1
|
Prussing E, Kinsman L, Jacob A, Doust J, Guy F, Tierney O. Everyone should have their own midwife: Women's and staff experiences during the implementation of two midwifery continuity of care models in regional Australia. Women Birth 2024; 37:101807. [PMID: 39208507 DOI: 10.1016/j.wombi.2024.101807] [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: 04/03/2024] [Revised: 07/18/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
PROBLEM Midwifery Continuity of Care (MCoC) remains inaccessible for most Australian women; this is especially true in rural and regional areas. BACKGROUND Strong evidence demonstrates MCoC models improve experiences for women and their babies and are also shown to improve midwifery workforce wellbeing. However, implementation and upscale remains limited. AIM To explore the views and experiences of implementing MCoC for both staff and women, understanding their experiences, concerns and solutions in a regional context. METHODS Qualitative data was collected via focus groups with women and healthcare staff, at six and twelve month post implementation. Data was thematically analysed using Braun and Clarke six step process. FINDINGS The findings support that 'women love it' and midwives working in the new MCoC model 'loved their job'. The major concern was that not all women could access the model and disconnected communication was problematic during implementation. 'Sharing stories' was a solution to overcoming these issues and promoting the positive impact of MCoC - in particular ways of working and adaption to an all-risk midwifery group practice. DISCUSSION This study supports widespread evidence that MCoC is valued by both women and staff. In a regional context it is important to recognise challenges faced during implementation and identifying solutions that other maternity services could consider when implementing MCoC. CONCLUSION The study offers strong recommendation for regional areas to consider MGP to maintain safe, quality local maternity services.
Collapse
Affiliation(s)
- Elysse Prussing
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Australia.
| | - Leigh Kinsman
- Centre for Rural and Remote Health, Latrobe University, Bendigo, Australia. https://twitter.com/@LDKinsman
| | - Alycia Jacob
- Centre for Rural and Remote Health, Latrobe University, Bendigo, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Australia
| | - Jenni Doust
- Mid North Coast Local Health District, New South Wales Health, Australia
| | - Frances Guy
- Mid North Coast Local Health District, New South Wales Health, Australia
| | - Olivia Tierney
- Mid North Coast Local Health District, New South Wales Health, Australia. https://twitter.com/@OliviaTierney9
| |
Collapse
|
2
|
Middlemiss AL, Channon S, Sanders J, Kenyon S, Milton R, Prendeville T, Barry S, Strange H, Jones A. Barriers and facilitators when implementing midwifery continuity of carer: a narrative analysis of the international literature. BMC Pregnancy Childbirth 2024; 24:540. [PMID: 39143464 PMCID: PMC11325633 DOI: 10.1186/s12884-024-06649-y] [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: 01/17/2024] [Accepted: 06/18/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Midwifery continuity of carer (MCoC) is a model of care in which the same midwife or small team of midwives supports women throughout pregnancy, birth and the postnatal period. The model has been prioritised by policy makers in a number of high-income countries, but widespread implementation and sustainability has proved challenging. METHODS In this narrative review and synthesis of the global literature on the implementation and sustainability of midwifery continuity of carer, we identify barriers to, and facilitators of, this model of delivering maternity care. By mapping existing research evidence onto the Consolidated Framework for Implementation Research (CFIR), we identify factors for organisations to consider when planning and implementing midwifery continuity of carer as well as gaps in the current research evidence. RESULTS Analysing international evidence using the CFIR shows that evidence around midwifery continuity of carer implementation is patchy and fragmented, and that the impetus for change is not critically examined. Existing literature pays insufficient attention to core aspects of the innovation such as the centrality of on call working arrangements and alignment with the professional values of midwifery. There is also limited attention to the political and structural contexts into which midwifery continuity of carer is introduced. CONCLUSIONS By synthesizing international research evidence with the CFIR, we identify factors for organisations to consider when planning and implementing midwifery continuity of carer. We also call for more systematic and contextual evidence to aid understanding of the implementation or non-implementation of midwifery continuity of carer. Existing evidence should be critically evaluated and used more cautiously in support of claims about the model of care and its implementation, especially when implementation is occurring in different settings and contexts to the research being cited.
Collapse
Affiliation(s)
| | - Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Tina Prendeville
- Women's Health Research Centre, Imperial College London & Imperial College NHS Trust, London, UK
| | - Susan Barry
- Division of Women's Children's and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
| | | | - Aled Jones
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| |
Collapse
|
3
|
Hjorth S, Brülle AL, Kristensen H, Frederiksen A, Nohr EA. Labor outcomes in caseload midwifery compared with standard midwifery care: A cohort study. Birth 2024. [PMID: 39140615 DOI: 10.1111/birt.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/09/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Research has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark. METHODS Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log-binomial regression. RESULTS Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54-0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75-0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02-1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96-1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82-0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37-0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17-1.28]) in caseload midwifery. CONCLUSION In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.
Collapse
Affiliation(s)
- Sarah Hjorth
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne-Line Brülle
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Helle Kristensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Anette Frederiksen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ellen Aagard Nohr
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Hu Y, Gamble J, Allen J, Creedy DK, Toohill J, Callander E. A cost analysis of upscaling access to continuity of midwifery carer: Population-based microsimulation in Queensland, Australia. Midwifery 2024; 133:103998. [PMID: 38615374 DOI: 10.1016/j.midw.2024.103998] [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: 08/30/2023] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To quantify the economic impact of upscaling access to continuity of midwifery carer, compared with current standard maternity care, from the perspective of the public health care system. METHODS We created a static microsimulation model based on a whole-of-population linked administrative data set containing all public hospital births in one Australian state (Queensland) between July 2017 to June 2018 (n = 37,701). This model was weighted to represent projected State-level births between July 2023 and June 2031. Woman and infant health service costs (inpatient, outpatient and emergency department) during pregnancy and birth were summed. The base model represented current standard maternity care and a counterfactual model represented two hypothetical scenarios where 50 % or 65 % of women giving birth would access continuity of midwifery carer. Costs were reported in 2021/22 AUD. RESULTS The estimated cost savings to Queensland public hospital funders per pregnancy were $336 in 2023/24 and $546 with 50 % access. With 65 % access, the cost savings were estimated to be $534 per pregnancy in 2023/24 and $839 in 2030/31. A total State-level annual cost saving of $12 million in 2023/24 and $19 million in 2030/31 was estimated with 50 % access. With 65 % access, total State-level annual cost savings were estimated to be $19 million in 2023/24 and $30 million in 2030/31. CONCLUSION Enabling most childbearing women in Australia to access continuity of midwifery carer would realise significant cost savings for the public health care system by reducing the rate of operative birth.
Collapse
Affiliation(s)
- Yanan Hu
- Faculty of Medicine, Monash Centre for Health Research and Implementation, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jenny Gamble
- Research Centre for Healthcare and Communities, Coventry University, Coventry, United Kingdom; School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Jyai Allen
- Faculty of Medicine, Monash Centre for Health Research and Implementation, Nursing and Health Sciences, Monash University, Melbourne, Australia; Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Jocelyn Toohill
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia; Clinical Excellence Division, Queensland Health, Queensland, Australia
| | - Emily Callander
- School of Public Health, University of Technology Sydney, Sydney, Australia.
| |
Collapse
|
5
|
McLean MA, Klimos C, Lequertier B, Keedle H, Elgbeili G, Kildea S, King S, Dahlen HG. Model of perinatal care but not prenatal stress exposure is associated with birthweight and gestational age at Birth: The Australian birth in the time of COVID (BITTOC) study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100981. [PMID: 38739983 DOI: 10.1016/j.srhc.2024.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/24/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The present study aimed to understand, relative to standard care, whether continuity of care models (private midwifery, continuity of care with a private doctor, continuity of care with a public midwife), and women's experience of maternity care provision, during the perinatal period buffered the association between prenatal maternal stress (PNMS) and infant birth outcomes (gestational age [GA], birth weight [BW] and birth weight for gestational age [BW for GA]). METHODS 2207 women who were pregnant in Australia while COVID-19 restrictions were in place reported on their COVID-19 related objective hardship and subjective distress during pregnancy and provided information on their model of maternity care. Infant birth outcomes (BW, GA) were reported on at 2-months postpartum. RESULTS Multiple linear regressions showed no relationship between PNMS and infant BW, GA or BW for GA, and neither experienced continuity of care, nor model of maternity care moderated this relationship. However, compared with all other models of care, women enrolled in private midwifery care reported the highest levels of experienced continuity of care and birthed infants at higher GA. BW and BW for GA were higher in private midwifery care, relative to standard care. CONCLUSION Enrollment in continuous models of perinatal care may be a better predictor of infant birth outcomes than degree of PNMS exposure. These results highlight the possibility that increased, continuous support to women during pregnancy may play an important role in ensuring positive infant birth outcomes during future pandemics.
Collapse
Affiliation(s)
- Mia A McLean
- School of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand; BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Chloé Klimos
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Belinda Lequertier
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | | | - Sue Kildea
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Suzanne King
- Douglas Institute Research Centre, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia.
| |
Collapse
|
6
|
Gao Y, Wilkes L, Tafe A, Quanchi A, Ruthenberg L, Warriner M, Kildea S. Clinical outcomes and financial estimates for women attending the largest private midwifery service in Australia compared to national data: a retrospective cohort study. Women Birth 2024; 37:101591. [PMID: 38402093 DOI: 10.1016/j.wombi.2024.101591] [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: 10/19/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND PROBLEM Multiple barriers to national scale-out of private midwifery practice in Australia exist. AIM To describe and compare maternal infant health outcomes of the largest private midwifery service in Australia with the national core maternity indicators and estimate the financial impact on collaborating public hospitals. METHODS A retrospective cohort of 2747 maternal health records from 2014 to 2022 were compared to national indicators. Financial calculations estimated the impact on hospitals. FINDINGS Compared to national data, women cared by private midwives were significantly: more likely to be 25-34 years and primiparous; less likely to be Indigenous, have diabetes, hypertension or multiple births. At birth, 5% required discussion with specialists, 25% required consultation and 39% were referred; 86% women had their primary midwife at birth; 12.5% birthed at home and 14.5% at a birth centre. Compared to national data, primiparous women had fewer inductions (22.9% vs 45.8%), caesarean sections (22.6% vs 32.1%), instrumental vaginal births (17.0% vs 25.7%), episiotomies (9.5% vs 23.9%) and more birthed vaginally after caesarean section (75.9% vs 11.9%). Significantly less babies were born with a birthweight <2750 g (0.5% vs 1.2%) and 83.7% babies were exclusively breastfed at six weeks. Collaborating hospitals would receive less DRG funding compared to public patients, require less intrapartum midwifery staff and receive a net benefit, even when bed fees were waived. CONCLUSION Women attending My Midwives had significantly lower intervention rates when compared to national indicators although maternal characteristics could be contributing. Multidisciplinary care was evident. Financial modelling shows positive impacts for hospitals.
Collapse
Affiliation(s)
- Yu Gao
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane, Queensland 4000, Australia
| | - Liz Wilkes
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane, Queensland 4000, Australia; My Midwives, 29 Hill Street, Toowoomba, Queensland 4350, Australia
| | - Annabel Tafe
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane, Queensland 4000, Australia
| | - Andrea Quanchi
- My Midwives, 29 Hill Street, Toowoomba, Queensland 4350, Australia
| | | | | | - Sue Kildea
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Brisbane, Queensland 4000, Australia.
| |
Collapse
|
7
|
Shenton EK, Carter AG, Gabriel L, Slavin V. Improving maternal and neonatal outcomes for women with gestational diabetes through continuity of midwifery care: A cross-sectional study. Women Birth 2024; 37:101597. [PMID: 38547549 DOI: 10.1016/j.wombi.2024.101597] [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: 10/24/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
PROBLEM Gestational Diabetes Mellitus (GDM) is a complication of pregnancy which may exclude women from midwife-led models of care. BACKGROUND There is a paucity of research evaluating the safety and feasibility of continuity of midwifery care (CoMC) for women with GDM. AIM To investigate the impact of CoMC on maternal and neonatal outcomes, for otherwise low-risk women with GDM. METHODS This exploratory cross-sectional study observed maternal and neonatal outcomes including onset of labour, augmentation, labour analgesia, mode of birth, perineal trauma, gestation at birth, shoulder dystocia, infant birth weight, neonatal feeding at discharge. FINDINGS Participants were 287 otherwise low-risk pregnant women, who developed GDM, and either received CoMC (n=36) or standard hospital maternity care (non-CoMC) (n=251). Women with GDM who received CoMC were significantly more likely to experience an spontaneous onset of labour (OR 6.3; 95% CI 2.7-14.5; p<.001), labour without an epidural (OR 4.2; 95% CI 2.0 - 9.2,<0.001) and exclusively breastfeed (OR 4.3; 95% CI 1.26 - 14.32; p=0.02). DISCUSSION Receiving CoMC may be a public health initiative which not only improves maternal and neonatal outcomes, but also long-term morbidity associated with GDM. CONCLUSION Findings provide preliminary evidence suggesting CoMC improves maternal and neonatal outcomes and is likely a safe and viable option for otherwise low-risk women with GDM. Larger studies are recommended to confirm findings and explore the full impact of CoMC for women with GDM.
