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Dey T, Shah MG, Baba A, Mugo N, Thommesen T, Vivilaki V, Boniol M, Alam N, Dibley M, Okoro D, Tenhoope-bender P, Triantafyllou T, Langlois EV. Reproductive, maternal, newborn, child and adolescent health services in humanitarian and fragile settings: A mixed methods study of midwives' and women's experiences. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003384. [PMID: 38959267 PMCID: PMC11221643 DOI: 10.1371/journal.pgph.0003384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/31/2024] [Indexed: 07/05/2024]
Abstract
Insufficient progress has been made to reduce morbidity and mortality for women, children and adolescents particularly in Humanitarian and Fragile settings (HFS). Midwives play a critical and unique role in ensuring communities receive quality and safe essential sexual, reproductive, maternal, newborn, child, and adolescent health services. A lack of knowledge exists on the availability and experiences of midwifery services in HFS. This manuscript provides an overview of the midwifery density in HFS and a synthesis of the experiences of women receiving midwifery care, and barriers and facilitators for midwives providing essential SRMNCAH services in HFS. Guided by an expert committee, a concurrent mixed methods approach was applied, using secondary analysis of primary quantitative and qualitative data sources. Quantitative analysis of the global distribution of midwives compared to fragility was undertaken. Qualitative analysis of experiences of receipt and provision of midwifery care was undertaken across four settings providing humanitarian care. There is a critically low density of midwives in humanitarian and fragile settings. Sub-Saharan Africa accounts for the highest levels of fragility yet lowest density of midwives able to provide SRMNCAH services. Lack of finances both constrains midwives from effectively providing services and prevent communities from utilising services. Sub-optimal working conditions through rising workloads, insufficient and/or inconsistent resources were frequently reported to impede midwives from providing care in HFS. Uniquely for HFS, threats to the safety and security of midwives to conduct their work was widely reported. Key facilitators identified included, complex adaptive health system designs to respond effectively to the rapidly changing HFS environment, realisation of supporting "power, agency and status" as instrumental for midwives to provide quality care and promotion of community-centric approaches may enable continuity of care and uptake of essential SRMNCAH services. Midwives are critical to protect the health and well-being of communities. They require urgent protection and prioritisation in HFS areas where the need is greatest.
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Affiliation(s)
- T. Dey
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | - M. G. Shah
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | - A. Baba
- Institut Panafricain de Santé Communautaire, Aru, Democratic Republic of Congo
| | - N. Mugo
- NSW Health, Priority population Unit, Integrated and community health, Cumberland Hospital, New South Wales, Sydney, Australia
| | - T. Thommesen
- Stavanger University Hospital, Stavanger, Norway
| | - V. Vivilaki
- International Confederation of Midwives (ICM), The Hague, The Netherlands
| | - M. Boniol
- World Health Organization (WHO), Geneva, Switzerland
| | - N. Alam
- University of Sydney, Sydney, Australia
| | - M. Dibley
- University of Sydney, Sydney, Australia
| | - D. Okoro
- United Nations Population Fund (UNFPA), New York, United States of America
| | - P. Tenhoope-bender
- United Nations Population Fund (UNFPA), New York, United States of America
| | | | - E. V. Langlois
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
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Weeks AD. Reducing maternal deaths from haemorrhage: Seeking the low-hanging fruit. BJOG 2024; 131:1025-1028. [PMID: 38177088 DOI: 10.1111/1471-0528.17753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Andrew D Weeks
- Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK
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Eikemo R, Barimani M, Nyman V, Jonas W, Vikström A. "Health challenges and midwifery support for new mothers after childbirth: A cross-sectional study in Sweden". Midwifery 2024; 134:104020. [PMID: 38692249 DOI: 10.1016/j.midw.2024.104020] [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: 11/12/2023] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE This study aimed to investigate new mothers' self-rated and perceived health problems and complications; their reasons for, and the frequency of, emergency department visits; how emergency department visits were associated with sociodemographic and obstetric factors; and new mothers' experiences of received support from the midwifery clinic. DESIGN A cross-sectional survey. SETTING AND PARTICIPANTS The study was conducted at 35 of 64 midwifery clinics in Stockholm, Sweden. The study population consisted of 580 new mothers. MEASUREMENT AND FINDINGS Descriptive statistics and logistic regression were used. New mothers experience a range of different health problems and complications during the first four weeks after giving birth. Sixteen percent sought emergency care. The odds of seeking emergency care increased for women with higher age and poorer self-rated health. Sixty-three percent of the new mothers received support from a midwife in primary care within the first four weeks after childbirth. Mothers who did not receive the support they wanted, expressed a wish for earlier contact and better accessibility. CONCLUSION AND IMPLICATION FOR PRACTICE It is notable that 16 % of new mothers seek emergency care in the first weeks after childbirth. This study has practical implications for midwifery practice and policy. There is a need for tailored postnatal support strategies so that midwives potentially are able to mitigate emergency department visits. Further studies should look at whether the high number of emergency visits among new mothers varies throughout Sweden, and whether this may be a result of reduced time of hospital stay after childbirth or other factors.
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Affiliation(s)
- Ragnhild Eikemo
- Academic Primary Care Centre, Region Stockholm, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | - Mia Barimani
- Academic Primary Care Centre, Region Stockholm, Sweden; Department of Medical and Health Sciences, Linköping University, Sweden
| | - Viola Nyman
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Wibke Jonas
- Departement of Women's and Children's Health, Karolinska institute, Stockholm, Sweden
| | - Anna Vikström
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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HakemZadeh F. Differential Relationships Between Work-Life Interface Constructs and Intention to Stay in or Leave the Profession: Evidence From Midwives in Canada. Psychol Rep 2024; 127:1381-1407. [PMID: 36240200 PMCID: PMC11067423 DOI: 10.1177/00332941221132994] [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] [Indexed: 11/16/2022]
Abstract
This paper investigates how positive and negative work-personal life interface constructs are differentially associated with intentions to stay in or leave the profession. The findings help map work-personal life interface constructs on the typology of determinants of intention to stay and intention to leave (disengagers, retainers, criticals, and neutrals). The ordered logistic regression (ologit) modelling of cross-sectional data from a representative sample (n = 601) of midwives in Canada shows that work interference with personal life is a disengager, which has a stronger association with intention to leave than with intention to stay in the profession. Among the work-personal life interface constructs, work enhancement of personal life seems to be the most critical determinant, showing the most substantive association with both intention to stay and intention to leave. This finding suggests that interventions to increase midwives' intention to stay and decrease their intention to leave should focus on amplifying the enhancing effects of working on midwives' personal lives. Interventions that aim to reduce work interference with personal life might be more effective in decreasing intention to leave the profession than increasing intention to stay.
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Affiliation(s)
- Farimah HakemZadeh
- School of Human Resources Management, York University, Toronto, ON, Canada
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Ganapathy D, Tzeli M, Vivilaki V. Midwives: Essential guardians in the climate crisis journey. Eur J Midwifery 2024; 8:EJM-8-22. [PMID: 38779537 PMCID: PMC11110073 DOI: 10.18332/ejm/188196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Deepti Ganapathy
- Centre for Management Communication, Indian Institute of Management, Bangalore, India
| | - Maria Tzeli
- Midwifery Department, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Victoria Vivilaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
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Zhu W, Zhu C, Min H, Li L, Wang X, Wu J, Zhu X, Gu C. Status of the midwifery workforce and childbirth services and the impact of midwife staffing on birth outcomes in China: a multicentre cross-sectional study. BMJ Open 2024; 14:e082527. [PMID: 38692722 PMCID: PMC11086407 DOI: 10.1136/bmjopen-2023-082527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/02/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE To investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes. DESIGN A descriptive, multicentre cross-sectional survey. SETTING Maternity hospitals from the eastern, central and western regions of China. PARTICIPANTS Stratified sampling of maternity hospitals between 1 July and 31 December 2021.The sample hospitals received a package of questionnaires, and the head midwives from the participating hospitals were invited to fill in the questionnaires. RESULTS A total of 180 hospitals were selected and investigated, staffed with 4159 midwives, 412 obstetric nurses and 1007 obstetricians at the labour and delivery units. The average efficiency index of annual midwifery services was 272 deliveries per midwife. In the sample hospitals, 44.9% of women had a caesarean delivery and 21.4% had an episiotomy. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery (adjusted β -0.032, 95% CI -0.115 to -0.012, p<0.05) and episiotomy (adjusted β -0.171, 95% CI -0.190 to -0.056, p<0.001). CONCLUSION The rates of childbirth interventions including the overall caesarean section in China and the episiotomy rate, especially in the central region, remain relatively high. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery and episiotomy, indicating that further investments in the midwifery workforce could produce better childbirth outcomes.
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Affiliation(s)
- Wenli Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
| | - Chunxiang Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hui Min
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Lingling Li
- Department of Gynecology and Obstetrics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jiangnan Wu
- Clinical Research Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xinli Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chunyi Gu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
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Patriksson K, Andersson O, Stierna F, Haglund K, Thies-Lagergren L. Midwives' Experiences of Intact Cord Resuscitation in Nonvigorous Neonates After Vaginal Birth in Sweden. J Obstet Gynecol Neonatal Nurs 2024; 53:255-263. [PMID: 38228286 DOI: 10.1016/j.jogn.2023.12.003] [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: 06/28/2023] [Revised: 12/06/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVE To describe midwives' experiences of intact cord resuscitation close to the mother for nonvigorous neonates after vaginal birth. DESIGN Descriptive qualitative. SETTING Four labor wards in Sweden. PARTICIPANTS Midwives (N = 13) currently or previously employed in labor wards where the Sustained Cord Circulation and Ventilation (SAVE) study was conducted. METHODS We analyzed semistructured interviews using reflexive thematic analysis. RESULTS Participants' experiences are presented in an overarching theme: Midwives balance knowledge with doing the right thing in a challenging work environment during intact cord resuscitation. Three primary themes emerged: A New Workflow, Zero Separation: The Big Advantage, and The Midwife: Guardian of Childbirth. CONCLUSION The participants were keen to keep the umbilical cord intact even for nonvigorous neonates. They wanted to work with the neonate close to the mother to facilitate zero separation and family participation. Ventilation with an intact umbilical cord was considered a routine to be implemented in the future, but the participants identified certain difficulties with the design of the SAVE study.
