demand for antenatal care (ANC) in Mexico based on the definition of access provided by Donabedian: the "degree of adjustment" between resources and needs. Alignment was studied in the teenage and adult population of Mexico that lacked conventional social security between 2008 and 2015, a period of expanding financial resources for health and public health insurance coverage. Spatial econometric methods were used to analyze data from the Ministry of Health on the supply and demand for ANC in 2,314 municipalities (94% of all municipalities in Mexico). During this period, the relative weight of ANC demand among adolescents increased 37% while the production of antenatal consultations for adolescent and adult women remained unchanged. Bivariate spatial analyses of correlation between supply and demand for ANC services yielded a minimal spatial correlation, or lack of territorial correspondence, between supply and demand among women in both age groups. Spatial econometric analysis confirmed a non-significant association between supply and demand for ANC services. Our findings suggest the existence of misalignment between supply and demand for these services. This requires a reassessment of the management and delivery of ANC services at the local level in order to increase effective coverage and improve the overall performance of the health system.
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Theodore S, de Costa C, McLean A, Woods C. Vitamin D supplementation in pregnant women with diabetes in Far North Queensland. Aust J Rural Health 2018; 26:451-452. [PMID: 29846030 DOI: 10.1111/ajr.12437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sigrid Theodore
- Obstetrics and Gynaecology, James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia
| | - Caroline de Costa
- Obstetrics and Gynaecology, James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia
| | - Anna McLean
- Endocrinology, Cairns Hospital, Cairns, Queensland, Australia
| | - Cindy Woods
- University of New England School of Health, Armidale, New South Wales, Australia
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