Collapse
Affiliation(s)
- Eleanor K Shenton
- Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6153, Australia.
| | - Amanda G Carter
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD 4131, Australia
| | - Laura Gabriel
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD 4131, Australia
| | - Valerie Slavin
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD 4131, Australia; Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
| |
Collapse
|
8
|
Torres JA, Leite TH, Fonseca TCO, Domingues RMSM, Figueiró AC, Pereira APE, Theme-Filha MM, da Silva Ayres BV, Scott O, de Cássia Sanchez R, Borem P, de Maio Osti MC, Rosa MW, Andrade AS, Filho FMP, Nakamura-Pereira M, do Carmo Leal M. An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals. Reprod Health 2024; 20:190. [PMID: 38671479 PMCID: PMC11052714 DOI: 10.1186/s12978-024-01773-6] [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: 05/31/2021] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. METHOD Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA-"Participation of women" and "Reorganization of care" - among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". RESULTS PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 - 0.32) and "Participation of Women" (0.21 - 0.34). The combined implementation score was 0.39-0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. CONCLUSION The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Paulo Borem
- Institute for Healthcare Improvement, Brasília, Brazil
| | | | | | | | - Fernando Maia Peixoto Filho
- Oswaldo Cruz Foundation, National Institute of Health for Women, Children and Adolescents Fernandes Figueira, Rio de Janeiro, Brazil
| | - Marcos Nakamura-Pereira
- Oswaldo Cruz Foundation, National Institute of Health for Women, Children and Adolescents Fernandes Figueira, Rio de Janeiro, Brazil
| | | |
Collapse
|
9
|
Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024; 4:CD004667. [PMID: 38597126 PMCID: PMC11005019 DOI: 10.1002/14651858.cd004667.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016. OBJECTIVES To compare the effects of midwife continuity of care models with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (17 August 2022), as well as the reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife continuity of care models or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion criteria, scientific integrity, and risk of bias, and carried out data extraction and entry. Primary outcomes were spontaneous vaginal birth, caesarean section, regional anaesthesia, intact perineum, fetal loss after 24 weeks gestation, preterm birth, and neonatal death. We used GRADE to rate the certainty of evidence. MAIN RESULTS We included 17 studies involving 18,533 randomised women. We assessed all studies as being at low risk of scientific integrity/trustworthiness concerns. Studies were conducted in Australia, Canada, China, Ireland, and the United Kingdom. The majority of the included studies did not include women at high risk of complications. There are three ongoing studies targeting disadvantaged women. Primary outcomes Based on control group risks observed in the studies, midwife continuity of care models, as compared to other models of care, likely increase spontaneous vaginal birth from 66% to 70% (risk ratio (RR) 1.05, 95% confidence interval (CI) 1.03 to 1.07; 15 studies, 17,864 participants; moderate-certainty evidence), likelyreduce caesarean sections from 16% to 15% (RR 0.91, 95% CI 0.84 to 0.99; 16 studies, 18,037 participants; moderate-certainty evidence), and likely result in little to no difference in intact perineum (29% in other care models and 31% in midwife continuity of care models, average RR 1.05, 95% CI 0.98 to 1.12; 12 studies, 14,268 participants; moderate-certainty evidence). There may belittle or no difference in preterm birth (< 37 weeks) (6% under both care models, average RR 0.95, 95% CI 0.78 to 1.16; 10 studies, 13,850 participants; low-certainty evidence). We arevery uncertain about the effect of midwife continuity of care models on regional analgesia (average RR 0.85, 95% CI 0.79 to 0.92; 15 studies, 17,754 participants, very low-certainty evidence), fetal loss at or after 24 weeks gestation (average RR 1.24, 95% CI 0.73 to 2.13; 12 studies, 16,122 participants; very low-certainty evidence), and neonatal death (average RR 0.85, 95% CI 0.43 to 1.71; 10 studies, 14,718 participants; very low-certainty evidence). Secondary outcomes When compared to other models of care, midwife continuity of care models likely reduce instrumental vaginal birth (forceps/vacuum) from 14% to 13% (average RR 0.89, 95% CI 0.83 to 0.96; 14 studies, 17,769 participants; moderate-certainty evidence), and may reduceepisiotomy 23% to 19% (average RR 0.83, 95% CI 0.77 to 0.91; 15 studies, 17,839 participants; low-certainty evidence). When compared to other models of care, midwife continuity of care models likelyresult in little to no difference inpostpartum haemorrhage (average RR 0.92, 95% CI 0.82 to 1.03; 11 studies, 14,407 participants; moderate-certainty evidence) and admission to special care nursery/neonatal intensive care unit (average RR 0.89, 95% CI 0.77 to 1.03; 13 studies, 16,260 participants; moderate-certainty evidence). There may be little or no difference in induction of labour (average RR 0.92, 95% CI 0.85 to 1.00; 14 studies, 17,666 participants; low-certainty evidence), breastfeeding initiation (average RR 1.06, 95% CI 1.00 to 1.12; 8 studies, 8575 participants; low-certainty evidence), and birth weight less than 2500 g (average RR 0.92, 95% CI 0.79 to 1.08; 9 studies, 12,420 participants; low-certainty evidence). We are very uncertain about the effect of midwife continuity of care models compared to other models of care onthird or fourth-degree tear (average RR 1.10, 95% CI 0.81 to 1.49; 7 studies, 9437 participants; very low-certainty evidence), maternal readmission within 28 days (average RR 1.52, 95% CI 0.78 to 2.96; 1 study, 1195 participants; very low-certainty evidence), attendance at birth by a known midwife (average RR 9.13, 95% CI 5.87 to 14.21; 11 studies, 9273 participants; very low-certainty evidence), Apgar score less than or equal to seven at five minutes (average RR 0.95, 95% CI 0.72 to 1.24; 13 studies, 12,806 participants; very low-certainty evidence) andfetal loss before 24 weeks gestation (average RR 0.82, 95% CI 0.67 to 1.01; 12 studies, 15,913 participants; very low-certainty evidence). No maternal deaths were reported across three studies. Although the observed risk of adverse events was similar between midwifery continuity of care models and other models, our confidence in the findings was limited. Our confidence in the findings was lowered by possible risks of bias, inconsistency, and imprecision of some estimates. There were no available data for the outcomes: maternal health status, neonatal readmission within 28 days, infant health status, and birth weight of 4000 g or more. Maternal experiences and cost implications are described narratively. Women receiving care from midwife continuity of care models, as opposed to other care models, generally reported more positive experiences during pregnancy, labour, and postpartum. Cost savings were noted in the antenatal and intrapartum periods in midwife continuity of care models. AUTHORS' CONCLUSIONS Women receiving midwife continuity of care models were less likely to experience a caesarean section and instrumental birth, and may be less likely to experience episiotomy. They were more likely to experience spontaneous vaginal birth and report a positive experience. The certainty of some findings varies due to possible risks of bias, inconsistencies, and imprecision of some estimates. Future research should focus on the impact on women with social risk factors, and those at higher risk of complications, and implementation and scaling up of midwife continuity of care models, with emphasis on low- and middle-income countries.
Collapse
Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Declan Devane
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, School of Business and Economics, Institute for Lifecourse and Society, University of Galway, Galway, Ireland
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Leanne V Jones
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Hannah Rayment-Jones
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| |
Collapse
|
10
|
Martín-Vázquez C, Goás-Gómez N, Calvo-Ayuso N, Rosón-Matilla L, Quiroga-Sánchez E, García-Fernández R. Analysis of Maternal Positions during the Dilation and Expulsive Phase and Their Relationship with Perineal Injuries in Eutocic Deliveries Attended by Midwives. Healthcare (Basel) 2024; 12:441. [PMID: 38391816 PMCID: PMC10888027 DOI: 10.3390/healthcare12040441] [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: 12/23/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
This cross-sectional descriptive study aimed to analyze the relationship between maternal positions during the expulsion phase and perineal outcomes in 367 eutocic births attended by midwives or midwifery residents at a public hospital in northern Spain in 2018. A total of 94.3% of women opted for horizontal positions. Limited sacral retroversion was observed in 71.7%, potentially influencing perineal outcomes. A low incidence of tears indicated effective management during the expulsive phase, with an episiotomy rate of 15.3%, which was slightly above the 15% standard. Primiparity and maternal age were identified as risk factors associated with episiotomy. Additionally, sacral mobilization and vertical positions during delivery were significantly related to fewer perineal injuries, suggesting benefits for both mother and newborn. The correlation between maternal positions and the need for epidural analgesia highlighted the importance of considering these in pain management during childbirth. Despite limitations, the study provides valuable insight into obstetric practices and advocates for a woman-centered approach that respects autonomy during childbirth. Further research is needed to explore biomechanical parameters and enhance childbirth experiences.
Collapse
Affiliation(s)
- Cristian Martín-Vázquez
- Department of Nursing and Physiotherapy, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Noelia Goás-Gómez
- Centro de Salud Vilalba, Servizo Galego de Saúde (SERGAS), 27800 Lugo, Spain
| | - Natalia Calvo-Ayuso
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | | | - Enedina Quiroga-Sánchez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Rubén García-Fernández
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, 1600-190 Lisbon, Portugal
| |
Collapse
|
11
|
Pelak H, Dahlen HG, Keedle H. A content analysis of women's experiences of different models of maternity care: the Birth Experience Study (BESt). BMC Pregnancy Childbirth 2023; 23:864. [PMID: 38102547 PMCID: PMC10722666 DOI: 10.1186/s12884-023-06130-2] [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: 06/04/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Pregnancy, birth, and early parenthood are significant life experiences impacting women and their families. Growing evidence suggests models of maternity care impact clinical outcomes and birth experiences. The aim of this study was to explore the strengths and limitations of different maternity models of care accessed by women in Australia who had given birth in the past 5 years. METHODS The data analysed and presented in this paper is from the Australian Birth Experience Study (BESt), an online national survey of 133 questions that received 8,804 completed responses. There were 2,909 open-ended comments in response to the question on health care provider/s. The data was analysed using content analysis and descriptive statistics. RESULTS In models of fragmented care, including standard public hospital care (SC), high-risk care (HRC), and GP Shared care (GPS), women reported feelings of frustration in being unknown and unheard by their health care providers (HCP) that included themes of exhaustion in having to repeat personal history and the difficulty in navigating conflicting medical advice. Women in continuity of care (CoC) models, including Midwifery Group Practice (MGP), Private Obstetric (POB), and Privately Practising Midwifery (PPM), reported positive experiences of healing past birth trauma and care extending for multiple births. Compared across models of care in private and public settings, comments in HRC contained the lowest percentage of strengths (11.94%) and the highest percentage of limitations (88.06%) while comments in PPM revealed the highest percentage of strengths (95.93%) and the lowest percentage of limitations (4.07%). CONCLUSIONS Women across models of care in public and private settings desire relational maternity care founded on their unique needs, wishes, and values. The strengths of continuity of care, specifically private midwifery, should be recognised and the limitations for women in high risk maternity care investigated and prioritised by policy makers and managers in health services. TRIAL REGISTRATION The study is part of a larger project that has been retrospectively registered with OSF Registries Registration DOI https://doi.org/10.17605/OSF.IO/4KQXP .