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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.
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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
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Cheney K, Mignacca E, Black KI, Homer C, Bradfield Z. An exploration of the contraceptive counselling practices of midwives who provide postpartum care in Australia. Midwifery 2024; 131:103948. [PMID: 38335692 DOI: 10.1016/j.midw.2024.103948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/13/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE We sought to explore and describe midwives' attitudes and practices relating to their provision of postpartum contraception counselling. DESIGN We used an exploratory cross-sectional design. Recruitment used an anonymous online survey using electronic communication platforms of professional, and special-interest organisations, over six months . Descriptive and quantitative analysis was used. SETTING AND PARTICIPANTS Australian Midwives who provide postpartum care. MEANING AND FINDINGS A total of 289 complete responses were included. Findings from this national survey of midwives showed that almost 75% of Australian midwives reported providing some contraceptive advice to women. Those working in continuity of care models were significantly more likely to fulfil this responsibility. More than half (67%) indicated they had not received any formal contraception education or training. Those working in private obstetric-led settings were significantly less likely to have received education compared to midwives in community settings. Systems barriers preventing the provision of contraceptive counselling included: clinical workload; lack of management support; lack of education; and models of care. KEY CONCLUSIONS Most midwives (82%) wanted to provide postpartum contraception counselling as part of their role. They cited barriers from within the health system, ambiguity about roles and responsibilities and offered solutions to improve the provision of postnatal contraception counselling. IMPLICATIONS FOR PRACTICE Recommendations include the development of education programs for midwives. Continuity of care models provided the time, autonomy and opportunity for midwives to undertake contraceptive counselling and fulfil this part of their professional scope. Consideration should be given to expanding access and provision of continuity of midwifery care. An urgent investment in the education and skills of midwives is recommended to ensure all women across acute and community services benefit from improved outcomes associated with pregnancy spacing.
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Affiliation(s)
- Kate Cheney
- The Sydney School of Nursing and Midwifery, Faculty of Medicine and Health, Susan Wakil Health Building, The University of Sydney, NSW 2006, Australia.
| | - Emily Mignacca
- School of Nursing, Midwifery, Oral Health Therapy, Paramedicine, Faculty of Health Science, Curtin University Perth, WA 6102, Australia
| | - Kirsten I Black
- The Sydney Medical School, Faculty of Medicine and Health, Susan Wakil Health Building, The University of Sydney, NSW 2006, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health, Burnet Institute, Melbourne 3004, Australia
| | - Zoe Bradfield
- School of Nursing, Midwifery, Oral Health Therapy, Paramedicine, Faculty of Health Science, Curtin University Perth, WA 6102, Australia
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Alspaugh A, Blumenfeld J, Wright LV, Recalde S, Lindberg LD. "You and Me Do It for the Love of Teaching": Exploring the Expansion of Clinical Training Opportunities for Midwives. J Perinat Neonatal Nurs 2024; 38:147-157. [PMID: 38758271 DOI: 10.1097/jpn.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
PURPOSE To better understand the barriers and facilitators to precepting midwifery students from across the healthcare ecosystem in New Jersey. BACKGROUND Growing the midwifery workforce is a crucial step to alleviating disparately poor perinatal health outcomes and expanding access to care. Difficulty recruiting and retaining preceptors has been identified as a barrier to graduating more midwives. METHODS In-depth qualitative interviews were conducted with 19 individuals involved in different stages of the clinical training process: midwives, physicians, and administrators. Transcripts were coded using the tenets of qualitative description and thematic analysis. Analysis was guided by the Promoting Action on Research Implementation in Health Services framework. RESULTS The following themes were identified and organized within the domains identified by our conceptual framework. Evidence: (mis)understanding the benefits of midwifery care and impacts on patient care. Context: the time and energy it takes to precept and practice considerations. Facilitations: developing the next generation of healthcare providers and the quiet and ever-present role of money in healthcare. CONCLUSIONS Findings from this study support the importance of approaching midwifery precepting as a multifaceted endeavor, one that necessitates the full support of individuals within many different roles in an organization. IMPLICATIONS FOR PRACTICE AND RESEARCH Getting buy-in from various levels of the healthcare ecosystem requires a flexible approach but must include a targeted effort toward showing the value of midwifery care in terms of patient outcomes, satisfaction, and cost.
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Affiliation(s)
- Amy Alspaugh
- Author Affiliations: College of Nursing, University of Tennessee, Knoxville, Tennessee (Dr Alspaugh); Midwifery Program, Division of Advanced Nursing Practice, School of Nursing, Rutgers, The State University of New Jersey, Newark (Dr Blumenfeld); School of Public Health, Rutgers, School of Public Health, The State University of New Jersey, Newark (Ms Wright and Dr Lindberg)
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Luo H, Gong H, Luo F, Xing Y, Wang X, Huang J, Ding M, Lin D, Lan Y. Core competence of midwives in township hospitals and its influencing factors-A cross-sectional study. Heliyon 2024; 10:e25475. [PMID: 38327397 PMCID: PMC10848002 DOI: 10.1016/j.heliyon.2024.e25475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
Objective This study aimed to assess the core competence of midwives in township hospitals through a self-assessment questionnaire. The relationship between professional identity and core competence and the factors influencing midwives' core competence was also investigated. Method Convenience sampling was conducted in 77 township hospitals in Ganzhou, Jiangxi Province, China, with 150 participants. The questionnaires were distributed online in November 2021. We conducted a descriptive data analysis, a correlation analysis of the two variables of professional identity and core competencies, and multivariate linear regression to analyse the influencing factors, including the sociodemographic information, the Midwife Core Competence Scale, and the Nurses' Professional Identity Scale scores. Results The mean score for the core competence was 206.43 (±37.45) out of 270. The highest score was for pregnancy care (3.97 ± 0.70) and the lowest was for newborn care (3.72 ± 0.78). The independent sample t-test results and one-way analysis of variance showed that qualifications, midwifery training situation, and midwifery working years had differential effects on midwives' core competencies (P < 0.05). Multiple linear regression showed that qualifications, midwifery working years, and level of professional identity were influencing factors (P < 0.05). Conclusions The core competencies of midwives in township hospitals were lower than those reported in other studies. Advancements in education, midwifery working years, and professional identity may increase midwives' core competencies.
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Affiliation(s)
- Huiyi Luo
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huping Gong
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Feng Luo
- Department of Obstetrics, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Ying Xing
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xin Wang
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Jingwen Huang
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Mei Ding
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Dongmei Lin
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yanli Lan
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
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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.
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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
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Kubota S, Ando M, Murray J, Khambounheuang S, Theppanya K, Nanthavong P, Tengbriacheu C, Sisavanh M, Khattiyod T, Asai D, Sobel H, Jimba M. A regulatory gap analysis of midwifery to deliver essential reproductive, maternal, newborn, child and adolescent health services in Lao People's Democratic Republic. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100960. [PMID: 38146489 PMCID: PMC10749282 DOI: 10.1016/j.lanwpc.2023.100960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/15/2023] [Accepted: 10/22/2023] [Indexed: 12/27/2023]
Abstract
Background In Lao Peoples Democratic Republic, midwives are the main providers of primary reproductive, maternal, newborn, child and adolescent (RMNCAH) services. We analyzed to what extent practice regulations allow midwives to provide nationally defined essential RMNCAH services. Methods Stakeholder consultations and document reviews were conducted to identify the essential RMNCAH interventions and care tasks midwives are expected to provide without physicians. These were defined in: 1) the Essential Health Service Package (EHSP) and 2) 18 national standards and guidelines. We then mapped whether midwifery regulations, which provide the legal framework for clinical service provision, supported delivery of these standards to identify regulatory gaps. Data were used to update regulations. Findings Midwives were expected to provide 39 RMNCAH interventions without physicians, representing 1100 care tasks. Midwifery practice regulations allowed eight of 39 interventions (20.5%) and 705 of 1100 care tasks (64.1%) at baseline. Of the 31 interventions not allowed for provision by midwives, 83.9% (26) required prescribing and giving medicines, 51.6% (16) ordering and conducting diagnostics, 38.7% (12) making a clinical diagnosis, and 22.6% (7) use of non-pharmacological interventions. The Ministry of Health convened a multi-stakeholder group to revise the midwifery practice regulations, which increased the legally supported interventions and care tasks to 37 (94.9%) and 1081 (98.3%), respectively. Interpretation This novel methodology enabled systematic identification and quantification of regulatory gaps in midwifery practice and data-driven revisions. Consequently, regulatory support for delivery of primary RMNCAH interventions vastly improved. The approach can be applied to other clinical cadres, service areas and countries. Funding Korea Foundation for International Health Care (KOFIH) supported research operation.
