Contextual factors influencing the implementation of midwifery-led care units in India

Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study

BACKGROUND

In recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of "Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model".

METHODS/DESIGN

The current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants' attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants' average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method.

DISCUSSION

This is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably.

ETHICAL CODE

IR.MUMS.NURSE.REC. 1403. 014.

A community evaluation of post-partum quality of life using a locally adapted mother-generated-index: the Delhi Delivery Care (DELCARE) Survey (2009-2011)

Post-partum quality of life is an inadequately studied and poorly understood outcome of delivery care, especially in low- and middle-income countries. Hence, we evaluated the postpartum quality of life and its clinic-demographic context as part of a 3-stage cluster randomized community survey (DECLARE; covered quality of care as primary outcome) conducted in 2009-2011 in Delhi. In stage 1 of participant selection(sampling), 20 wards (of 150; geographically defined administrative units) were selected using a probability-proportionate-to-size systematic method. In stage 2, one from each income stratum (high, middle, and low; multiple colonies within each ward) was selected from each ward by simple random sampling (total 60 colonies of 2311). In stage 3, a house-to-house survey was conducted to recruit ~1800 recently delivered women for the multidimensional work, which included quality-of-care, cost-of-care, and PPQOL. Among the participants, those with high school or above education were invited to administer the Mother-Generated Index and calculate the primary and secondary index scores (PIS and SIS). A total of 794 (of 857 eligible; 118846 households) women were administered MGI. The mean PIS was 4.6[95 percent CI 4.4-4.7] while the average SIS was 4.0[95 percent CI 3.8-4.2]. The PIS was worse for primiparous vs. multiparous mothers. On multivariate analysis, poorer psychological state, obstetric complications, and premature delivery correlated with poorer QOL scores, while better gestational weight gain, higher age, and labor-pain relief correlated with better QOL scores. The study benchmarks the poor status of post-partum quality-of-life and documents the spectrum, severity, and complexity of its key social, psychological, physical, and demographic determinants.

Midwifery Students' Knowledge and Perceptions of a Midwifery-Led Model of Care in North Karnataka, India

OBJECTIVE

To assess the knowledge and perceptions of midwifery students regarding a midwifery-led model of care.

DESIGN

Cross-sectional study.

SETTING

A nursing college in North Karnataka, India. The midwifery-led care model is a relatively new concept in India. In 2018, guidelines on midwifery services in India were released during the Partners Forum held in New Delhi as the initiation of the model and with the support of the Ministry of Health and Family Welfare. The initiative began with the training of nurse practitioners in midwifery and is progressing.

PARTICIPANTS

Final-year diploma and bachelor's degree students.

METHODS

Participants completed an online survey, which consisted of a 20-item questionnaire with a 5-point Likert scale to collect their knowledge and perceptions of the midwifery-led model of care. Descriptive statistics were used to describe the knowledge and perceptions of the students, including the mean, standard deviation, frequency, and percentage. Chi-square analysis and the Pearson's correlation coefficient were used to assess relationships between variables of interest.

RESULTS

Among the 165 participants, 85.5% (n = 141) had a poor level of knowledge of the midwifery-led care model, and only 14.5% (n = 24) showed average knowledge, with none possessing adequate knowledge. Notably, gender was significantly associated with knowledge (p < .05), with female participants demonstrating lower knowledge levels compared to male participants. A substantial portion (76.4%, n = 126) had a negative perception of the midwifery-led care model, 23.6% (n = 39) had a neutral perception, and none had a positive perception. There was no significant correlation between students' knowledge and perceptions of the midwifery-led model of care.

CONCLUSION

These results suggest that there is an urgent need for awareness, knowledge, and educational initiatives to help nursing students in India better comprehend the midwifery-led model of care and to strengthen the midwifery training in nursing colleges.

Contextual factors influencing the implementation of a new midwife education programme in India: a qualitative study

The Indian Government has committed to educate 90,000 midwives in accordance with international norms. This goal is critical as midwives provide evidence-based, high-quality midwifery care. There is a need to explore the contextual factors influencing this new midwifery education programme. Hence, the aim of this study is to explore contextual factors influencing the implementation of the national midwifery education programme for midwifery educators and the future Nurse Practitioners in Midwifery (NPMs) in India. A qualitative research design was used, with data collected through focus group discussions (n = 8) with a total of 27 participants representing seven national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis. This study on contextual factors influencing the implementation of the new midwifery education programme in India showed that organisational and administrative processes are complex and the development of midwifery educators and nurse practitioners in midwifery needs to be fast tracked. The education of educators and future midwives in India, and elsewhere in similar settings, could benefit from efforts to simplify the organisational and administration processes and, in parallel, mobilize innovative teaching and learning approaches to bridge theory and practice.