Collapse
Affiliation(s)
- Helen Pelak
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 167 Great Western Highway, Blackheath, Penrith, NSW, 2751, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 167 Great Western Highway, Blackheath, Penrith, NSW, 2751, Australia
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 167 Great Western Highway, Blackheath, Penrith, NSW, 2751, Australia.
| |
Collapse
|
12
|
Martin E, Ayoub B, Miller YD. A systematic review of the cost-effectiveness of maternity models of care. BMC Pregnancy Childbirth 2023; 23:859. [PMID: 38093244 PMCID: PMC10717830 DOI: 10.1186/s12884-023-06180-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES In this systematic review, we aimed to identify the full extent of cost-effectiveness evidence available for evaluating alternative Maternity Models of Care (MMC) and to summarize findings narratively. METHODS Articles that included a decision tree or state-based (Markov) model to explore the cost-effectiveness of an MMC, and at least one comparator MMC, were identified from a systematic literature review. The MEDLINE, Embase, Web of Science, CINAHL and Google Scholar databases were searched for papers published in English, Arabic, and French. A narrative synthesis was conducted to analyse results. RESULTS Three studies were included; all using cost-effectiveness decision tree models with data sourced from a combination of trials, databases, and the literature. Study quality was fair to poor. Each study compared midwife-led or doula-assisted care to obstetrician- or physician-led care. The findings from these studies indicate that midwife and doula led MMCs may provide value. CONCLUSION The findings of these studies indicate weak evidence that midwife and doula models of care may be a cost-effective or cost-saving alternative to standard care. However, the poor quality of evidence, lack of standardised MMC classifications, and the dearth of research conducted in this area are barriers to conclusive evaluation and highlight the need for more research incorporating appropriate models and population diversity.
Collapse
Affiliation(s)
- Elizabeth Martin
- Wesley Research Institute, Auchenflower, Qld, Australia.
- Mater Research Institute - University of Queensland, South Brisbane, Qld, Australia.
| | - Bassel Ayoub
- School of Public Health and Social Work, Faculty of Health, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Qld, Australia
| | - Yvette D Miller
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
| |
Collapse
|
13
|
Callander EJ, Enticott JC, Eklom B, Gamble J, Teede HJ. The value of maternity care in Queensland, 2012-18, based on an analysis of administrative data: a retrospective observational study. Med J Aust 2023; 219:535-541. [PMID: 37940105 PMCID: PMC10952409 DOI: 10.5694/mja2.52156] [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: 07/26/2022] [Accepted: 08/18/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To quantify the value of maternity health care - the relationship of outcomes to costs - in Queensland during 2012-18. STUDY DESIGN Retrospective observational study; analysis of Queensland Perinatal Data Collection data linked with the Queensland Health Admitted Patient, Non-Admitted Patient, and Emergency Data Collections, and with the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) databases. SETTING, PARTICIPANTS All births in Queensland during 1 July 2012 - 30 June 2018. MAIN OUTCOME MEASURES Maternity care costs per birth (reported in 2021-22 Australian dollars), both overall and by funder type (public hospital funders, MBS, PBS, private health insurers, out-of-pocket costs); value of care, defined as total cost per positive birth outcome (composite measure). RESULTS The mean cost per birth (all funders) increased from $20 471 (standard deviation [SD], $17 513) during the second half of 2012 to $30 000 (SD, $22 323) during the first half of 2018; the annual total costs for all births increased from $1.31 billion to $1.84 billion, despite a slight decline in the total number of births. In a mixed effects linear analysis adjusted for demographic, clinical, and birth characteristics, the mean total cost per birth in the second half of 2018 was $9493 higher (99.9% confidence interval, $8930-10 056) than during the first half of 2012. The proportion of births that did not satisfy our criteria for a positive birth outcome increased from 27.1% (8404 births) during the second half of 2012 to 30.5% (9041 births) during the first half of 2018. CONCLUSION The costs of maternity care have increased in Queensland, and many adverse birth outcomes have become more frequent. Broad clinical collaboration, effective prevention and treatment strategies, as well as maternal health services focused on all dimensions of value, are needed to ensure the quality and viability of maternity care in Australia.
Collapse
Affiliation(s)
| | - Joanne C Enticott
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
| | | | | | - Helena J Teede
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
| |
Collapse
|
14
|
Bingham J, Kalu FA, Healy M. The impact on midwives and their practice after caring for women who have a traumatic childbirth: A systematic review. Birth 2023; 50:711-734. [PMID: 37602792 DOI: 10.1111/birt.12759] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Women's birth experiences can range from positive and satisfying to negative and traumatizing. Midwives caring for women can also be exposed to these traumatic childbirth experiences. There is a paucity of research on the impact these experiences have on midwives and their practice. The PEO framework guided the research review question. METHODS Seven electronic databases were systematically searched. The quality of each included study was assessed using the tool appropriate to the study's methodological approach; Critical Appraisal Skills Program (CASP) criteria and the Mixed Methods Appraisal Tool (MMAT) Version 2018. The Consolidated Criteria for Reporting Qualitative Research (COREQ) tool was utilized to assess reported findings. Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to grade the confidence in the evidence of the qualitative research. Data were thematically analyzed to formalize the identification and development of themes. RESULTS A total of 12 studies were included. Synthesis of the evidence generated one overarching theme, "Midwives, the forgotten victims", and three themes describing the essences of midwives' experiences: "Bruised and battered but still smiling"; "Wearing armour to protect my soul"; "Members of my team are holding me up, others are pulling me down". CONCLUSIONS Midwives expressed feelings of shock, fear, responsibility, and powerlessness which may contribute to some experiencing serious mental illness. They reported a shaken belief in the normal physiologic birth process which consequently led to more defensive practice. Research is needed to identify high-quality interventions to support midwives after these events. This systematic review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; Registration CRD42021252033).
Collapse
Affiliation(s)
- Janet Bingham
- Obstetric Unit, Antrim Area Hospital, Antrim, Northern Ireland, UK
| | - Felicity Agwu Kalu
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Maria Healy
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| |
Collapse
|
15
|
Wassén L, Borgström Bolmsjö B, Frantz S, Hagman A, Lindroth M, Rubertsson C, Strandell A, Svanberg T, Wessberg A, Wallerstedt SM. Child and maternal benefits and risks of caseload midwifery - a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:663. [PMID: 37715118 PMCID: PMC10504769 DOI: 10.1186/s12884-023-05967-x] [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: 10/21/2022] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND It has been reported that caseload midwifery, which implies continuity of midwifery care during pregnancy, childbirth, and the postnatal period, improves the outcomes for the mother and child. The aim of this study was to review benefits and risks of caseload midwifery, compared with standard care comparable to the Swedish setting where the same midwife usually provides antenatal care and the checkup postnatally, but does not assist during birth and the first week postpartum. METHODS Medline, Embase, Cinahl, and the Cochrane Library were searched (Nov 4th, 2021) for randomized controlled trials (RCTs). Retrieved articles were assessed and pooled risk ratios calculated when possible, using random-effects meta-analyses. Certainty of evidence was assessed according to GRADE. RESULTS In all, 7,594 patients in eight RCTs were included, whereof five RCTs without major risk of bias, including 5,583 patients, formed the basis for the conclusions. There was moderate certainty of evidence for little or no difference regarding the risk of Apgar ≤ 7 at 5 min, instrumental birth, and preterm birth. There was low certainty of evidence for little or no difference regarding the risk of perinatal mortality, neonatal intensive care, perineal tear, bleeding, and acute caesarean section. Caseload midwifery may reduce the overall risk of caesarean section. Regarding breastfeeding after hospital discharge, maternal mortality, maternal morbidity, health-related quality of life, postpartum depression, health care experience/satisfaction and confidence, available studies did not allow conclusions (very low certainty of evidence). For severe child morbidity and Apgar ≤ 4 at 5 min, there was no literature available. CONCLUSIONS When caseload midwifery was compared with models of care that resembles the Swedish one, little or no difference was found for several critical and important child and maternal outcomes with low-moderate certainty of evidence, but the risk of caesarean section may be reduced. For several outcomes, including critical and important ones, studies were lacking, or the certainty of evidence was very low. RCTs in relevant settings are therefore required.
Collapse
Affiliation(s)
- Lotta Wassén
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Beata Borgström Bolmsjö
- Department Research and education, HTA syd, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Sophia Frantz
- Department Research and education, HTA syd, Skåne University Hospital, Lund, Sweden
- Clinical Physiology and Nuclear Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Malmö, Sweden
| | - Anna Hagman
- Regional Healthcare, Region Västra Götaland, Gothenburg, Sweden
| | - Marie Lindroth
- Midwifery Clinic in Primary Care, Region Skåne, Malmö, Sweden
| | | | - Annika Strandell
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- HTA-centrum, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Therese Svanberg
- Medical library, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Anna Wessberg
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- HTA-centrum, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 431, Gothenburg, SE-405 30, Sweden.
| |
Collapse
|
16
|
Medway P, Hutchinson A, Sweet L. In what ways does maternity care in Australia align with the values and principles of the national maternity strategy? A scoping review. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100900. [PMID: 37634300 DOI: 10.1016/j.srhc.2023.100900] [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: 11/21/2022] [Revised: 07/13/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
Australia's national maternity strategy Woman-centred care: strategic directions for Australian maternity services (the Strategy) was released by the federal government in November 2019. It was developed to provide national guidance on the effective provision of woman-centred maternity care. The Strategy is structured around four values of safety, respect, choice, and access, and underpinned by twelve principles of woman-centred care. By examining previous research, this review aims to provide a baseline understanding of how maternity care provision is being met in relation to these core values. A systematic search of Australian literature was undertaken via four databases using the Strategy's values and 41 articles met the selection criteria. Include articles were predominantly published pre-2019, providing a baseline understanding of Australian maternity care provision prior to the Strategy's publication. Findings suggest that the four values align with those of women; however, women were not always receiving care in accordance with the values, particularly among women from priority populations. Women prioritised safety for themselves and their babies, articulated the need for respectful relationships with maternity care providers, wanted autonomy to make their own decisions, and desired access to appropriate, local, maternity services. Additionally, while pockets of appropriate care do exist, these are more likely to occur at a single-service level than more broadly at a population level. This implies the Strategy is needed, and its operationalisation must be prioritised through a coordinated national response to better meet the maternity care needs of Australian women. Further research is warranted to determine the Strategy's effectiveness.
Collapse
Affiliation(s)
- Paula Medway
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia. https://twitter.com/@PaulaMedway
| | - Alison Hutchinson
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia
| |
Collapse
|
17
|
Homer C, Neylon K, Kennedy K, Baird K, Gilkison A, Keogh S, Middleton S, Gray R, Whitehead L, Finn J, Rickard C, Sharplin G, Neville S, Eckert M. Midwife led randomised controlled trials in Australia and New Zealand: A scoping review. Women Birth 2023; 36:401-408. [PMID: 36894484 DOI: 10.1016/j.wombi.2023.03.003] [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: 09/29/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Midwives are the largest workforce involved in caring for pregnant women and their babies, and are well placed to translate research into practice and ensure midwifery priorities are appropriately targeted in researched. Currently, the number and focus of randomised controlled trials led by midwives in Australia and New Zealand is unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established in 2020 to build nursing and midwifery research capacity. To aid this, scoping reviews of the quality and quantity of nurse and midwife led trials were undertaken. AIM To identify midwife led trials conducted between 2000 and 2021 in Australia and New Zealand. METHODS This review was informed by the JBI scoping review framework. Medline, Emcare, and Scopus were searched from 2000-August 2021. ANZCTR, NHMRC, MRFF, and HRC (NZ) registries were searched from inception to July 2021. FINDINGS Of 26,467 randomised controlled trials registered on the Australian and New Zealand Clinical Trials Registry, 50 midwife led trials, and 35 peer-reviewed publications were identified. Publications were of moderate to high quality with scores limited due to an inability to blind participants or clinicians. Blinding of assessors was included in 19 published trials. DISCUSSION Additional support for midwives to design and conduct trials and publish findings is required. Further support is needed to translate registration of trial protocols into peer reviewed publications. CONCLUSION These findings will inform the Australasian Nursing and Midwifery Clinical Trials Network plans to promote quality midwife led trials.