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Affiliation(s)
| | | | - John Murray
- WHO Western Pacific Region, Manilla, Philippines
| | | | | | | | - Chankham Tengbriacheu
- National Mother and Child Health Center, Department of Hygiene and Health Promotion, Ministry of Health, Vientiane, Lao PDR
| | | | | | | | - Howard Sobel
- WHO Western Pacific Region, Manilla, Philippines
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Matthews RP, Hyde RL, McLachlan HL, Llewelyn F, Forster DA. Midwifery workforce challenges in Victoria, Australia. A cross-sectional study of maternity managers. Women Birth 2024; 37:144-152. [PMID: 37553273 DOI: 10.1016/j.wombi.2023.07.130] [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: 03/21/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND In Australia, there is a lack of accurate data on midwifery workforce staffing and skill mix, which in turn hinders workforce policy and planning. AIM To describe the current staffing levels of the midwifery workforce in Victoria, Australia, explore workforce challenges and assess the impact of COVID-19 pandemic on staffing. DESIGN Cross-sectional. METHODS Midwifery managers in all public and private maternity services in Victoria, Australia were invited to complete a survey exploring midwifery staffing numbers and adequacy. Topics explored included midwifery turnover, recruitment, and skill mix. Descriptive statistics were used. FINDINGS The survey was open March to October 2021, and 56 % (38/68) of managers responded. Of these, 76 % reported inadequate midwifery staff levels, with deficits ranging from one to 19 estimated Full-Time Equivalent (EFT) midwives, with a combined total deficit of 135 EFT. In the 12 months prior to the survey, 73 % of services had found it difficult to recruit midwives, with increased difficulty during the COVID-19 pandemic. Managers were concerned about retaining and recruiting 'experienced' midwives due to an ageing workforce and high turnover due to work/life imbalance and job dissatisfaction. These issues have led to a predominantly early career midwifery workforce and created concern about skill mix. CONCLUSION Victorian maternity services have a midwifery workforce shortage and are experiencing significant skill mix issues. The pandemic has exacerbated these considerable gaps in the workforce. Urgent implementation of retention and recruitment schemes are needed, along with strategies to improve the working conditions for the current workforce.
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Affiliation(s)
- Robyn P Matthews
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia.
| | - Rebecca L Hyde
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Fleur Llewelyn
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
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15
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Tallhage S, Årestedt K, Schildmeijer K, Oscarsson M. Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: A Swedish nationwide register study. Acta Obstet Gynecol Scand 2024; 103:304-312. [PMID: 37969005 PMCID: PMC10823388 DOI: 10.1111/aogs.14717] [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: 06/22/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Umbilical cord prolapse (UCP) is a rare but severe obstetric complication in the presence of a rupture of the membranes. Although it is not possible to prevent a spontaneous rupture of the membranes (SROM), it is possible to prevent an amniotomy, which is a commonly used intervention in labor. This study aimed to explore the incidence and risk factors that are associated with UCP in labor when amniotomy is used vs SROM. MATERIAL AND METHODS A retrospective nationwide register study was conducted of all births in Sweden from January 2014 to June 2020 that were included in the Swedish Pregnancy Register (n = 717 336). The main outcome, UCP, was identified in the data by the International Classification of Diseases (ICD-10) diagnosis code O69.0. Multiple binary logistic regression analysis was used to identify the risk factors. RESULTS Amniotomy was performed in 230 699 (43.6%) of all pregnancies. A UCP occurred in 293 (0.13%) of these cases. SROM occurred in 298 192 (56.4%) of all cases, of which 352 (0.12%) were complicated by UCP. Risk factors that increased the odds of UCP for both amniotomy and SROM were: higher parity, non-cephalic presentation and an induction of labor. Greater gestational age reduced the odds of UCP. Risk factors associated with only amniotomy were previous cesarean section and the presence of polyhydramnios. Identified risk factors for UCP in labor with SROM were a higher maternal age and maternal origin outside of the EU. CONCLUSIONS UCP is a rare complication in Sweden. Beyond confirming the previously recognized risk factors, this study found induction of labor and previous cesarean section to be risk factors in labor when amniotomy is used.
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Affiliation(s)
- Sofia Tallhage
- Faculty of Health and Life SciencesLinnaeus UniversityKalmarSweden
- Department of Obstetrics and GynecologyRegion Kalmar CountyKalmarSweden
| | - Kristofer Årestedt
- Faculty of Health and Life SciencesLinnaeus UniversityKalmarSweden
- Department of ResearchRegion Kalmar CountyKalmarSweden
| | | | - Marie Oscarsson
- Faculty of Health and Life SciencesLinnaeus UniversityKalmarSweden
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Griffin G, Bradfield Z, Than KK, Smith R, Tanimizu A, Raina N, Homer CSE. Strengthening midwifery in the South-East Asian region: A scoping review of midwifery-related research. PLoS One 2023; 18:e0294294. [PMID: 38100488 PMCID: PMC10723687 DOI: 10.1371/journal.pone.0294294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/29/2023] [Indexed: 12/17/2023] Open
Abstract
Improving sexual, reproductive, maternal, newborn, and adolescent health outcomes necessitates greater commitment to, and investments in, midwifery. To identify future research priorities to advance and strengthen midwifery, we conducted a scoping review to synthesise and report areas of midwifery that have been explored in the previous 10 years in the 11 countries of the World Health Organization's South-East Asia region. Electronic peer-reviewed databases were searched for primary peer-reviewed research published in any language, published between January 2012 and December 2022 inclusive. A total of 7086 citations were screened against the review inclusion criteria. After screening and full text review, 195 sources were included. There were 94 quantitative (48.2%), 67 qualitative (34.4%) and 31 mixed methods (15.9%) studies. The majority were from Indonesia (n = 93, 47.7%), India (n = 41, 21.0%) and Bangladesh (n = 26, 13.3%). There were no sources identified from the Democratic People's Republic of Korea or the Maldives. We mapped the findings against six priority areas adapted from the 2021 State of the World's Midwifery Report and Regional Strategic Directions for Strengthening Midwifery in the South-East Asia region (2020-2024): practice or service delivery (n = 73, 37.4%), pre-service education (n = 60, 30.8%), in-service education or continuing professional development (n = 51, 26.2%), workforce management (n = 46, 23.6%), governance and regulation (n = 21, 10.8%) and leadership (n = 12, 6.2%). Most were published by authors with affiliations from the country where the research was conducted. The volume of published midwifery research reflects country-specific investment in developing a midwifery workforce, and the transition to midwifery-led care. There was variation between countries in how midwife was defined, education pathways, professional regulation, education accreditation, governance models and scope of practice. Further evaluation of the return on investment in midwifery education, regulation, deployment and retention to support strategic decision-making is recommended. Key elements of leadership requiring further exploration included career pathways, education and development needs and regulatory frameworks to support and embed effective midwifery leadership at all levels of health service governance.
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Affiliation(s)
- Georgia Griffin
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Zoe Bradfield
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Kyu Kyu Than
- Burnet Myanmar Program, Burnet Institute, Yangon, Myanmar
| | - Rachel Smith
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Ai Tanimizu
- Family and Gender through the Life Course, South-East Asia Regional Office, World Health Organization, New Delhi, India
| | - Neena Raina
- Family and Gender through the Life Course, South-East Asia Regional Office, World Health Organization, New Delhi, India
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
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Noghanibehambari H, Fletcher J. Long-Term Health Benefits of Occupational Licensing: Evidence from Midwifery Laws. JOURNAL OF HEALTH ECONOMICS 2023; 92:102807. [PMID: 37722296 PMCID: PMC10841694 DOI: 10.1016/j.jhealeco.2023.102807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/19/2023] [Accepted: 09/03/2023] [Indexed: 09/20/2023]
Abstract
During the late 19th and early 20th century, several states mandated midwifery licensing requirements to improve midwives' knowledge, education, and quality. Previous studies point to the health benefits of midwifery quality improvements for maternal and infant health outcomes. This paper exploits the staggered adoption of midwifery laws across states using event-study and difference-in-difference frameworks. We use the universe of death records in the US over the years 1979-2020 and find that exposure to a midwifery licensing law at birth is associated with a 2.5 percent reduction in cumulative mortality rates and an increase of 0.6 months in longevity during adulthood and old age. The effects are concentrated on deaths due to infectious diseases, neoplasm diseases, and suicide mortality. We also show that the impacts are confined among blacks and are slightly larger among males. Additional analyses using alternative data sources suggest small but significant increases in educational attainments, income, measures of socioeconomic status, employment, and measures of height as potential mechanism channels. We provide a discussion on the economic magnitude and policy implication of the results.
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Affiliation(s)
- Hamid Noghanibehambari
- College of Business, Austin Peay State University, Marion St, Clarksville, TN 37040, USA.
| | - Jason Fletcher
- La Follette School of Public Affairs, University of Wisconsin-Madison, 1225 Observatory Drive, Madison, WI 53706-1211, USA.
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Thaels E, Meermans H, Beeckman K. What influences women's experiences of childbirth in Flanders? - A quantitative cross-sectional analysis of the Babies Born Better survey. Midwifery 2023; 126:103810. [PMID: 37690313 DOI: 10.1016/j.midw.2023.103810] [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: 03/10/2022] [Revised: 07/06/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Labour and birth experiences are of great importance since these can have positive, but also negative effects on women's health and wellbeing. This is the first study, which investigated the factors that influence women's experiences of childbirth in Flanders, Belgium. DESIGN A cross-sectional quantitative analysis was used to examine primary data obtained by the Babies Born Better project. Data collection took place via an online survey from April 2018 until August 2018 in Flanders. PARTICIPANTS 1414 women that gave birth across all birth settings between 2013 and 2018, who speak Flemish/Dutch were included. Participants were self-selected by filling out the Babies Born Better survey in 2018. FINDINGS The majority of the Flemish women included in this study reported a positive labour and birth experience. Analysis of the demographic variables showed that women who were single or not co-habiting reported a worse experience of labour and birth (P = 0.012). All obstetric factors included showed significant differences (P<0.01). Lastly, women were more likely to report a better experience when birth took place at home or in a midwifery unit and when the main care provider was a midwife (P<0.01). When controlled for significant variables from the univariate analysis, an impact on the birth experience was only found with the obstetric factors. A preterm (OR 0.544, 95%CI 0.362-0.817) and post term birth (OR 0.664, 95% CI 0.462-0.953) were found to reduce the chance of a good experience compared to a birth at term. In case of complications during pregnancy, women were less likely to report having had a good experience (OR 0.632, 95% CI 0.470 - 0.849). Medical interventions such as induction- (OR 0.346, 95% CI 0.241 - 0.497) and augmentation of labour (OR 0.318, 95% CI 0.218-0.463), an instrumental birth (OR 0.318, 95% CI 0.218-0.463) or a planned- (OR 0.349, 95% CI 0.205-0.596) or emergency caesarean section (OR 0.190, 95% CI 0.109-0.329) reduced the chances of women reporting to have had a good experience with care around labour and birth. KEY CONCLUSIONS The majority of women included in this study reported a good experience of care during labour and at birth. Certain obstetric factors such as having a straightforward pregnancy without complications, a physiological onset of labour at term without the need for augmentation and to give birth vaginally (without instrument) have shown a positive impact on women's reported birth experiences. IMPLICATIONS FOR PRACTICE Women's involvement in decision-making, especially when medical interventions are wanted or needed can improve positive birth experiences. More research is needed on how to support women and empower them, even more so in case of complications to ensure a sense of control and achievement.
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Affiliation(s)
- Ellen Thaels
- Faculty of Health & Wellbeing, School of Community Health & Midwifery, University of Central Lancashire, Fylde Rd, Preston, England PR1 2HE, UK.
| | - Hanne Meermans
- Verpleeg- en Vroedkunde, Centre for Research and Innovation in Care, Midwifery Research Education and Policymaking (MIDREP), Universiteit Antwerpen, Prinsstraat 13, Antwerp 2000, Belgium
| | - Katrien Beeckman
- Verpleeg- en Vroedkunde, Centre for Research and Innovation in Care, Midwifery Research Education and Policymaking (MIDREP), Universiteit Antwerpen, Prinsstraat 13, Antwerp 2000, Belgium; Faculty of Medicine and Pharmacy, Public Health, Nursing and Midwifery Research Unit, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels 1090, Belgium
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19
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Smith RM, Calvert B, Kata E, Hataogo S, Ioane TR, Tarabo M, Kiritome M, Abraham J, Lees T, Devi C, Ross L, Mafi LL, Tuitupou T, Blackburn K, Homer CS. Midwifery education in Pacific Island countries: A discussion paper. Women Birth 2023; 36:e605-e612. [PMID: 37263877 DOI: 10.1016/j.wombi.2023.05.008] [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: 03/18/2023] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The aim for 95% maternal health care coverage and zero-unmet need for family planning in Pacific Island countries by 2030 could be achieved by strengthening the midwifery workforce. To enable health services to provide accessible, locally acceptable, and high-quality care, the midwifery workforce must be regulated and educated to global standards and supported to practice in enabling environments. In 2019, around 64,000 live births occurred in Pacific Island countries, yet information regarding the state the midwifery workforce and midwifery education is limited. AIM Using data from recent reports and country case studies, this paper provides an overview of the current midwifery education situation in Pacific Island countries and discusses strategic directions for strengthening quality midwifery education and therefore quality midwifery care provision in Pacific Island countries. DISCUSSION Six Pacific Island countries have midwifery curricula, all post-nursing programs, although few offer midwifery education programs on a regular annual basis. Current programs do not meet ICM Global Standards for Midwifery Education. Critical areas for strengthening include making underpinning philosophical frameworks, the vision for midwifery education, and program intended learning outcomes explicit in curricula documents and ensuring integration of these in program implementation. Fortunately, five of six midwifery education programs are under processes of renewal and strengthening against global, regional, and national standards. CONCLUSION Strengthening the midwifery workforce in the Pacific to meet maternal and newborn health targets can be achieved through supporting the existing midwifery education programs to meet global standards. Strengthened midwifery education programs in Pacific Island countries offer an opportunity to meet each country's maternal and newborn health targets.
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Affiliation(s)
| | | | | | | | | | - Monica Tarabo
- School of Midwifery, Kiribati Institute of Technology, Kiribati
| | - Maile Kiritome
- School of Midwifery, Kiribati Institute of Technology, Kiribati
| | | | | | - Clara Devi
- Solomon Islands National University, Solomon Islands
| | - Leila Ross
- Solomon Islands National University, Solomon Islands
| | | | - Telesia Tuitupou
- Queen Salote Institute of Nursing and Allied Health, Kingdom of Tonga
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Kawish AB, Umer MF, Arshed M, Khan SA, Hafeez A, Waqar S. Respectful Maternal Care Experience in Low- and Middle-Income Countries: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1842. [PMID: 37893560 PMCID: PMC10608623 DOI: 10.3390/medicina59101842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Respectful maternity care promotes practices that acknowledge women's preferences and women and newborns' needs. It is an individual-centered strategy founded on ethical and human rights principles. The objective of this systematic review is to identify the impact of income on maternal care and respectful maternity care in low- and middle-income countries. Materials and Methods: Data were searched from Google Scholar, PubMed, Web of Science, NCBI, CINAHL, National Library of Medicine, ResearchGate, MEDLINE, EMBASE database, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Maternity and Infant Care database. This review followed PRISMA guidelines. The initial search for publications comparing low- and middle-income countries with respectful maternity care yielded 6000 papers, from which 700 were selected. The review articles were further analyzed to ensure they were pertinent to the comparative impact of income on maternal care. A total of 24 articles were included, with preference given to those published from 2010 to 2023 during the last fourteen years. Results: Considering this study's findings, respectful maternity care is a crucial component of high-quality care and human rights. It can be estimated that there is a direct association between income and maternity care in LMICs, and maternity care is substandard compared to high-income countries. Moreover, it is determined that the evidence for medical tools that can enhance respectful maternity care is sparse. Conclusions: This review highlights the significance of improving maternal care experiences, emphasizing the importance of promoting respectful practices and addressing disparities in low- and middle-income countries.
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Affiliation(s)
- Ayesha Babar Kawish
- Alshifa School of Public Health, AlShifa Trust, Rawalpindi 46200, Pakistan; (A.B.K.); (S.W.)
| | - Muhammad Farooq Umer
- Department of Preventive Dental Sciences, College of Dentistry, King Faisal University, Hofuf 31982, Saudi Arabia
| | - Muhammad Arshed
- University Institute of Public Health, Faculty of Allied Health Sciences, University of Lahore, Near Bhuptian Chowk, Lahore 54590, Pakistan;
| | - Shahzad Ali Khan
- Office of the Vice Chancellor, Health Services Academy University, Chak Shahzad, Islamabad 44000, Pakistan;
| | - Assad Hafeez
- Country Representative World Health Organization (WHO), Salmiya 20001, Kuwait;
| | - Saman Waqar
- Alshifa School of Public Health, AlShifa Trust, Rawalpindi 46200, Pakistan; (A.B.K.); (S.W.)
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21
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Anderson R, Zaman SB, Jimmy AN, Read JM, Limmer M. Strengthening quality in sexual, reproductive, maternal, and newborn health systems in low- and middle-income countries through midwives and facility mentoring: an integrative review. BMC Pregnancy Childbirth 2023; 23:712. [PMID: 37798690 PMCID: PMC10552246 DOI: 10.1186/s12884-023-06027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND There is an urgent global call for health systems to strengthen access to quality sexual, reproductive, maternal, newborn and adolescent health, particularly for the most vulnerable. Professional midwives with enabling environments are identified as an important solution. However, a multitude of barriers prevent midwives from fully realizing their potential. Effective interventions to address known barriers and enable midwives and quality sexual, reproductive, maternal, newborn and adolescent health are less well known. This review intends to evaluate the literature on (1) introducing midwives in low- and middle-income countries, and (2) on mentoring as a facilitator to enable midwives and those in midwifery roles to improve sexual, reproductive, maternal, newborn and adolescent health service quality within health systems. METHODS An integrative systematic literature review was conducted, guided by the Population, Intervention, Comparison, Outcome framework. Articles were reviewed for quality and relevance using the Gough weight-of-evidence framework and themes were identified. A master table categorized articles by Gough score, methodology, country of focus, topic areas, themes, classification of midwives, and mentorship model. The World Health Organization health systems building block framework was applied for data extraction and analysis. RESULTS Fifty-three articles were included: 13 were rated as high, 36 as medium, and four as low according to the Gough criteria. Studies that focused on midwives primarily highlighted human resources, governance, and service delivery while those focused on mentoring were more likely to highlight quality services, lifesaving commodities, and health information systems. Midwives whose pre-service education met global standards were found to have more efficacy. The most effective mentoring packages were comprehensive, integrated into existing systems, and involved managers. CONCLUSIONS Effectively changing sexual, reproductive, maternal, newborn and adolescent health systems is complex. Globally standard midwives and a comprehensive mentoring package show effectiveness in improving service quality and utilization. TRIAL REGISTRATION The protocol is registered in PROSPERO (CRD42022367657).
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Affiliation(s)
- Rondi Anderson
- The Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Sojib Bin Zaman
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia, USA
| | - Abdun Naqib Jimmy
- Environmental Science Department, Jahangirnagar University, Dhaka, Bangladesh
| | - Jonathan M Read
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Mark Limmer
- The Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Mola M, Arefeyine M, Abegaz Z, Kebede N. Birth preparedness, complication readiness, and associated factors among pregnant women in South Wollo Zone, Northeast Ethiopia. AJOG GLOBAL REPORTS 2023; 3:100255. [PMID: 37593687 PMCID: PMC10430576 DOI: 10.1016/j.xagr.2023.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Birth preparedness and complication readiness is a preparation strategy for normal birth and potential emergency situations, and is important for the safety and health of mothers and newborns during pregnancy, childbirth, and the postpartum period. OBJECTIVE This study aimed to assess the prevalence of birth preparedness and complication readiness and the associated factors among pregnant women. STUDY DESIGN This was a community-based, cross-sectional study conducted among randomly selected 480 pregnant women from February to April of 2020. Bivariable logistic regression was performed to assess the association of each independent variable with the dependent variable. All variables with a P value of <.2 were entered into a multivariable logistic regression model to identify associated factors. Adjusted odds ratios with 95% confidence intervals were estimated to measure the strength of the association. RESULTS Out of the 498 sampled pregnant women, 480 (96.4%) agreed to participate in the study; 104 were found to have satisfactory birth preparedness and complication readiness (21.7%; 95% confidence interval, 18.3-25.7). Having had an experience of obstetrical complications (adjusted odds ratio, 1.83; 95% confidence interval, 1.07-3.14), early starting time for antenatal care visits (adjusted odds ratio, 5.22; 95% confidence interval, 2.26-12.06), advice about birth preparedness (adjusted odds ratio, 2.99; 95% confidence interval, 1.21-7.39), and awareness about obstetrical danger signs during childbirth and the postpartum period (adjusted odds ratio, 2.23; 95% confidence interval, 1.33-3.74) were found to be significantly associated with birth preparedness and complication readiness. CONCLUSION The prevalence of birth preparedness and complication readiness was low. Experience of obstetrical complications, starting time for antenatal care visits, advice about birth preparedness and complication readiness, and awareness of key danger signs during childbirth and the postpartum period were significantly associated with birth preparedness and complication readiness.