Collapse
Affiliation(s)
| | - Kim Neylon
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Kathleen Baird
- University Technology Sydney, School of Nursing and Midwifery, New South Wales, Australia
| | - Andrea Gilkison
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand
| | - Samantha Keogh
- Queensland University of Technology, Faculty of Health, School of Nursing, Queensland, Australia
| | - Sandy Middleton
- Australian Catholic University, Nursing Research Institute, New South Wales, Australia
| | | | | | - Judith Finn
- Curtin University, Faculty of Health Sciences, Curtin School of Nursing, Western Australia, Australia
| | - Claire Rickard
- University of Queensland, School of Nursing, Midwifery and Social Work, Queensland, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Stephen Neville
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, South Australia, Australia.
| |
Collapse
|
18
|
Griffiths A, Kingsley S, Mason Z, Tome R, Tomkinson M, Jenkinson B. Listening to larger bodied women: Time for a new approach to maternity care. Women Birth 2023; 36:397-400. [PMID: 37468374 DOI: 10.1016/j.wombi.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Ahlia Griffiths
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Sara Kingsley
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Zena Mason
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Renee Tome
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Malyssa Tomkinson
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Bec Jenkinson
- Body Positive Birth Alliance, Australia; Australian Women and Girls Health Research Centre, School of Public Health, The University of Queensland, Australia.
| |
Collapse
|
19
|
Näsänen-Gilmore PK, Koivu AM, Hunter PJ, Muthiani Y, Pörtfors P, Heimonen O, Kajander V, Ashorn P, Ashorn U. A modular systematic review of antenatal interventions targeting modifiable environmental exposures in improving low birth weight. Am J Clin Nutr 2023; 117 Suppl 2:S160-S169. [PMID: 37331762 DOI: 10.1016/j.ajcnut.2022.11.029] [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: 06/14/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Low birth weight (LBW) increases the risk of short- and long-term morbidity and mortality from early life to adulthood. Despite research effort to improve birth outcomes the progress has been slow. OBJECTIVE This systematic search and review of English language scientific literature on clinical trials aimed to compare the efficacy antenatal interventions to reduce environmental exposures including a reduction of toxins exposure, and improving sanitation, hygiene, and health-seeking behaviors, which target pregnant women to improve birth outcomes. METHODS We performed eight systematic searches in MEDLINE (OvidSP), Embase (OvidSP), Cochrane Database of Systematic Reviews (Wiley Cochrane Library), Cochrane Central Register of Controlled Trials (Wiley Cochrane Library), CINAHL Complete (EbscoHOST) between 17 March 2020 and 26 May 2020. RESULTS Four documents identified describe interventions to reduce indoor air pollution: two randomised controlled trials (RCTs), one systematic review and meta-analysis (SRMA) on preventative antihelminth treatment and one RCT on antenatal counselling against unnecessary caesarean section. Based on the published literature, interventions to reduce indoor air pollution (LBW: RR: 0.90 [0.56, 1.44], PTB: OR: 2.37 [1.11, 5.07]) or preventative antihelminth treatment (LBW: RR: 1.00 [0.79, 1.27], PTB: RR: 0.88 [0.43, 1.78]) are not likely to reduce the risk of LBW or Preterm birth (PTB). Data is insufficient on antenatal counselling against caesarian-sections. For other interventions, there is lack of published research data from RCTs. CONCLUSIONS We conclude that there is a paucity of evidence from RCT on interventions that modify environmental risk factors during pregnancy to potentially improve birth outcomes. Magic bullets approach might not work and that it would be important to study the effect of the broader interventions, particularly in LMIC settings. Global interdisciplinary action to reduce harmful environmental exposures, is likely to help to reach global targets for LBW reduction and sustainably improve long-term population health.
Collapse
Affiliation(s)
- Pieta K Näsänen-Gilmore
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland.
| | - Annariina M Koivu
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Yvonne Muthiani
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pia Pörtfors
- Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland
| | - Otto Heimonen
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Viivi Kajander
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| |
Collapse
|
20
|
Heynen JP, McHugh RR, Boora NS, Simcock G, Kildea S, Austin MP, Laplante DP, King S, Montina T, Metz GAS. Urinary 1H NMR Metabolomic Analysis of Prenatal Maternal Stress Due to a Natural Disaster Reveals Metabolic Risk Factors for Non-Communicable Diseases: The QF2011 Queensland Flood Study. Metabolites 2023; 13:metabo13040579. [PMID: 37110237 PMCID: PMC10145263 DOI: 10.3390/metabo13040579] [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: 03/23/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Prenatal stress alters fetal programming, potentially predisposing the ensuing offspring to long-term adverse health outcomes. To gain insight into environmental influences on fetal development, this QF2011 study evaluated the urinary metabolomes of 4-year-old children (n = 89) who were exposed to the 2011 Queensland flood in utero. Proton nuclear magnetic resonance spectroscopy was used to analyze urinary metabolic fingerprints based on maternal levels of objective hardship and subjective distress resulting from the natural disaster. In both males and females, differences were observed between high and low levels of maternal objective hardship and maternal subjective distress groups. Greater prenatal stress exposure was associated with alterations in metabolites associated with protein synthesis, energy metabolism, and carbohydrate metabolism. These alterations suggest profound changes in oxidative and antioxidative pathways that may indicate a higher risk for chronic non-communicable diseases such obesity, insulin resistance, and diabetes, as well as mental illnesses, including depression and schizophrenia. Thus, prenatal stress-associated metabolic biomarkers may provide early predictors of lifetime health trajectories, and potentially serve as prognostic markers for therapeutic strategies in mitigating adverse health outcomes.
Collapse
Affiliation(s)
- Joshua P Heynen
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| | - Rebecca R McHugh
- Department of Chemistry and Biochemistry, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| | - Naveenjyote S Boora
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
- Department of Chemistry and Biochemistry, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| | - Gabrielle Simcock
- Midwifery Research Unit, Mater Research Institute, University of Queensland, Brisbane, QLD 4072, Australia
- School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia
| | - Sue Kildea
- Midwifery Research Unit, Mater Research Institute, University of Queensland, Brisbane, QLD 4072, Australia
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Alice Springs, NT 0870, Australia
| | - Marie-Paule Austin
- Perinatal and Woman's Health Unit, University of New South Wales, Sydney, NSW 2052, Australia
| | - David P Laplante
- Centre for Child Development and Mental Health, Lady Davis Institute for Medical Research, Jewish General Hospital, 4335 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E4, Canada
| | - Suzanne King
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montreal, QC H4H 1R3, Canada
| | - Tony Montina
- Southern Alberta Genome Sciences Centre, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
- Department of Chemistry and Biochemistry, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| |
Collapse
|
21
|
Midwifery continuity of care for women with complex pregnancies in Australia: An integrative review. Women Birth 2023; 36:e187-e194. [PMID: 35869009 DOI: 10.1016/j.wombi.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND All women require access to quality maternity care. Continuity of midwifery care can enhance women's experiences of childbearing and is associated with positive outcomes for women and infants. Much research on these models has been conducted with women with uncomplicated pregnancies; less is known about outcomes for women with complexities. AIM To explore the outcomes and experiences for women with complex pregnancies receiving midwifery continuity of care in Australia. METHODS This integrative review used Whittemore and Knafl's approach. Authors searched five electronic databases (PubMed/MEDLINE, EMBASE, CINAHL, Scopus, and MAG Online) and assessed the quality of relevant studies using the Critical Appraisal Skills Programme (CASP) appraisal tools. FINDINGS Fourteen studies including women with different levels of obstetric risk were identified. However, only three reported outcomes separately for women categorised as either moderate or high risk. Perinatal outcomes reported included mode of birth, intervention rates, blood loss, perineal trauma, preterm birth, admission to special care and breastfeeding rates. Findings were synthesised into three themes: 'Contributing to safe processes and outcomes', 'Building relational trust', and 'Collaborating and communicating'. This review demonstrated that women with complexities in midwifery continuity of care models had positive experiences and outcomes, consistent with findings about low risk women. DISCUSSION The nascency of the research on midwifery continuity of care for women with complex pregnancies in Australia is limited, reflecting the relative dearth of these models in practice. CONCLUSION Despite favourable findings, further research on outcomes for women of all risk is needed to support the expansion of midwifery continuity of care.
Collapse
|
22
|
Tafe A, Cummins A, Catling C. Exploring women's experiences in a midwifery continuity of care model following a traumatic birth. Women Birth 2023:S1871-5192(23)00019-7. [PMID: 36774286 DOI: 10.1016/j.wombi.2023.01.006] [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: 08/20/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/12/2023]
Abstract
PROBLEM Over one third of women report their birth experience as psychologically traumatic. Psychological birth trauma has been associated with perinatal mental illness and post-traumatic stress disorder. BACKGROUND Midwifery continuity of care provides improved outcomes for mothers and babies as well as increased birth satisfaction. Some women who have experienced psychological birth trauma will seek out midwifery continuity of care in their next pregnancy. The aim of this study was to explore women's experiences of midwifery continuity of care following a previous traumatic birth experience in Australia. METHODS A qualitative descriptive approach was undertaken. Eight multiparous women who self-identified as having psychological birth trauma were interviewed. Data were analysed using thematic analysis to discover how participants subsequently experienced care in a midwifery continuity of care model. FINDINGS Seven out of eight participants had care from a private midwife following birth trauma. Four themes were discovered. The nightmare lives on: despite a positive and/or healing experience in midwifery continuity of care, women still carry their traumatic birth experiences with them. Determination to find better care: Women sought midwifery continuity of care following a previous traumatic birth in their desire to prevent a similar experience. A broken maternity system: women described difficulties accessing these models including financial barriers and lack of availability. The power of continuity: All reported a positive experience birthing in a midwifery continuity of care model and some reported that this had a healing effect. CONCLUSION Offering midwifery continuity of care models to women with a history of psychological birth trauma can be beneficial. More research is necessary to confirm the findings of this small study, and on ways women who have psychological birth trauma can be prioritised for midwifery continuity of care models in Australia.
Collapse
Affiliation(s)
- Annabel Tafe
- Collaborative of Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia.
| | - Allison Cummins
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Australia
| | - Christine Catling
- Collaborative of Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia
| |
Collapse
|
23
|
Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia: Women's experiences and birth outcomes. Women Birth 2023; 36:80-88. [PMID: 35339411 DOI: 10.1016/j.wombi.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The ongoing closure of regional maternity services in Australia has significant consequences for women and communities. In South Australia, a regional midwifery model of care servicing five birthing sites was piloted with the aim of bringing sustainable birthing services to the area. An independent evaluation was undertaken. This paper reports on women's experiences and birth outcomes. AIM To evaluate the effectiveness, acceptability, continuity of care and birth outcomes of women utilising the new midwifery model of care. METHOD An anonymous questionnaire incorporating validated surveys and key questions from the Quality Maternal and Newborn Care (QMNC) Framework was used to assess care across the antenatal, intrapartum and postnatal period. Selected key labour and birth outcome indicators as reported by the sites to government perinatal data collections were included. FINDINGS The response rate was 52.6% (205/390). Women were overwhelmingly positive about the care they received during pregnancy, birth and the postnatal period. About half of women had caseload midwives as their main antenatal care provider; the other half experienced shared care with local general practitioners and caseload midwives. Most women (81.4%) had a known midwife at their birth. Women averaged 4 post-natal home visits with their midwife and 77.5% were breastfeeding at 6-8 weeks. Ninety-five percent of women would seek this model again and recommend it to a friend. Maternity indicators demonstrated a lower induction rate compared to state averages, a high primiparous normal birth rate (73.8%) and good clinical outcomes. CONCLUSION This innovative model of care was embraced by women in regional SA and labour and birth outcomes were good as compared with state-wide indicators.