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Affiliation(s)
- Meseret Mola
- Department of Reproductive and Family Health, Kemissie General Hospital, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia (XX Mola)
| | - Mastewal Arefeyine
- Department of Public Health Officer, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia (XX Abegaz and XX Arefeyine)
| | - Zinet Abegaz
- Department of Public Health Officer, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia (XX Abegaz and XX Arefeyine)
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia (XX Kebede)
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Moridi A, Abedi P, Iravani M, Khosravi S, Alianmoghaddam N, Maraghi E, Saadati N. Experiences of health providers regarding implementation of the physiologic birth program in Iran: A qualitative content analysis. PLoS One 2023; 18:e0283022. [PMID: 37390105 PMCID: PMC10313046 DOI: 10.1371/journal.pone.0283022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/28/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION The rate of cesarean section is on the rise in both developed and developing countries, and Iran is no exception. According to the WHO, physiologic labor is one of the main strategies for reducing cesarean section and improving the health of mothers and newborns. The aim of this qualitative study was to explain the experiences of health providers regarding implementation of the physiologic birth program in Iran. METHODS This study is a part of a mixed-methods study, in which 22 health providers were interviewed from January 2022 to June 2022. Data analysis was performed using Graneheim and Lundman's conventional content analysis approach and using MAXQDA10 software. RESULTS Two main categories and nine subcategories emerged from the results of this study. The main categories included "the obstacles to the implementation of the physiologic birth program" and "strategies for improving implementation of the program". The subcategories of the first category included: lack of continuous midwifery care in the healthcare system, lack of free accompanying midwives, lack of integrated healthcare and hospitals in service provision, low quality of childbirth preparation and implementation of physiologic birth classes, and lack of requirements for the implementation of physiologic birth in the maternity ward. The second category included the following subcategories: Supervising the implementation of childbirth preparation classes and physiologic childbirth, support of midwives by insurance companies, holding training courses on physiologic birth, and evaluation of program implementation. CONCLUSIONS The experiences of the health providers with the physiologic birth program revealed that policymakers should provide the ground for the implementation of this type of labor by removing the obstacles and providing the particular operational strategies needed in Iran. Important measures that can contribute to the implementation of the physiologic labor program in Iran include the following: Setting the stage for physiologic birth in the healthcare system, creating low- and high-risk wards in maternity hospitals, providing professional autonomy for midwifery, training childbirth providers on physiologic birth, monitoring the quality of program implementation, and providing insurance support for midwifery services.
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Affiliation(s)
- Azam Moridi
- Department of Midwifery, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Abedi
- Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Iravani
- Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shala Khosravi
- Department of Community Medicine, Faculty Member of Medicine School, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Elham Maraghi
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmieh Saadati
- Obstetrics and Gynecology, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Anderson R, Zaman SB, Limmer M. The Impact of Introducing Midwives and also Mentoring on the Quality of Sexual, Reproductive, Maternal, Newborn, and Adolescent Health Services in Low- and Middle-Income Countries: An Integrative Review Protocol. Methods Protoc 2023; 6:mps6030048. [PMID: 37218908 DOI: 10.3390/mps6030048] [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: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Midwives have the potential to significantly contribute to health-delivery systems by providing sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) care. However, scant research finds barriers to understanding what midwives need to realize their full potential. There are gaps in the definition of a midwife and an understanding of effective means to support the implementation of midwifery care. Mentorship has been found to support systems and healthcare providers to improve care availability and quality. OBJECTIVES We describe the methodology of an integrative review that aims to generate evidence of the impact of introducing midwives and also on-site facility mentoring to better understand facilitators and barriers to implementation of the quality and availability of SRMNAH services in low- and middle-income countries (LMICs). METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used to carry out the integrative review. Four electronic bibliographic databases, PubMed MEDLINE, EMBASE, Scopus, and CINAHL, will be used to identify eligible studies. All types of qualitative or quantitative studies will be considered. Eligible studies will be screened according to Population, Intervention, Comparison, and Outcome (PICO) inclusion criteria, and data will be extracted against a predetermined format. The aspects of health system strengthening in providing improved SRMNCH care will be examined in this review to generate evidence on how midwives and mentorship can improve routine care and health outcomes using the World Health Organization's Six Building Blocks approach. The quality of the articles will be thematically analyzed in four areas: coherence and integrity, appropriateness for answering the question, relevance and focus, and overall assessment using the Gough weight-of-evidence framework. EXPECTED RESULTS The literature review will consider assessing both upstream health systems regulators and downstream effectors for implementing midwifery interventions. Within this building block framework, this research will report on the outcomes and experiences of introducing midwives and the effectiveness of mentoring midwives and other staff in midwives' roles in improving care quality and health outcomes.
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Affiliation(s)
- Rondi Anderson
- The Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne 3800, Australia
| | - Mark Limmer
- Centre for Health Inequalities Research, Division of Health Research, Lancaster University, Lancaster LA1 4YW, UK
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Niles PM, Baumont M, Malhotra N, Stoll K, Strauss N, Lyndon A, Vedam S. Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter? Reprod Health 2023; 20:67. [PMID: 37127624 PMCID: PMC10152585 DOI: 10.1186/s12978-023-01584-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/16/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Analyses of factors that determine quality of perinatal care consistently rely on clinical markers, while failing to assess experiential outcomes. Understanding how model of care and birth setting influence experiences of respect, autonomy, and decision making, is essential for comprehensive assessment of quality. METHODS We examined responses (n = 1771) to an online cross-sectional national survey capturing experiences of perinatal care in the United States. We used validated patient-oriented measures and scales to assess four domains of experience: (1) decision-making, (2) respect, (3) mistreatment, and (4) time spent during visits. We categorized the provider type and birth setting into three groups: midwife at community birth, midwife at hospital-birth, and physician at hospital-birth. For each group, we used multivariate logistic regression, adjusted for demographic and clinical characteristics, to estimate the odds of experiential outcomes in all the four domains. RESULTS Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy (aOR: 5.22, 95% CI: 3.65-7.45), higher respect (aOR: 5.39, 95% CI: 3.72-7.82) and lower odds of mistreatment (aOR: 0.16, 95% CI: 0.10-0.26). We found significant differences across birth settings: participants cared for by midwives in the community settings had significantly better experiential outcomes than those in the hospital settings: high- autonomy (aOR: 2.97, 95% CI: 2.66-4.27), respect (aOR: 4.15, 95% CI: 2.81-6.14), mistreatment (aOR: 0.20, 95% CI: 0.11-0.34), time spent (aOR: 8.06, 95% CI: 4.26-15.28). CONCLUSION Participants reported better experiential outcomes when cared for by midwives than by physicians. And for those receiving midwifery care, the quality of experiential outcomes was significantly higher in community settings than in hospital settings. Care settings matter and structures of hospital-based care may impair implementation of the person-centered midwifery care model.
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Affiliation(s)
- P. Mimi Niles
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Monique Baumont
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Nisha Malhotra
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Nan Strauss
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Audrey Lyndon
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Saraswathi Vedam
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
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Combellick JL, Telfer ML, Ibrahim BB, Novick G, Morelli EM, James-Conterelli S, Kennedy HP. Midwifery care during labor and birth in the United States. Am J Obstet Gynecol 2023; 228:S983-S993. [PMID: 37164503 DOI: 10.1016/j.ajog.2022.09.044] [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: 07/21/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 05/12/2023]
Abstract
The intrapartum period is a crucial time in the continuum of pregnancy and parenting. Events during this time are shaped by individuals' unique sociocultural and health characteristics and by their healthcare providers, practice protocols, and the physical environment in which care is delivered. Childbearing people in the United States have less opportunity for midwifery care than in other high-income countries. In the United States, there are 4 midwives for every 1000 live births, whereas, in most other high-income countries, there are between 30 and 70 midwives. Furthermore, these countries have lower maternal and neonatal mortality rates and have consistently lower costs of care. National and international evidences consistently report that births attended by midwives have fewer interventions, cesarean deliveries, preterm births, inductions of labor, and more vaginal births after cesarean delivery. In addition, midwifery care is consistently associated with respectful care and high patient satisfaction. Midwife-physician collaboration exists along a continuum, including births attended independently by midwives, births managed in consultation with a physician, and births attended primarily by a physician with a midwife acting as consultant on the normal aspects of care. This expert review defined midwifery care and provided an overview of midwifery in the United States with an emphasis on the intrapartum setting. Health outcomes associated with midwifery care, specific models of intrapartum care, and workforce issues have been presented within national and international contexts. Recommendations that align with the integration of midwifery have been suggested to improve national outcomes and reduce pregnancy-related disparities.
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Affiliation(s)
| | | | | | - Gina Novick
- Yale University School of Nursing, Orange, CT
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Smith RM, Gray JE, Homer CSE. Common content, delivery modes and outcome measures for faculty development programs in nursing and midwifery: A scoping review. Nurse Educ Pract 2023; 70:103648. [PMID: 37121027 DOI: 10.1016/j.nepr.2023.103648] [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: 02/07/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Globally, there is a call for urgent investment in nursing and midwifery education as high-quality education leads to quality care provision. This call for investment includes a 'focus on faculty', that is, development of those who teach. However, challenges in the preparation and development of faculty have been identified and include lack of recognition of ongoing development, limited pathways for career progression, inadequate provision of, or access to, faculty development opportunities and a lack of research evaluating sustained impact of programs. OBJECTIVES The aim of this review was to identify, synthesise and report on common program content, modes of delivery and evaluation processes of faculty development programs in nursing and/or midwifery. METHODS A scoping review was conducted following Joanna Briggs Institute guidance. A comprehensive search strategy was developed and conducted in six health and/or education focussed databases. Peer-reviewed articles, published in English in the last decade and with a primary focus on nursing and/or midwifery faculty were included in the review. References lists of included studies were searched and a search to identify relevant grey literature was conducted. Using systematic review software, titles and abstracts were reviewed by two reviewers with a third reviewer used to resolve discrepancies. Data were extracted and recorded, key characteristics were mapped and content analysis used to synthesise, analyse and report findings. RESULTS Seventeen articles were included in the review and identified common content provided in nursing and midwifery faculty development programs. The predominant content was approaches for learning and teaching. Other common content was leadership, research and assessment practices. Modes for program delivery were most often a blend of online and face-to-face. Program evaluation was reliant on participants' self-reported measures of satisfaction and confidence and did not examine impact over time. CONCLUSIONS AND RECOMMENDATIONS Commonalities in program content primarily focussed on learning and teaching, but also included content linked to expected professional nursing and midwifery educator competencies such as leadership and research. However, a lack of content on the key faculty activity of curriculum design was noted and should be addressed in future program development. In addition, there was a lack of evaluation on the impact of different modes of delivery. Furthermore, an over-reliance on self-reported evaluation measures and a lack of longitudinal evaluation of impact on education practice and on student experience and outcomes. Future research should include evaluation of modes of delivery and impact on faculty practice over a sustained period.
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Affiliation(s)
- Rachel Mary Smith
- Faculty of Health, University of Technology Sydney, Australia; Burnet Institute, Melbourne, Australia.
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Dowou RK, Amu H, Saah FI, Adeagbo O, Bain LE. Increased investment in Universal Health Coverage in Sub-Saharan Africa is crucial to attain the Sustainable Development Goal 3 targets on maternal and child health. Arch Public Health 2023; 81:34. [PMID: 36871055 PMCID: PMC9985218 DOI: 10.1186/s13690-023-01052-z] [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: 09/05/2022] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Universal Health Coverage (UHC) is considered a strategic component of the Sustainable Development Goals specifically for goal 3 which seeks to ensure healthy lives and promote well-being for all, where all individuals and communities have equal access to key promotive, preventive, curative, and rehabilitative health interventions without financial constraints. Despite Sub-Saharan Africa (SSA) accelerated gains on the UHC effective coverage of 2.6% between 2010 to 2019, many countries in the sub-region show lagging performance. The major challenges faced in attaining the UHC in many countries include inadequate capital investment for health and their equitable distribution, fiscal space to finance UHC policies and programs. This paper discusses how increased investment in Universal Health Coverage in SSA is crucial to attain the Sustainable Development Goal 3 targets on maternal and child health. The Universal Health Monitoring Framework (UHMF) is adopted in this paper as the underpinning framework. The delivery of essential maternal and child health services to achieve UHC in SSA requires strategic actions such as policies, plans and programs with focus on maternal and child health. We report findings from recently published papers that clearly highlighted the strong connection between health insurance coverage and maternal health care utilization. Strategic actions such as implementing national health insurance scheme (NHIS) that directly incorporates free maternal and child health care could strengthen maternal health services and transform health systems in order to achieve UHC in SSA. We argue that achieving the SDG 3 on maternal and child health will only be possible if significant progress in made in increasing UHC. This is key to ensure optimal maternal health care utilization, and consequently reducing maternal and child deaths.
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Affiliation(s)
- Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health, and Allied Science, Hohoe, Ghana.
| | - Hubert Amu
- grid.449729.50000 0004 7707 5975Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Farrukh Ishaque Saah
- grid.449729.50000 0004 7707 5975Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health, and Allied Science, Hohoe, Ghana
| | - Oluwafemi Adeagbo
- grid.214572.70000 0004 1936 8294Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, USA ,grid.412988.e0000 0001 0109 131XDepartment of Sociology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Luchuo Engelbert Bain
- grid.412988.e0000 0001 0109 131XDepartment of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, Auckland Park, South Africa ,grid.419341.a0000 0001 2109 9589International Development Research Centre, IDRC, Ottawa, Canada
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Kuipers YJ, Verschuren S. Students as researchers: An example of high-level participation of undergraduate midwifery students as co-investigators in research. Women Birth 2023; 36:171-176. [PMID: 36414496 DOI: 10.1016/j.wombi.2022.11.004] [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: 07/27/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is a shift in focus of the curricula of undergraduate midwifery research-education - from research content to the research process, and the student from being an observer to a participant. AIM AND METHODS To explore an example of how to involve midwifery students as co-investigators in research. This paper discusses the experiences of an educational research project that adopted the highest level of student autonomy in research, involving six Bachelor of Midwifery final-year students participating as co-investigators in qualitative research focusing on women's lived experiences of traumatic childbirth. The experiences are supported by the parameters of research-education and learning, and are discussed in the context of the dimensions of framing undergraduate research: Motivation, Inclusivity, Content, Originality, Setting, Collaboration, Focus and Audience DISCUSSION: Crucial for this educational research project is the recognition of the motivation, interests, (experiential) knowledge and real-world experiences of students. It starts with listening to the questions, thoughts and ideas that students bring, recognising and respecting the content and importance of their work and what is important and meaningful to them, while facilitating a student-led learning process. Collaboration between students and students and supervisors needs to be formally facilitated and supported, as this contributes to qualitative products for curricular and extra-curricular products. An academic infrastructure is necessary to support extra-curricular activities. CONCLUSION To embed research adequately and effectively in the curriculum, a pedagogical approach, institutional learning and student-centred teaching strategies and practices, including high impact practices to mainstream undergraduate research and enquiry, are crucial.
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Affiliation(s)
- Yvonne J Kuipers
- Edinburgh Napier University, School of Health and Social Care, Sighthill Court, Edinburgh EH11 4BN, Scotland, UK.
| | - Stans Verschuren
- Rotterdam University of Applied Sciences, Institute of Healthcare - School of Midwifery, Rochussenstraat 198, 3015 EK, Rotterdam, Netherlands
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We Do Not Know How People Have Babies: an Opportunity for Epidemiologists to Have Meaningful Impact on Population-Level Health and Wellbeing. CURR EPIDEMIOL REP 2023. [DOI: 10.1007/s40471-023-00321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis DL, O'Connell MA. The full potential of midwives will only be realised when midwifery has professional autonomy. Women Birth 2023; 36:1-2. [PMID: 36588046 DOI: 10.1016/j.wombi.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/10/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Deborah L Davis
- ACT Government Health Directorate and University of Canberra, Australia.
| | - Maeve A O'Connell
- Fatima College of Health Sciences, Institute of Applied Technology, Abu Dhabi, UAE
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Bogren M, Jha P, Sharma B, Erlandsson K. Contextual factors influencing the implementation of midwifery-led care units in India. Women Birth 2023; 36:e134-e141. [PMID: 35641395 DOI: 10.1016/j.wombi.2022.05.006] [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: 02/24/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Government of India has committed to educate 90,000 midwives functioning in midwifery-led care units (MLCUs) to care for women during labour and birth. There is a need to consider local circumstances in India, as there is no 'one size fits all' prescription for MLCUs. AIM To explore contextual factors influencing the implementation of MLCUs across India. METHOD Data were collected through six focus group interviews with 16 nurses, midwives, public health experts and physicians, representing six national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis. FINDINGS Four generic categories describe the contextual factors which influence the implementation of MLCUs in India: (i) Perceptions of the Nurse Practitioner in Midwifery and MLCUs and their acceptance, (ii) Reversing the medicalization of childbirth, (iii) Engagement with the community, and (iv) The need for legal frameworks and standards. CONCLUSION Based on the identified contextual factors in this study, we recommend that in India and other similar contexts the following should be in place when designing and implementing MLCUs: legal frameworks to enable midwives to provide full scope of practice in line with the midwifery philosophy and informed by global standards; pre- and in-service training to optimize interdisciplinary teamwork and the knowledge and skills required for the implementation of the midwifery philosophy; midwifery leadership acknowledged as key to the planning and implementation of midwifery-led care at the MLCUs; and a demand among women created through effective midwifery-led care and advocacy messages.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden.
| | - Paridhi Jha
- Foundation for Research in Health Systems, Bangalore, Karnataka, India
| | - Bharati Sharma
- Indian Institute of Public Health Gandhinagar, Gujarat, India
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Brigante L, Coxon K, Fernandez Turienzo C, Sandall J. "She was there all the time". A qualitative study exploring how women at higher risk for preterm birth experience midwifery continuity of care. Women Birth 2023:S1871-5192(23)00016-1. [PMID: 36682950 DOI: 10.1016/j.wombi.2023.01.003] [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: 06/28/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
PROBLEM There is a paucity of research on experiences and views of women at higher risk of preterm birth of midwifery continuity of care. BACKGROUND Midwifery continuity of care (MCoC) has been associated with improved maternal outcomes and with lower levels of preterm births and stillbirths. The majority of MCoC studies have focused on women without risk factors and little has been published on women with obstetric complexities. The aim of this study is to explore the views and experiences of women identified as a higher risk of preterm birth who have had continuity of care from midwives. DESIGN Face-to-face, semi-structured interviews with 16 women identified as at increased risk of preterm birth and experienced continuity of midwifery care across pregnancy, birth and the postnatal period. Care had been provided by the pilot intervention group for the pilot study of midwifery practice in preterm birth including women's experiences (POPPIE) trial. FINDINGS Women valued continuity of midwifery care across the care pathway and described the reassurance provided by having 24 h a day, seven days a week access to known midwives. Consistency of care, advocacy and accessibility to the team were described as the main factors contributing to their feelings of safety and control. KEY CONCLUSIONS Recognising that known midwives were 'there all the time' made women feel listened to and actively involved in clinical decision making, which contributed to women feeling less stressed and anxious during their pregnancy, birth and early parenthood. When developing MCoC models for women with obstetric complexities: access, advocacy and time should be embedded to ensure women can build trusting relationships and reduce anxiety levels.