Collapse
|
24
|
Haora P, Roe Y, Hickey S, Gao Y, Nelson C, Allen J, Briggs M, Worner F, Kruske S, Watego K, Maidment SJ, Hartz D, Sherwood J, Barclay L, Tracy S, Tracy M, Wilkes L, West R, Grant N, Kildea S. Developing and evaluating Birthing on Country services for First Nations Australians: the Building On Our Strengths (BOOSt) prospective mixed methods birth cohort study protocol. BMC Pregnancy Childbirth 2023; 23:77. [PMID: 36709265 PMCID: PMC9883816 DOI: 10.1186/s12884-022-05277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND With the impact of over two centuries of colonisation in Australia, First Nations families experience a disproportionate burden of adverse pregnancy and birthing outcomes. First Nations mothers are 3-5 times more likely than other mothers to experience maternal mortality; babies are 2-3 times more likely to be born preterm, low birth weight or not to survive their first year. 'Birthing on Country' incorporates a multiplicity of interpretations but conveys a resumption of maternity services in First Nations Communities with Community governance for the best start to life. Redesigned services offer women and families integrated, holistic care, including carer continuity from primary through tertiary services; services coordination and quality care including safe and supportive spaces. The overall aim of Building On Our Strengths (BOOSt) is to facilitate and assess Birthing on Country expansion into two settings - urban and rural; with scale-up to include First Nations-operated birth centres. This study will build on our team's earlier work - a Birthing on Country service established and evaluated in an urban setting, that reported significant perinatal (and organisational) benefits, including a 37% reduction in preterm births, among other improvements. METHODS Using community-based, participatory action research, we will collaborate to develop, implement and evaluate new Birthing on Country care models. We will conduct a mixed-methods, prospective birth cohort study in two settings, comparing outcomes for women having First Nations babies with historical controls. Our analysis of feasibility, acceptability, clinical and cultural safety, effectiveness and cost, will use data including (i) women's experiences collected through longitudinal surveys (three timepoints) and yarning interviews; (ii) clinical records; (iii) staff and stakeholder views and experiences; (iv) field notes and meeting minutes; and (v) costs data. The study includes a process, impact and outcome evaluation of this complex health services innovation. DISCUSSION Birthing on Country applies First Nations governance and cultural safety strategies to support optimum maternal, infant, and family health and wellbeing. Women's experiences, perinatal outcomes, costs and other operational implications will be reported for Communities, service providers, policy advisors, and for future scale-up. TRIAL REGISTRATION Australia & New Zealand Clinical Trial Registry # ACTRN12620000874910 (2 September 2020).
Collapse
Affiliation(s)
- Penny Haora
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Yvette Roe
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Darwin, Australia
| | - Sophie Hickey
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Yu Gao
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Carmel Nelson
- grid.492300.cInstitute for Urban Indigenous Health, Cox Road, Windsor, QLD 4030 Australia ,grid.1003.20000 0000 9320 7537Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD Australia
| | - Jyai Allen
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Melanie Briggs
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Faye Worner
- Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Sue Kruske
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Grevillea Drive, Sadadeen, NT 0870 Australia
| | - Kristie Watego
- grid.492300.cInstitute for Urban Indigenous Health, Cox Road, Windsor, QLD 4030 Australia
| | - Sarah-Jade Maidment
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Donna Hartz
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Juanita Sherwood
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Lesley Barclay
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Sally Tracy
- grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Mark Tracy
- grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Liz Wilkes
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,My Midwives Brisbane, Windsor Road, Red Hill, QLD 4059 Australia
| | - Roianne West
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Congress of Aboriginal & Torres Strait Islander Nurses and Midwives, Lytton Road, Murarrie, QLD 4172 Australia
| | - Nerida Grant
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Sue Kildea
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Grevillea Drive, Sadadeen, NT 0870 Australia
| |
Collapse
|
25
|
Springall T, Forster DA, McLachlan HL, McCalman P, Shafiei T. Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study. BMJ Open 2023; 13:e066978. [PMID: 36635038 PMCID: PMC9843190 DOI: 10.1136/bmjopen-2022-066978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES There is an urgent need to improve breast feeding rates for Australian First Nations (Aboriginal and Torres Strait Islander) infants. We explored breast feeding outcomes of women having a First Nations infant at three sites that introduced a culturally specific continuity of midwife care model. DESIGN Women having a First Nations infant booking for pregnancy care between March 2017 and November 2020 were invited to participate. Surveys at recruitment and 3 months post partum were developed with input from the First Nations Advisory Committee. We explored breast feeding intention, initiation, maintenance and reasons for stopping and factors associated with breast feeding. SETTING Three tertiary maternity services in Melbourne, Australia. PARTICIPANTS Of 479/926 eligible women approached, 343 (72%) completed the recruitment survey, and 213/343 (62%) the postnatal survey. OUTCOMES Primary: breast feeding initiation and maintenance. Secondary: breast feeding intention and reasons for stopping breast feeding. RESULTS Most women (298, 87%) received the culturally specific model. Breast feeding initiation (96%, 95% CI 0.93 to 0.98) was high. At 3 months, 71% were giving 'any' (95% CI 0.65 to 0.78) and 48% were giving 'only' breast milk (95% CI 0.41 to 0.55). Intending to breast feed 6 months (Adj OR 'any': 2.69, 95% CI 1.29 to 5.60; 'only': 2.22, 95% CI 1.20 to 4.12), and not smoking in pregnancy (Adj OR 'any': 2.48, 95% CI 1.05 to 5.86; 'only': 4.05, 95% CI 1.54 to 10.69) were associated with higher odds. Lower education (Adj OR 'any': 0.36, 95% CI 0.13 to 0.98; 'only': 0.50, 95% CI 0.26 to 0.96) and government benefits as the main household income (Adj OR 'any': 0.26, 95% CI 0.11 to 0.58) with lower odds. CONCLUSIONS Breast feeding rates were high in the context of service-wide change. Our findings strengthen the evidence that culturally specific continuity models improve breast feeding outcomes for First Nations women and infants. We recommend implementing and upscaling First Nations specific midwifery continuity models within mainstream hospitals in Australia as a strategy to improve breast feeding.
Collapse
Affiliation(s)
- Tanisha Springall
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - Della Anne Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Maternity Services, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Pamela McCalman
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
26
|
Li T, Zeng Y, Fan X, Yang J, Yang C, Xiong Q, Liu P. A Bibliometric Analysis of Research Articles on Midwifery Based on the Web of Science. J Multidiscip Healthc 2023; 16:677-692. [PMID: 36938484 PMCID: PMC10015947 DOI: 10.2147/jmdh.s398218] [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: 11/18/2022] [Accepted: 02/17/2023] [Indexed: 03/13/2023] Open
Abstract
Objective This study aimed to bibliometrically analyse the main features of the 100 top-cited articles on the midwifery index on the Web of Science. Methods Academic articles on midwifery' research published from 1985 to 2020 were included. VOSviewer 1.6.15, SPSS 22.0 software and a homemade applet were used to identify, analyse and visualise the citation ranking, publication year, journal, country and organisation of origin, authorship, journal impact factor and keywords along with the total link strength of countries, organisations and keywords. Results Among the 100 top-cited articles, the highest number of citations of the retrieved articles was 484. The median number of citations per year was 5.16 (interquartile range: 3.74-8.38). Almost two-thirds of the included articles (n = 61) centred on nursing and obstetrics/gynaecology. The top-cited articles were published in 38 different journals, the highest number of which was published by Midwifery (15%). Australia was the most productive country (24%). According to the total link strength, the sequence ran from the United States (28) to England (28) to Australia (19). The University of Technology Sydney and La Trobe University in Australia topped the list with four papers each. Hunter B was the most productive author (n = 4), and the average citations were positively related to the number of authors (r = 0.336, p < 0.05). Conclusion This study identified the most influential articles on midwifery and documented the core journals and the most productive countries, organisations and authors along with future research hotspots for this field; the findings may be beneficial to researchers in their publication and scientific cooperation endeavours.
Collapse
Affiliation(s)
- Tingting Li
- Department of Science and Education, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Yilan Zeng
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xianrong Fan
- Department of Hospital Office, The Maternal and Child Health Hospital of Yongchuan, Chongqing, People’s Republic of China
| | - Jing Yang
- Department of Obstetrics and Gynecology, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Chengying Yang
- Department of Obstetrics and Gynecology, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Qingyun Xiong
- Department of Ultrasonography, Changsha Hospital of Traditional Chinese Medicine, Changsha, Hunan Province, People’s Republic of China
- Qingyun Xiong, Department of Ultrasonography, Changsha Hospital of Traditional Chinese Medicine, No. 22, Xingsha Avenue, Changsha County, Changsha City, Hunan Province, 410100, People’s Republic of China, Tel +86 731-85259000, Email
| | - Ping Liu
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
- Correspondence: Ping Liu, Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, 311 Yingpan Road, Kaifu District, Changsha, Hunan Province, 410005, People’s Republic of China, Tel +86 15973136512, Email
| |
Collapse
|
27
|
Logan RG, McLemore MR, Julian Z, Stoll K, Malhotra N, Vedam S. Coercion and non-consent during birth and newborn care in the United States. Birth 2022; 49:749-762. [PMID: 35737547 DOI: 10.1111/birt.12641] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED In the United States, Black, Indigenous, and People of Color (BIPOC) experience more adverse health outcomes and report mistreatment during pregnancy and birth care. The rights to bodily autonomy and consent are core components of high-quality health care. To assess experiences of coercion and nonconsent for procedures during perinatal care among racialized service users in the United States, we analyzed data from the Giving Voice to Mothers (GVtM-US) study. METHODS In a subset analysis of the full sample of 2700, we examined survey responses for participants who described the experience of pressure or nonconsented procedures or intervention during perinatal care. We conducted multivariable logistic regression analyses by racial and ethnic identity for the outcomes: pressure to have perinatal procedures (eg, induction, epidurals, episiotomy, fetal monitoring), nonconsented procedures performed during perinatal care, pressure to have a cesarean birth, and nonconsented procedures during vaginal births. RESULTS Among participants (n = 2490), 34% self-identified as BIPOC, and 37% had a planned hospital birth. Overall, we found significant differences in pressure and nonconsented perinatal procedures by racial and ethnic identity. These inequities persisted even after controlling for contextual factors, such as birthplace, practitioner type, and prenatal care context. For example, more participants with Black racial identity experienced nonconsented procedures during perinatal care (AOR 1.89, 95% CI 1.35-2.64) and vaginal births (AOR 1.87, 95% CI 1.23-2.83) than those identifying as white. In addition, people who identified as other minoritized racial and ethnic identities reported experiencing more pressure to accept perinatal procedures (AOR 1.55, 95% CI 1.08-2.20) than those who were white. DISCUSSION There is a need to address human rights violations in perinatal care for all birthing people with particular attention to the needs of those identifying as BIPOC. By eliminating mistreatment in perinatal care, such as pressure to accept services and nonconsented procedures, we can help mitigate long-standing inequities.
Collapse
Affiliation(s)
| | - Monica R McLemore
- Department of Family Health Care Nursing, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA, USA
| | - Zoë Julian
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nisha Malhotra
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | -
- The Birth Place Lab, Vancouver, BC, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
28
|
Kildea S, Roe Y. Utilising the RISE Framework to implement birthing services for First Nations families. Women Birth 2022; 35:521-523. [DOI: 10.1016/j.wombi.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
29
|
Eckert M, Rickard CM, Forsythe D, Baird K, Finn J, Gilkison A, Gray R, Homer CSE, Middleton S, Neville S, Whitehead L, Sharplin GR, Keogh S. Harnessing the nursing and midwifery workforce to boost Australia's clinical research impact. Med J Aust 2022; 217:514-516. [PMID: 36335544 PMCID: PMC9827913 DOI: 10.5694/mja2.51758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Marion Eckert
- Rosemary Bryant AO Research CentreUniversity of South AustraliaAdelaideSA
| | - Claire M Rickard
- UQ Centre for Clinical ResearchUniversity of QueenslandBrisbaneQLD
| | - Deborah Forsythe
- Rosemary Bryant AO Research CentreUniversity of South AustraliaAdelaideSA
| | | | | | | | | | | | - Sandy Middleton
- Nursing Research InstituteAustralian Catholic University and St Vincent's Health AustraliaSydneyNSW
| | | | | | - Greg R Sharplin
- Rosemary Bryant AO Research CentreUniversity of South AustraliaAdelaideSA
| | - Samantha Keogh
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQLD
| |
Collapse
|
30
|
Dube M, Gao Y, Steel M, Bromley A, Ireland S, Kildea S. Effect of an Australian community-based caseload midwifery group practice service on maternal and neonatal outcomes for women from a refugee background. Women Birth 2022; 36:e353-e360. [PMID: 36344389 DOI: 10.1016/j.wombi.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Women from a refugee background who resettle in high-income countries experience poorer perinatal outcomes in comparison to women from host countries. There is a paucity of research on how best to improve these outcomes. AIM To report on the effectiveness of an Australian Refugee Midwifery Group Practice service on perinatal outcomes. METHODS We used inverse probability of treatment weighting to balance confounders and calculate treatment effect and compare maternal and neonatal outcomes for women from a refugee background who received Refugee Midwifery Group Practice care (n = 625), to those receiving standard care (n = 634) at a large tertiary hospital (1 January 2016-31 December 2019). Prespecified primary outcomes included: proportion of women attending ≥ 5 antenatal visits, preterm birth (<37 weeks), spontaneous onset of labour, epidural analgesia in the first stage of labour, normal birth (term, spontaneous onset, vertex, spontaneous vaginal birth, no epidural, no episiotomy), and exclusively breast-feeding at discharge. FINDINGS Women who received Refugee Midwifery Group Practice care were more likely to have spontaneous onset of labour (adjusted odds ratio 2·20, 95% CI 1·71-2·82; p < 0·0001), normal birth (1·55, 1·23-1·95; p < 0·0001), and less likely to use epidural analgesia (0·67, 0·50-0·89; p = 0·0067) and have a preterm baby (0·60, 0·36-0·99; p = 0·047). There was no difference between groups in women attending ≥ 5 antenatal visits and exclusive breastfeeding at discharge from hospital. DISCUSSION A Refugee Midwifery Group Practice is feasible and clinically effective. CONCLUSION Similar services could potentially improve outcomes for women from a refugee background who resettle in high-income countries.
Collapse
Affiliation(s)
- Mpho Dube
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Michelle Steel
- Mater Mothers Hospital, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Angela Bromley
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sarah Ireland
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia.
| |
Collapse
|
31
|
Ferguson B, Baldwin A, Henderson A, Harvey C. The grounded theory of Coalescence of Perceptions, Practice and Power: An understanding of governance in midwifery practice. J Nurs Manag 2022; 30:4587-4594. [PMID: 36325759 PMCID: PMC10099921 DOI: 10.1111/jonm.13892] [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: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIMS This study aimed to understand midwifery care during labour, particularly decision-making processes, within Australian health systems. BACKGROUND Midwifery, founded on a wellness model of motherhood, is at risk of being medicalized. Whilst medical intervention is lifesaving, it requires judicious use. Governance provides oversight to care. Exploring decision-making contributes to understanding governance of practices. METHOD Straussian grounded theory using semi-structured interviews. Eighteen Australian registered midwives were interviewed about their practice when caring for women during labour. RESULTS Midwives were caught between divergent positions; birth as natural versus birth as risk. Experienced midwives discussed focussing on the woman, yet less experienced were preoccupied with mandatory protocols like early warning tools. Practice was governed by midwives approach within context of labour. The final theory: The Coalescence of Perceptions, Practice and Power, comprising three categories: perceptions and behaviour, shifting practice and power within practice, emerged. CONCLUSIONS Coalescence Theory elucidates how professional decision making by midwives during care provision is subject to power within practice, thereby governed by tensions, competing priorities and organizational mandates. IMPLICATIONS FOR MIDWIFERY MANAGERS Midwifery managers are well positioned to negotiate the nuanced space that envelopes birthing processes, namely, expert knowledge, policy mandates and staffing capability and resources, for effective collaborative governance. In this way, managers sustain good governance.
Collapse
Affiliation(s)
- Bridget Ferguson
- Central Queensland University, North Rockhampton, Queensland, Australia
| | - Adele Baldwin
- Central Queensland University, Townsville, Queensland, Australia
| | - Amanda Henderson
- Central Queensland University, Brisbane City, Queensland, Australia
| | - Clare Harvey
- Central Queensland University, Townsville, Queensland, Australia.,Massey University, Wellington Campus, Wellington, New Zealand
| |
Collapse
|
32
|
Smith PA, Kilgour C, Rice D, Callaway LK, Martin EK. Implementation barriers and enablers of midwifery group practice for vulnerable women: a qualitative study in a tertiary urban Australian health service. BMC Health Serv Res 2022; 22:1265. [PMID: 36261823 PMCID: PMC9583548 DOI: 10.1186/s12913-022-08633-8] [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: 02/04/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Maternity services have limited formalised guidance on planning new services such as midwifery group practice for vulnerable women, for example women with a history of substance abuse (alcohol, tobacco and other drugs), mental health challenges, complex social issues or other vulnerability. Continuity of care through midwifery group practice is mostly restricted to women with low-risk pregnancies and is not universally available to vulnerable women, despite evidence supporting benefits of this model of care for all women. The perception that midwifery group practice for vulnerable women is a high-risk model of care lacking in evidence may have in the past, thwarted implementation planning studies that seek to improve care for these women. We therefore aimed to identify the barriers and enablers that might impact the implementation of a midwifery group practice for vulnerable women. Methods A qualitative context analysis using the Consolidated Framework for Implementation Research was conducted at a single-site tertiary health facility in Queensland, Australia. An interdisciplinary group of stakeholders from a purposeful sample of 31 people participated in semi-structured interviews. Data were analysed using manual and then Leximancer computer assisted methods. Themes were compared and mapped to the Framework. Results Themes identified were the woman’s experience, midwifery workforce capabilities, identifying “gold standard care”, the interdisciplinary team and costs. Potential enablers of implementation included perceptions that the model facilitates a relationship of trust with vulnerable women, that clinical benefit outweighs cost and universal stakeholder acceptance. Potential barriers were: potential isolation of the interdisciplinary team, costs and the potential for vicarious trauma for midwives. Conclusion There was recognition that the proposed model of care is supported by research and a view that clinical benefits will outweigh costs, however supervision and support is required for midwives to manage and limit vicarious trauma. An interdisciplinary team structure is also an essential component of the service design. Attention to these key themes, barriers and enablers will assist with identification of strategies to aid successful implementation. Australian maternity services can use our results to compare how the perceptions of local stakeholders might be similar or different to the results presented in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08633-8.
Collapse
Affiliation(s)
- Patricia A Smith
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.
| | - Catherine Kilgour
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, 4072, Brisbane, QLD, Australia
| | - Deann Rice
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia
| | - Leonie K Callaway
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston Road, 4006, Herston, Brisbane, QLD, Australia
| | - Elizabeth K Martin
- Mater Research Institute, Faculty of Medicine, University of Queensland, Raymond Terrace, 4101, South Brisbane, Brisbane, QLD, Australia
| |
Collapse
|
33
|
Shipton EV, Callaway L, Foxcroft K, Lee N, de Jersey SJ. Midwife-Led Continuity of Antenatal Care and Breastfeeding Duration Beyond Postpartum Hospital Discharge: A Systematic Review. J Hum Lact 2022:8903344221126644. [PMID: 36197006 DOI: 10.1177/08903344221126644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life and that breastfeeding should continue for 2 years and beyond. Most women initiate breastfeeding, but many do not continue for the recommended duration. While midwife-led continuity of antenatal care is linked to improved mother and infant outcomes, the influence on breastfeeding duration has not been previously reviewed. RESEARCH AIM To critically analyze the literature that compared midwife-led continuity of antenatal care with other models of care where researchers have measured breastfeeding duration beyond postpartum hospital discharge. METHODS A systematic literature review with critical analysis was used to answer the research aim. We systematically searched and screened five databases for quantitative studies where researchers had reported breastfeeding duration beyond postpartum hospital discharge after midwife-led continuity of antenatal care, compared with another model of antenatal care. Methodological quality was assessed using tools from the Cochrane Collaboration (RoB2 and ROBINS-I). In total, nine studies met the inclusion criteria. RESULTS Clear conclusions about the association between midwife-led continuity of antenatal care and breastfeeding duration were not found. The risk of bias within non-randomized studies ranged from serious to critical, and a judgement of "some concerns" of risk of bias in the one randomized study. CONCLUSION To date, the question of whether midwife-led continuity of antenatal care improves breastfeeding duration has not been established. There has been a lack of consistency in definitions of breastfeeding and descriptions of models of care, which has weakened the evidence-based of literature reviewed.Our review protocol was registered with PROSPERO; although due to COVID-19, this registration was not checked for eligibility by the PROSPERO team (CRD42020151276). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151276.
Collapse
Affiliation(s)
- Emma V Shipton
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Leonie Callaway
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Katie Foxcroft
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nigel Lee
- School of Nursing, Midwifery and Social Work, The University of Queensland, South Brisbane, QLD, Australia
| | - Susan J de Jersey
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
| |
Collapse
|
34
|
Mills TA, Roberts SA, Camacho E, Heazell AEP, Massey RN, Melvin C, Newport R, Smith DM, Storey CO, Taylor W, Lavender T. Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study. BMC Pregnancy Childbirth 2022; 22:634. [PMID: 35948884 PMCID: PMC9363262 DOI: 10.1186/s12884-022-04925-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Around 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS). Methods A prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks’ gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8). Results Overall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited. Conclusions Women and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities. Trial registration ISRCTN17447733 first registration 13/02/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04925-3.
Collapse
Affiliation(s)
- Tracey A Mills
- Department of International Public Health, Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine. Pembroke Place, Liverpool, L3 5QA, UK.
| | - Stephen A Roberts
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Elizabeth Camacho
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Alexander E P Heazell
- Division of Developmental Biology and Medicine, School of Medical Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Rachael N Massey
- East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, BB2 3HH, England
| | - Cathie Melvin
- East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, BB2 3HH, England
| | - Rachel Newport
- Northern Care Alliance NHS Trust, Royal Oldham Hospital, Oldham, OL1 2JH, England
| | - Debbie M Smith
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | | | - Wendy Taylor
- Division of Nursing Midwifery and Social Work, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Tina Lavender
- Department of International Public Health, Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine. Pembroke Place, Liverpool, L3 5QA, UK
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Doering K, McAra-Couper J, Gilkison A. The un-silencing of Japanese women's voices in maternity care: A hermeneutic phenomenological study of the woman-midwife relationship. Midwifery 2022; 112:103407. [PMID: 35750006 DOI: 10.1016/j.midw.2022.103407] [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: 12/13/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this article is to understand the meaning of the woman-midwife relationship, with the overall aim to improve maternity care and women's birth experiences in Japan. To better understand the meaning of the woman-midwife relationship, this article presents women's and midwives' experiences of having or not having a voice in maternity care. RESEARCH DESIGN Hermeneutic phenomenology, as described by Max van Manen, helped to uncover the meaning of the phenomenon-the woman-midwife relationship-through participants' lived experience. Individual interviews were conducted with 14 women and 10 midwives living in Japan. The interview data were interpreted and thematically analysed to reveal the meaning of the woman-midwife relationship. FINDINGS 'Having a voice' emerged as a central theme underpinning the meaning of the woman-midwife relationship; aspects of which included, 1) being unheard, 2) losing a voice, 3) having a voice, and 4) midwives speaking for women. Although having a voice should be a legitimate right for women in maternity care, some women's voices were unheard or lost in the experience with midwives. Conversely, some women gained a voice, especially when they positively and continuously developed their relationship with their midwife. How the woman and the midwife related to each other clearly affected their experience of having a voice in maternity care. KEY CONCLUSION Having a voice, which portrays dimensions of choice, control, and autonomy, in their own maternity care is vital for women's positive birth experience. The woman-midwife relationship is critical in enabling women to have a voice and midwives to speak for women. Women and midwives need to develop their relationship. Moreover, the maternity care system needs to allow sufficient time and space, for instance, by ensuring midwife continuity of care to develop a positive woman-midwife relationship.
Collapse
Affiliation(s)
- Keiko Doering
- Department of Human Health Sciences, Kyoto University, Japan.
| | | | - Andrea Gilkison
- School of Clinical Sciences, Auckland University of Technology, New Zealand
| |
Collapse
|
37
|
Kloester J, Willey S, Hall H, Brand G. Midwives’ experiences of facilitating informed decision-making – a narrative literature review. Midwifery 2022; 109:103322. [DOI: 10.1016/j.midw.2022.103322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
|
38
|
McLachlan HL, Newton M, McLardie-Hore FE, McCalman P, Jackomos M, Bundle G, Kildea S, Chamberlain C, Browne J, Ryan J, Freemantle J, Shafiei T, Jacobs SE, Oats J, Blow N, Ferguson K, Gold L, Watkins J, Dell M, Read K, Hyde R, Matthews R, Forster DA. Translating evidence into practice: Implementing culturally safe continuity of midwifery care for First Nations women in three maternity services in Victoria, Australia. EClinicalMedicine 2022; 47:101415. [PMID: 35747161 PMCID: PMC9142789 DOI: 10.1016/j.eclinm.2022.101415] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Strategies to improve outcomes for Australian First Nations mothers and babies are urgently needed. Caseload midwifery, where women have midwife-led continuity throughout pregnancy, labour, birth and the early postnatal period, is associated with substantially better perinatal health outcomes, but few First Nations women receive it. We assessed the capacity of four maternity services in Victoria, Australia, to implement, embed, and sustain a culturally responsive caseload midwifery service. METHODS A prospective, non-randomised research translational study design was used. Site specific culturally responsive caseload models were developed by site working groups in partnership with their First Nations health units and the Victorian Aboriginal Community Controlled Health Organisation. The primary outcome was to increase the proportion of women having a First Nations baby proactively offered and receiving caseload midwifery as measured before and after programme implementation. The study was conducted in Melbourne, Australia. Data collection commenced at the Royal Women's Hospital on 06/03/2017, Joan Kirner Women's and Children's Hospital 01/10/2017 and Mercy Hospital for Women 16/04/2018, with data collection completed at all sites on 31/12/2020. FINDINGS The model was successfully implemented in three major metropolitan maternity services between 2017 and 2020. Prior to this, over a similar timeframe, only 5.8% of First Nations women (n = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% (n = 758) accepted it, of whom 89% (n = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model. INTERPRETATION Key enablers included co-design of the study and programme implementation with First Nations people, staff cultural competency training, identification of First Nations women (and babies), and regular engagement between caseload midwives and First Nations hospital and community teams. Further work should include a focus on addressing cultural and workforce barriers to implementation of culturally responsive caseload midwifery in regional areas. FUNDING Partnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.