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Affiliation(s)
- L Brigante
- Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, London, United Kingdom; The Royal College of Midwives, London, United Kingdom.
| | - K Coxon
- School of Education, Midwifery and Social Work. Faculty of Health, Science, Social Care and Education. Kingston University, London, United Kingdom
| | - C Fernandez Turienzo
- Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, London, United Kingdom
| | - J Sandall
- Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, London, United Kingdom
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Wołejszo S, Genowska A, Motkowski R, Strukcinskiene B, Klukowski M, Konstantynowicz J. Insights into Prevention of Health Complications in Small for Gestational Age (SGA) Births in Relation to Maternal Characteristics: A Narrative Review. J Clin Med 2023; 12:jcm12020531. [PMID: 36675464 PMCID: PMC9862121 DOI: 10.3390/jcm12020531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Small for gestational age (SGA) births are a significant clinical and public health issue. The objective of this review was to summarize maternal biological and socio-demographic factors and preventive strategies used to reduce the risk of SGA births. A literature search encompassing data from the last 15 years was conducted using electronic databases MEDLINE/PubMed, Google Scholar and Scopus to review risk factors and preventive strategies for SGA. Current evidence shows that primiparity, previous stillbirths, maternal age ≤24 and ≥35 years, single motherhood, low socio-economic status, smoking and cannabis use during pregnancy confer a significant risk of SGA births. Studies on alcohol consumption during pregnancy and SGA birth weight are inconclusive. Beneficial and preventive factors include the "Mediterranean diet" and dietary intake of vegetables. Periconceptional folic acid supplementation, maternal 25-hydroxyvitamin D, zinc and iron levels are partly associated with birth weight. No significant associations between COVID-19 vaccinations and birthweight are reported. A midwifery-led model based on early and extensive prenatal care reduces the risk of SGA births in women with low socio-economic status. Major preventive measures relate to the awareness of modifiable and non-modifiable risk factors of SGA, leading to changes in parents' lifestyles. These data support that education, monitoring during pregnancy, and implementing preventive strategies are as important as biological determinants in risk reduction of SGA births.
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Affiliation(s)
- Sebastian Wołejszo
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
- Correspondence: (S.W.); (A.G.)
| | - Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, 15-295 Bialystok, Poland
- Correspondence: (S.W.); (A.G.)
| | - Radosław Motkowski
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
| | | | - Mark Klukowski
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
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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.
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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
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İsbir GG, Guner S, Beşen MA, Thomson G. Evaluation of labour and birth education by midwifery educators: A qualitative study from Turkey. Nurse Educ Pract 2023; 66:103515. [PMID: 36481496 DOI: 10.1016/j.nepr.2022.103515] [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: 03/10/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Midwifery students' education regarding labor and birth is crucial because it directly affects the quality of care provided to women in labor. AIMS Exploring educators' experiences of delivering labor and birth education to midwifery students and evaluating the circumstances that affect the quality of labor and birth education METHODS: This was a qualitative study. Semi-structured interviews were conducted with 16 educators teaching midwifery in 16 midwifery departments at universities in Turkey. Inductive thematic analysis was conducted. All transcripts were evaluated by two researchers, and codes were created. The codes formed the subthemes in terms of similarities and differences; themes were created based on combining subthemes. FINDINGS Three themes were identified. The first - "impacts of global changes on labor and birth education"- shows how labor and birth is affected by changing policies, philosophies, individuals, and cultures. The second theme - "opportunities/obstacles in labor and birth education"- shows how sources of information, as well as individual and systemic factors, create opportunities or obstacles for the quality of labor and birth education. The final theme - "recommendations for quality labor and birth education"- presents participants' suggestions for the effective integration of courses, use of sources of information, and updating of curriculum. DISCUSSION Changing policies, philosophies, individuals, and cultures affect labor and birth education. Individual and systemic factors and information sources create opportunities or barriers for the quality of labor and birth education. CONCLUSION A positive childbirth experience is a basic human right for both women and newborns. This can be made possible by professionals who have received quality labor and birth education. Thus, investment in midwifery education is an important cost-effective approach to improving health outcomes.
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Affiliation(s)
| | - Sevil Guner
- Mersin University, School of Health, Midwifery Department, Turkey.
| | | | - Gillian Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston PR1 2NE, UK.
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Suarez A, Yakupova V. The impacts of the COVID-19 pandemic on birth satisfaction and birth experiences in Russian women. Front Glob Womens Health 2022; 3:1040879. [PMID: 36619591 PMCID: PMC9810808 DOI: 10.3389/fgwh.2022.1040879] [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: 09/24/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Women's satisfaction with their childbirth experiences has significant impacts on their health and the health of their children. Recently, childbirth and maternity care systems have been disrupted by the COVID-19 pandemic. This study aimed to investigate the association of birth satisfaction with mode of birth, medical interventions, support during labour, type of childbirth healthcare plan and antenatal education in the context of the COVID-19 pandemic in Russia. Methods 1,645 Russian women who gave birth during the first year of the COVID-19 pandemic and 611 matched controls who gave birth in the previous year participated in an anonymous Internet survey about their childbirth experience. The survey included questions regarding women's demographic and obstetric characteristics as well as their childbirth experiences. Birth satisfaction was measured using the Birth Satisfaction Scale Revised Indicator (BSS-RI). Results Birth satisfaction scores did not show notable changes before and during the pandemic (Pearson Chi-square = 19.7, p = 0.22). Women had lower BSS-RI scores if they tested positive for COVID-19 during labour (F = 9.18, p = 0.002), but not during pregnancy or postpartum (p > 0.32). In both cohorts women who had vaginal births rated birth satisfaction higher than those who had caesarean births. The more medical interventions there were, the lower were the BSS-RI scores (B = -0.234, 95% CI: -0.760; -0.506, p < 0.001), but only during the pandemic. Birth satisfaction was higher if women had a support person present during labour (F > 7.44, p < 0.001), which was not possible for over 70% of participants during the pandemic. In both cohorts birth satisfaction was associated with the childbirth healthcare plan (F > 5.27, p < 0.001), but not with antenatal education (F < 0.15, p > 0.43). Conclusions Our study highlights the significant impacts of the COVID-19 pandemic on the birth experiences of Russian women. Sustaining the rights of women to informed decisions during labour, respect for their preferred childbirth healthcare plan, presence of the birth team of choice and professional support for home birth are essential for higher birth satisfaction and better health outcomes for mothers and their infants.
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Simoncic V, Deguen S, Enaux C, Vandentorren S, Kihal-Talantikite W. A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416592. [PMID: 36554473 PMCID: PMC9779203 DOI: 10.3390/ijerph192416592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 05/12/2023]
Abstract
Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.
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Affiliation(s)
- Valentin Simoncic
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
- Correspondence:
| | - Séverine Deguen
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
| | - Christophe Enaux
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
| | - Stéphanie Vandentorren
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
- Santé Publique France, French National Public Health Agency, 94410 Saint-Maurice, France
| | - Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
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Souto SPAD, Silva RCGD, Prata AP, Guerra MJ, Couto C, Albuquerque RSD. Midwives' interventions for reducing fear of childbirth in pregnant women: a scoping review. JBI Evid Synth 2022; 20:2867-2935. [PMID: 35976033 DOI: 10.11124/jbies-21-00382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review was to map and analyze midwives' interventions for reducing fear of childbirth in pregnant women. INTRODUCTION Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy. Over the past few decades, there has been growing research interest in interventions for reducing fear of childbirth in pregnant women. One of the challenges in midwifery care is to provide an appropriate model of care for pregnant women with fear of childbirth. Further research efforts are needed to identify midwives' interventions for reducing fear of childbirth in pregnant women and to examine their characteristics. INCLUSION CRITERIA This scoping review considered studies that included midwives' interventions for reducing fear of childbirth in pregnant women. Specifically, interventions were led and/or implemented by midwives during the antenatal period, and integrating all possible midwifery practice settings. Quantitative, qualitative, and mixed methods studies were included. This review also considered systematic reviews, text and opinion papers, and conference abstracts. METHODS The JBI methodology for conducting scoping reviews was used. Published and unpublished literature in English, Portuguese, and Spanish from January 1981 to October 2020 was included. MEDLINE (PubMed), CINAHL Complete, APA PsycINFO, Scopus, Embase, Web of Science, SciELO, MedicLatina, Academic Search Complete, ERIC, Psychology and Behavioral Sciences Collection, and the Cochrane Library databases were searched. Searches for gray literature were also undertaken on the Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, British Library EThOS, OvidSP Resource Center, Banco de Teses da CAPES, and OpenGrey. A three-step search strategy was followed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist was used. Two independent reviewers extracted the data using a data extraction tool developed specifically for this scoping review. RESULTS A total of 3704 articles were identified and screened, of which 34 articles were included. The majority of studies had been published in the past 10 years (88%) in Scandinavian countries or Australia (79%). Several midwives' antenatal interventions were found, such as midwife-led team models of care. Midwives played a facilitator role that varied across the included studies. In 20 studies (59%), midwives led and implemented the interventions alone ( n = 13; 38%) or with the participation of other health professionals ( n = 7; 21%). In the remaining 14 studies (41%), midwives were part of a multidisciplinary team that included different health professionals (mainly obstetricians and psychologists) who had been involved in delivering interventions alongside midwives or with minor participation from midwives. Counseling ( n = 12; 35%) and psychoeducation ( n = 8; 24%) were the most common midwife interventions for reducing fear of childbirth in pregnant women. CONCLUSIONS Midwives working across their full scope of practice play a pivotal role in reducing fear of childbirth, which may explain the variety of midwives' antenatal interventions. Reducing fear of childbirth in pregnant women and promoting normal childbirth as a positive experience are key features of midwives' interventions, which should include women's empowerment measures. Evidence-based midwife-led intervention programs for pregnant women with fear of childbirth should be designed and tested to improve clinical practice as well as women's reproductive outcomes and perinatal experiences.