Collapse
Affiliation(s)
- Helen L. McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- Corresponding author at: Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia.
| | - Michelle Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Fiona E. McLardie-Hore
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Pamela McCalman
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Marika Jackomos
- Mercy Hospital for Women, Heidelberg, Victoria 3084, Australia
| | - Gina Bundle
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Alice Springs 0870, Australia
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
- Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch, Western Australia 6150, Australia
- The Lowitja Institute, Carlton, Victoria 3053, Australia
| | - Jennifer Browne
- Deakin University Institute for Health Transformation, Geelong, Victoria 3220, Australia
- Victorian Aboriginal Community Controlled Health Organisation, Collingwood, Victoria 3066, Australia
| | - Jenny Ryan
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Jane Freemantle
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
- Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria 3630, Australia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Susan E. Jacobs
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
- Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria 3052, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
| | - Ngaree Blow
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
| | - Karyn Ferguson
- Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria 3630, Australia
| | - Lisa Gold
- Deakin University Institute for Health Transformation, Geelong, Victoria 3220, Australia
| | - Jacqueline Watkins
- Joan Kirner Hospital, Western Health St Albans, Victoria 3021, Australia
| | - Maree Dell
- Joan Kirner Hospital, Western Health St Albans, Victoria 3021, Australia
| | - Kim Read
- Goulburn Valley Health, Shepparton, Victoria 3644, Australia
| | - Rebecca Hyde
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Robyn Matthews
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Della A. Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| |
Collapse
|
39
|
McCaffery S, Small K, Gamble J. Rural Australian Doctors’ Views About Midwifery and Midwifery Models of Care: A Qualitative Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSEAustralian rural areas access to midwifery continuity of carer models is restricted. Lack of medical support has been identified as one of the reasons midwifery continuity of carer models have not been implemented. The purpose of his study was to explore rural Australian doctors’ views about midwifery and midwifery continuity of carer models.STUDY DESIGNA qualitative study with general practitioner and specialist obstetricians (n = 10) working in Australian rural maternity services. Semi-structured interviews were undertaken and analyzed using thematic analysis.FINDINGSParticipants’ views of midwifery and midwifery continuity of carer models were expressed in three themes. The themes related to the concepts of knowing: knowing the model, knowing the midwife, and knowing the system. Participants had misconceptions and misunderstandings of the model, midwifery, and systems issues relating to midwifery continuity of carer models.CONCLUSIONIncreasing understanding about midwifery and midwifery continuity of carer models may facilitate implementation of these models. A national education program for doctors about the structure and function of midwifery continuity of carer models would support knowledge building for obstetric doctors. Strong leadership and incentivization for health services may be needed to sustainably roll-out rural models. At a service level, responsibility for establishing and sustaining models should shift from local midwife leaders to hospital executives.
Collapse
|
40
|
"It Makes My Skin Crawl": Women's experience of breastfeeding aversion response (BAR). Women Birth 2022; 35:582-592. [PMID: 35012885 DOI: 10.1016/j.wombi.2022.01.001] [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: 10/03/2021] [Revised: 12/01/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022]
Abstract
PROBLEM Some women who intend to breastfeed experience a breastfeeding aversion response (BAR) while breastfeeding. BACKGROUND Little is known about the experience of those who have feelings of aversion while breastfeeding. AIM This study aimed to investigate the experiences of women who have an aversion response to breastfeeding while their infant is latched at the breast. This is the first study that aims to understand this breastfeeding aversion response (BAR) as described by women who experience this phenomenon. METHODS Interpretative phenomenological analysis (IPA) was used to conduct and analyse ten semi-structured in-depth interviews with women who self-identified as experiencing BAR. FINDINGS Four overarching themes were identified: (1) Involuntary, strong sensations of aversion in response to the act of breastfeeding, (2) Internal conflict and effects on maternal identity, (3) The connection between BAR and relationships with others, and (4) Reflections on coping with BAR and building resilience. DISCUSSION Some women who intend to breastfeed can experience BAR, and this negative sensation conflicts with their desire to breastfeed. BAR can impact on maternal wellbeing. Those who experience BAR may benefit from person-centred support that directly addresses the challenges associated with BAR to achieve their personal breastfeeding goals. CONCLUSION The experience of BAR is unexpected and difficult for mothers. If support is not available, BAR can have detrimental effects on maternal identity, mother-child bonds, and intimate family relationships.
Collapse
|
41
|
Options for improving low birthweight and prematurity birth outcomes of indigenous and culturally and linguistically diverse infants: a systematic review of the literature using the social-ecological model. BMC Pregnancy Childbirth 2022; 22:3. [PMID: 34979997 PMCID: PMC8722221 DOI: 10.1186/s12884-021-04307-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prematurity and low birthweight are more prevalent among Indigenous and Culturally and Linguistically Diverse infants. METHODS To conduct a systematic review that used the social-ecological model to identify interventions for reducing low birthweight and prematurity among Indigenous or CALD infants. Scopus, PubMed, CINAHL, and Medline electronic databases were searched. Studies included those published in English between 2010 and 2021, conducted in high-income countries, and reported quantitative results from clinical trials, randomized controlled trials, case-control studies or cohort studies targeting a reduction in preterm birth or low birthweight among Indigenous or CALD infants. Studies were categorized according to the level of the social-ecological model they addressed. FINDINGS Nine studies were identified that met the inclusion criteria. Six of these studies reported interventions targeting the organizational level of the social-ecological model. Three studies targeted the policy, community, and interpersonal levels, respectively. Seven studies presented statistically significant reductions in preterm birth or low birthweight among Indigenous or CALD infants. These interventions targeted the policy (n = 1), community (n = 1), interpersonal (n = 1) and organizational (n = 4) levels of the social-ecological model. INTERPRETATION Few interventions across high-income countries target the improvement of low birthweight and prematurity birth outcomes among Indigenous or CALD infants. No level of the social-ecological model was found to be more effective than another for improving these outcomes.
Collapse
|
42
|
Bradford BF, Wilson AN, Portela A, McConville F, Fernandez Turienzo C, Homer CSE. Midwifery continuity of care: A scoping review of where, how, by whom and for whom? PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000935. [PMID: 36962588 PMCID: PMC10021789 DOI: 10.1371/journal.pgph.0000935] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022]
Abstract
Systems of care that provide midwifery care and services through a continuity of care model have positive health outcomes for women and newborns. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? Using a scoping review framework, we searched electronic and grey literature databases for reports in any language between January 2012 and January 2022, which described current and recent trials, implementation or scaling-up of midwifery continuity of care studies or initiatives in high-, middle- and low-income countries. After screening, 175 reports were included, the majority (157, 90%) from high-income countries (HICs) and fewer (18, 10%) from low- to middle-income countries (LMICs). There were 163 unique studies including eight (4.9%) randomised or quasi-randomised trials, 58 (38.5%) qualitative, 53 (32.7%) quantitative (cohort, cross sectional, descriptive, observational), 31 (19.0%) survey studies, and three (1.9%) health economics analyses. There were 10 practice-based accounts that did not include research. Midwives led almost all continuity of care models. In HICs, the most dominant model was where small groups of midwives provided care for designated women, across the antenatal, childbirth and postnatal care continuum. This was mostly known as caseload midwifery or midwifery group practice. There was more diversity of models in low- to middle-income countries. Of the 175 initiatives described, 31 (18%) were implemented for women, newborns and families from priority or vulnerable communities. With the exception of New Zealand, no countries have managed to scale-up continuity of midwifery care at a national level. Further implementation studies are needed to support countries planning to transition to midwifery continuity of care models in all countries to determine optimal model types and strategies to achieve sustainable scale-up at a national level.
Collapse
Affiliation(s)
- Billie F Bradford
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Alyce N Wilson
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Anayda Portela
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Fran McConville
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | | | - Caroline S E Homer
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| |
Collapse
|
43
|
Martin-Arribas A, Escuriet R, Borràs-Santos A, Vila-Candel R, González-Blázquez C. A comparison between midwifery and obstetric care at birth in Spain: Across-sectional study of perinatal outcomes. Int J Nurs Stud 2021; 126:104129. [PMID: 34890836 DOI: 10.1016/j.ijnurstu.2021.104129] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The organizational structure of maternity services determines the choice of which professionals provide care during pregnancy, birth, and the postnatal period, and it influences the kind of care they deliver and the level of continuity of care offered. There is considerable evidence that demonstrates a relationship between how care is provided and the maternal and neonatal health outcomes. Registered midwives and obstetricians provide maternity care across Spain. To date, no studies have assessed whether maternity outcomes differ between these two groups. OBJECTIVE The aim of this study was to examine the association between the care received (midwifery care versus obstetric care) and the maternal and neonatal outcomes in women with normal, low- and medium-risk pregnancies in Spain from 2016 to 2019. DESIGN A prospective, multicentre, cross-sectional study was carried out as part of COST Action IS1405 at 44 public hospitals in Spain in the years 2016-2019. The protocol can be accessed through the registry ISRCTN14062994. The sample size of this study was 11,537 women. The primary outcome was mode of birth. The secondary outcomes included augmentation with oxytocin, use of epidural analgesia, women's position at birth, perineal integrity, third stage of labour management, maternal and neonatal admission to intensive care, Apgar score, neonatal resuscitation, and early initiation of breastfeeding. Chi-square tests for categorical variables and independent sample t-test for continuous variables to assess differences between the midwifery and obstetric groups were calculated. Odds ratio with intervals of confidence at 95% were calculated for obstetric interventions and perinatal outcomes. A multivariate logistic regression model was applied in order to examine the effect of type of healthcare provider on perinatal outcomes. These models were adjusted for care provider, type of onset of labour, use of anaesthesia, pregnancy risk, maternal age, parity, and gestational age at birth. RESULTS Midwifery care was associated with lower rates of operative births and severe perineal damage and had no higher adverse outcomes. No statistically significant differences were observed in the use of other obstetric interventions between the two groups. CONCLUSIONS The findings of this study should encourage a shift in the current maternity care system towards a greater integration of midwifery-led services in order to achieve optimal birth outcomes for women and newborns. REGISTRY NUMBER ISRCTN14062994.
Collapse
Affiliation(s)
- Anna Martin-Arribas
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain; Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.
| | - Ramon Escuriet
- Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain.
| | - Alicia Borràs-Santos
- Gimbernat School of Nursing, Universitat Autònoma de Barcelona (UAB), Sant Cugat del Vallès, Spain.
| | - Rafael Vila-Candel
- La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Alzira, Valencia, Spain; Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain; Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.
| | - Cristina González-Blázquez
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.
| |
Collapse
|
44
|
Hadebe R, Seed PT, Essien D, Headen K, Mahmud S, Owasil S, Fernandez Turienzo C, Stanke C, Sandall J, Bruno M, Khazaezadeh N, Oteng-Ntim E. Can birth outcome inequality be reduced using targeted caseload midwifery in a deprived diverse inner city population? A retrospective cohort study, London, UK. BMJ Open 2021; 11:e049991. [PMID: 34725078 PMCID: PMC8562498 DOI: 10.1136/bmjopen-2021-049991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES (1) To report maternal and newborn outcomes of pregnant women in areas of social deprivation in inner city London. (2) To compare the effect of caseload midwifery with standard care on maternal and newborn outcomes in this cohort of women. DESIGN Retrospective observational cohort study. SETTING Four council wards (electoral districts) in inner city London, where over 90% of residents are in the two most deprived quintiles of the English Index of Multiple Deprivation (IMD) (2019) and the population is ethnically diverse. PARTICIPANTS All women booked for antenatal care under Guys and St Thomas' National Health Service Foundation Trust after 11 July 2018 (when the Lambeth Early Action Partnership (LEAP*) caseload midwifery team was implemented) until data collection 18 June 2020. This included 523 pregnancies in the LEAP area, of which 230 were allocated to caseload midwifery, and 8430 pregnancies from other areas. MAIN OUTCOME MEASURES To explore if targeted caseload midwifery (known to reduce preterm birth) will improve important measurable outcomes (preterm birth, mode of birth and newborn outcomes). RESULTS There was a significant reduction in preterm birth rate in women allocated to caseload midwifery, when compared with those who received traditional midwifery care (5.1% vs 11.2%; risk ratio: 0.41; p=0.02; 95% CI 0.18 to 0.86; number needed to treat: 11.9). Caesarean section births were significantly reduced in women allocated to caseload midwifery care, when compared with traditional midwifery care (24.3% vs 38.0%; risk ratio: 0.64: p=0.01; 95% CI 0.47 to 0.90; number needed to treat: 7.4) including emergency caesarean deliveries (15.2% vs 22.5%; risk ratio: 0.59; p=0.03; 95% CI 0.38 to 0.94; number needed to treat: 10) without increase in neonatal unit admission or stillbirth. CONCLUSION This study shows that a model of caseload midwifery care implemented in an inner city deprived community improves outcome by significantly reducing preterm birth and birth by caesarean section when compared with traditional care. This data trend suggests that when applied to targeted groups (women in higher IMD quintile and women of diverse ethnicity) that the impact of intervention is greater.
Collapse
Affiliation(s)
- Ruth Hadebe
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London, UK
| | - Diana Essien
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kyle Headen
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Saheel Mahmud
- King's College London School of Medicine, London, UK
| | - Salwa Owasil
- King's College London School of Medicine, London, UK
| | | | - Carla Stanke
- Public Health, National Childrens Bureau, London, UK
- Lambeth Early Action Partnership, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, London, UK
| | - Mara Bruno
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nina Khazaezadeh
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Women and Children's Health, King's College London, London, UK
| |
Collapse
|
45
|
Hansen MK, Midtgaard J, Hegaard HK, Broberg L, de Wolff MG. Monitored but not sufficiently guided - A qualitative descriptive interview study of maternity care experiences and needs in women with chronic medical conditions. Midwifery 2021; 104:103167. [PMID: 34763179 DOI: 10.1016/j.midw.2021.103167] [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: 04/16/2021] [Revised: 09/10/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore maternity care experiences and needs of women with various types of chronic medical conditions receiving specialised maternity care. Design A qualitative descriptive study. SETTING A highly specialised hospital providing maternity care to women with high-risk pregnancies in Copenhagen, Denmark. Participants Fourteen purposefully selected women referred to specialist maternity care at a large tertiary hospital due to one or more chronic medical conditions. METHODS Individual in-depth interviews (n = 14) were performed between January 2018 and June 2019. Analysed using thematic analysis. RESULTS One overarching theme was identified: Monitored but not sufficiently guided. Three main themes unfolding this overarching theme were: Chronic condition as determining pregnancy care, Childbearing woman as messenger and interpreter, and Feelings of abandonment after giving birth. KEY CONCLUSIONS Across various types of chronic medical conditions, women expressed a need for increased continuity in specialised maternity care. Healthcare professionals should help women with chronic medical conditions navigate the healthcare system and interpret complex information. IMPLICATIONS FOR PRACTICE Pregnancy should be recognised as a significant life event, even though the childbearing woman is living with a chronic medical condition, and professionals should emphasise the aspects of pregnancy that develop uncomplicated. Information about the anticipated development of chronic medical conditions postpartum and concerns regarding breastfeeding could preferably be addressed during pregnancy. Continuity of care was particularly important to the women and could relieve some of the worrying women experienced during pregnancy.
Collapse
Affiliation(s)
- Mette K Hansen
- The Research Unit for Women's and Children's Health, The Juliane Marie Centre, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Amager Hvidovre Hospital - Copenhagen University Hospitals, Kettegård Allé 30, 2650 Hvidovre, Denmark.
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3, 2100 Copenhagen, Denmark; Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej, 2600 Glostrup, Denmark
| | - Hanne K Hegaard
- The Research Unit for Women's and Children's Health, The Juliane Marie Centre, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3, 2100 Copenhagen, Denmark
| | - Lotte Broberg
- The Research Unit for Women's and Children's Health, The Juliane Marie Centre, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3, 2100 Copenhagen, Denmark
| | - Mie G de Wolff
- The Research Unit for Women's and Children's Health, The Juliane Marie Centre, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3, 2100 Copenhagen, Denmark
| |
Collapse
|
46
|
Mortensen B. Sammenheng i jordmortjenesten gjør en forskjell – hva venter vi på i Norge? TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
47
|
Scarf VL, Yu S, Viney R, Cheah SL, Dahlen H, Sibbritt D, Thornton C, Tracy S, Homer C. Modelling the cost of place of birth: a pathway analysis. BMC Health Serv Res 2021; 21:816. [PMID: 34391422 PMCID: PMC8364024 DOI: 10.1186/s12913-021-06810-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown. OBJECTIVES The objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective. METHODS This was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year. FINDINGS 496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth, $AUD4979 for a birth centre birth and $AUD5463 for a hospital birth. CONCLUSION The findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective.
Collapse
Affiliation(s)
- Vanessa L Scarf
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW, 2007, Australia.
| | - Serena Yu
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Seong Leang Cheah
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW, 2007, Australia
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - David Sibbritt
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW, 2007, Australia
| | | | - Sally Tracy
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW, 2007, Australia.,Burnet Institute, Melbourne, Australia
| |
Collapse
|
48
|
de Wolff MG, Midtgaard J, Johansen M, Rom AL, Rosthøj S, Tabor A, Hegaard HK. Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157875. [PMID: 34360168 PMCID: PMC8345548 DOI: 10.3390/ijerph18157875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/30/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
The proportion of childbearing women with pre-existing chronic medical conditions (CMC) is rising. In a randomized controlled trial, we aimed to evaluate the effects of a midwife-coordinated maternity care intervention (ChroPreg) in pregnant women with CMC. The intervention consisted of three main components: (1) Midwife-coordinated and individualized care, (2) Additional ante-and postpartum consultations, and (3) Specialized known midwives. The primary outcome was the total length of hospital stay (LOS). Secondary outcomes were patient-reported outcomes measuring psychological well-being and satisfaction with maternity care, health utilization, and maternal and infant outcomes. A total of 362 women were randomized to the ChroPreg intervention (n = 131) or Standard Care (n = 131). No differences in LOS were found between groups (median 3.0 days, ChroPreg group 0.1% lower LOS, 95% CI −7.8 to 7%, p = 0.97). Women in the ChroPreg group reported being more satisfied with maternity care measured by the Pregnancy and Childbirth Questionnaire (PCQ) compared with the Standard Care group (mean PCQ 104.5 vs. 98.2, mean difference 6.3, 95% CI 3.0–10.0, p < 0.0001). In conclusion, the ChroPreg intervention did not reduce LOS. However, women in the ChroPreg group were more satisfied with maternity care.
Collapse
Affiliation(s)
- Mie G. de Wolff
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- The Research Unit for Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Correspondence: ; Tel.: +45-23306414
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Mental Health Centre Glostrup, University of Copenhagen, 2600 Glostrup, Denmark
| | - Marianne Johansen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- Unit for Pregnancy and Heart Disease, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ane L. Rom
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- The Research Unit for Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Susanne Rosthøj
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
| | - Ann Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Hanne K. Hegaard
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- The Research Unit for Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
| |
Collapse
|
49
|
Hanley A, Davis D, Kurz E. Job satisfaction and sustainability of midwives working in caseload models of care: An integrative literature review. Women Birth 2021; 35:e397-e407. [PMID: 34257046 DOI: 10.1016/j.wombi.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Demand for caseload midwifery care continues to outstrip supply. We know little about what sustains midwives working in caseload models of care. AIM This review systematically identifies and synthesises research findings reporting on factors which contribute to job satisfaction, and therefore the sustainability of practice, of midwives working in caseload models of care. METHODS A comprehensive search strategy explored the electronic databases CINAHL Plus with Full Text, MEDLINE, PubMED, Cochrane Database of Systematic Reviews, and Scopus. Articles were assessed using the Crowe Critical Appraisal Tool. Data analysis and synthesis of these publications were conducted using a narrative synthesis approach. FINDINGS Twenty-two articles were reviewed. Factors which contribute to the job satisfaction and sustainability of practice of midwives working in caseload models are: the ability to build relationships with women; flexibility and control over own working arrangements; professional autonomy and identity; and, organisational and practice arrangements. CONCLUSION Insights into the factors which contribute to the job satisfaction and sustainability of practice of midwives in caseload models of care enables both midwives and healthcare administrators to more effectively implement and support midwifery-led caseload models of care which have been shown to improve outcomes for childbearing women.
Collapse
Affiliation(s)
- Andrea Hanley
- Faculty of Health, University of Canberra and ACT Government Health Directorate, ACT, Australia
| | - Deborah Davis
- Faculty of Health, University of Canberra and ACT Government Health Directorate, ACT, Australia
| | - Ella Kurz
- Faculty of Health, University of Canberra, University Drive, Belconnen, ACT 2617, Australia.
| |
Collapse
|
50
|
Callander EJ, Slavin V, Gamble J, Creedy DK, Brittain H. Cost-effectiveness of public caseload midwifery compared to standard care in an Australian setting: a pragmatic analysis to inform service delivery. Int J Qual Health Care 2021; 33:6275641. [PMID: 33988712 DOI: 10.1093/intqhc/mzab084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 05/13/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Decision-makers need quantifiable data on costs and outcomes to determine the optimal mix of antenatal models of care to offer. This study aimed to examine the cost utility of a publicly funded Midwifery Group Practice (MGP) caseload model of care compared to other models of care and demonstrate the feasibility of conducting such an analysis to inform service decision-making. OBJECTIVE To provide a methodological framework to determine the value of public midwifery in different settings. METHODS Incremental costs and incremental utility (health gains measured in quality-adjusted life years (QALYs)) of public MGP caseload were compared to other models of care currently offered at a large tertiary hospital in Australia. Patient Reported Outcomes Measurement Information System Global Short Form scores were converted into utility values by mapping to the EuroQol 5 dimensions and then converting to QALYs. Costs were assessed from a health system funder's point of view. RESULTS There were 85 women in the public MGP caseload care group and 72 received other models of care. Unadjusted total mean cost for mothers' and babies' health service use from study entry to 12 months post-partum was $27 618 for MGP caseload care and $33 608 for other models of care. After adjusting for clinical and demographic differences between groups, total costs were 22% higher (cost ratio: 1.218, P = 0.04) for other models of maternity care. When considering costs to all funders, public MGP caseload care cost $5208 less than other models of care. There was no significant difference in QALY between the two groups (difference: 0.010, 95% CI: -0.038, 0.018). CONCLUSION Public MGP caseload care costs 22% less than other models of care, after accounting for differences in baseline characteristics between groups. There were no significant differences in QALYs. Public MGP caseload care produced comparable health outcomes, with some indication that outcomes may be better for lower cost per woman.
Collapse
Affiliation(s)
- Emily J Callander
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Valerie Slavin
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Nursing and Midwifery, Griffith University, 68 University Dr, Meadowbrook, QLD 4131, Australia.,Women, Newborn and Children's, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
| | - Jenny Gamble
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Nursing and Midwifery, Griffith University, 68 University Dr, Meadowbrook, QLD 4131, Australia
| | - Deera K Creedy
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Nursing and Midwifery, Griffith University, 68 University Dr, Meadowbrook, QLD 4131, Australia
| | - Hazel Brittain
- Transforming Maternity Care Collaborative, 68 University Dr, Meadowbrook, QLD 4131, Australia.,School of Nursing and Midwifery, Griffith University, 68 University Dr, Meadowbrook, QLD 4131, Australia.,Women, Newborn and Children's, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
| |
Collapse
|