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Affiliation(s)
- Sandra Patrícia Arantes do Souto
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Maternity unit, Hospital Center Póvoa de Varzim/Vila do Conde, Póvoa de Varzim, Portugal
| | - Rosa Carla Gomes da Silva
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC).,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, Coimbra, Portugal
| | - Ana Paula Prata
- CINTESIS - Center for Health Technology and Services Research, Nursing School of Porto (ESEP), Porto, Portugal
| | - Maria João Guerra
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal
| | - Cristina Couto
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Maternity unit, Hospital Center Tâmega e Sousa, Penafiel, Portugal
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Community-based bilingual doula support during labour and birth to improve migrant women's intrapartum care experiences and emotional well-being-Findings from a randomised controlled trial in Stockholm, Sweden [NCT03461640]. PLoS One 2022; 17:e0277533. [PMID: 36399476 PMCID: PMC9674173 DOI: 10.1371/journal.pone.0277533] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/11/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of community-based bilingual doula (CBD) support for improving the intrapartum care experiences and postnatal wellbeing of migrant women giving birth in Sweden. DESIGN Randomised controlled trial. SETTING Six antenatal care clinics and five hospitals in Stockholm, Sweden. PARTICIPANTS 164 pregnant Somali-, Arabic-, Polish-, Russian- and Tigrinya-speaking women who could not communicate fluently in Swedish, were ≥18 years and had no contra-indications for vaginal birth. INTERVENTION In addition to standard labour support, women were randomised to CBD support (n = 88) or no such support during labour (n = 76). Trained CBDs met with women prior to labour, provided support by telephone after labour had started, then provided emotional, physical and communication support to women throughout labour and birth in hospital, and then met again with women after the birth. PRIMARY OUTCOMES Women's overall ratings of the intrapartum care experiences (key question from the Migrant Friendly Maternity Care Questionnaire) and postnatal wellbeing (mean value of Edinburgh Postnatal Depression Scale) at 6-8 weeks after birth. RESULTS In total, 150 women remained to follow-up; 82 women (93.2%) randomised to receive CBD support and 68 women (89.5%) randomised to standard care (SC). Of women allocated CBD support, 60 (73.2%) received support during labour. There were no differences between the groups regarding women's intrapartum care experiences (very happy with care: CBD 80.2% (n = 65) vs SC 79.1% (n = 53); OR 1.07 CI 95% 0.48-2.40) or emotional wellbeing (EPDS mean value: CBD 4.71 (SD 4.96) vs SC 3.38 (SD 3.58); mean difference 1.33; CI 95% - 0.10-2.75). CONCLUSIONS Community-based doula support during labour and birth for migrant women neither increased women's ratings of their care for labour and birth nor their emotional well-being 2 months postpartum compared with receiving standard care only. Further studies on the effectiveness of CBD powered to evaluate obstetric outcomes are needed. TRIAL REGISTRATION Trial registration at ClinicalTrial.gov NCT03461640 https://www.google.com/search?client=firefox-b-d&q=NCT03461640.
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Huang S, Hee JY, Zhang YO, Gongye R, Zou S, Tang K. Association between pregnancy and pregnancy loss with COPD in Chinese women: The China Kadoorie Biobank study. Front Public Health 2022; 10:990057. [PMID: 36388344 PMCID: PMC9660272 DOI: 10.3389/fpubh.2022.990057] [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: 07/09/2022] [Accepted: 09/12/2022] [Indexed: 01/26/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease characterized by airflow blockage. Pregnancy and pregnancy loss may be related to an elevated risk of COPD, although studies have yet to report on this association. Hence, this study aims to investigate the association between pregnancy and pregnancy loss with the risk of COPD among Chinese women. Methods Data on 302,510 female participants from the China Kadoorie Biobank were utilized for this study. Multivariable logistic regression, stratified by sociodemographic and lifestyle factors, was employed to obtain the odds ratio (ORs) and 95% confidence intervals (CIs) for the association between pregnancy and pregnancy loss with COPD. Results Pregnancy loss was significantly associated with increased risk of COPD (OR 1.19, 95% CI 1.13-1.25), specifically, spontaneous (OR 1.19, 95% CI 1.11-1.29) and induced abortion (OR 1.18, 95% CI 1.12-1.25). Stillbirth, however, was not significantly associated with the risk of COPD (OR 1.09, 95% CI 0.99-1.20). Increasing number of pregnancy losses was associated with increasing risk of COPD (one pregnancy loss: OR 1.14, 95% CI 1.07-1.21, two or more pregnancy loss: OR 1.25, 95% CI 1.17-1.32, and each additional pregnancy loss: OR 1.06, 95% CI 1.03-1.09). A single pregnancy was significantly associated with reduced risk of COPD (OR 0.75, 95% CI 0.59-0.97), although each additional pregnancy was significantly associated with increased risk of COPD (OR 1.03, 95% CI 1.01-1.04). Conclusion Pregnancy loss, in particular, spontaneous and induced abortions are associated with increased risk of COPD among Chinese women. A single pregnancy, however, demonstrated protective effects.
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Affiliation(s)
- Sha Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jia Yi Hee
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Ruofan Gongye
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Siyu Zou
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China,*Correspondence: Kun Tang
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Firoozehchian F, Zareiyan A, Geranmayeh M, Behboodi Moghadam Z. Domains of competence in midwifery students: a basis for developing a competence assessment tool for iranian undergraduate midwifery students. BMC MEDICAL EDUCATION 2022; 22:704. [PMID: 36199088 PMCID: PMC9533548 DOI: 10.1186/s12909-022-03759-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/02/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Current study was conducted with the aim of explaining domains of clinical competence in undergraduate midwifery students so that it addresses the challenges in midwifery curriculum and improving clinical assessment methods in Iranian undergraduate midwifery students. METHODS Qualitative approach and conventional content analysis were used in the design of the present study. The research setting included midwifery and nursing schools and hospitals and health centers affiliated to Tehran and Guilan universities of medical sciences in Iran. The target population consisted of undergraduate midwifery students in the fourth to eighth semesters of school, midwives working in hospitals and health centers, midwifery faculty members, and obstetricians. The participants were selected through purposive maximum variation sampling, which continued until data saturation. After in-depth semi-structured interviews, the content of the interviews was analyzed according to the steps proposed by Zhang & Wildemuth. RESULTS Twenty-four people participated in this study, including seven midwifery students, seven midwives, nine midwifery and reproductive and sexual health faculty members, and one obstetrician. The participants were aged 20-56 years and their mean age was 39.75 years. Their level of education varied from midwifery student to PhD. The mean work experience of the participants was 13.62 years and the mean duration of the interviews was 48 min. The analysis of the data obtained from the experiences of the participants led to the formation of the four categories of ethical and professional function in midwifery, holistic midwifery care, effective interaction, and personal and professional development, along with ten subcategories. CONCLUSION The findings of the present study showed that clinical competence in midwifery students involves different domains that correspond well overall to the general definitions of clinical competence in different sources. These findings can be used as a basis for the design and psychometric assessment of a clinical competence assessment tool for undergraduate midwifery students.
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Affiliation(s)
- Firoozeh Firoozehchian
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Armin Zareiyan
- Department of Public Health, Department of Health in Disaster & Emergencies, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Geranmayeh
- Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Behboodi Moghadam
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Vedam S, Titoria R, Niles P, Stoll K, Kumar V, Baswal D, Mayra K, Kaur I, Hardtman P. Advancing quality and safety of perinatal services in India: opportunities for effective midwifery integration. Health Policy Plan 2022; 37:1042-1063. [PMID: 35428886 PMCID: PMC9469892 DOI: 10.1093/heapol/czac032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/12/2022] Open
Abstract
India has made significant progress in improving maternal and child health. However, there are persistent disparities in maternal and child morbidity and mortality in many communities. Mistreatment of women in childbirth and gender-based violence are common and reduce women's sense of safety. Recently, the Government of India committed to establishing a specialized midwifery cadre: Nurse Practitioners in Midwifery (NPMs). Integration of NPMs into the current health system has the potential to increase respectful maternity care, reduce unnecessary interventions, and improve resource allocation, ultimately improving maternal-newborn outcomes. To synthesize the evidence on effective midwifery integration, we conducted a desk review of peer-reviewed articles, reports and regulatory documents describing models of practice, organization of health services and lessons learned from other countries. We also interviewed key informants in India who described the current state of the healthcare system, opportunities, and anticipated challenges to establishing a new cadre of midwives. Using an intersectional feminist theoretical framework, we triangulated the findings from the desk review with interview data to identify levers for change and recommendations. Findings from the desk review highlight that benefits of midwifery on outcomes and experience link to models of midwifery care, and limited scope of practice and prohibitive practice settings are threats to successful integration. Interviews with key informants affirm the importance of meeting global standards for practice, education, inter-professional collaboration and midwifery leadership. Key informants noted that the expansion of respectful maternity care and improved outcomes will depend on the scope and model of practice for the cadre. Domains needing attention include building professional identity; creating a robust, sustainable education system; addressing existing inter-professional issues and strengthening referral and quality monitoring systems. Public and professional education on midwifery roles and scope of practice, improved regulatory conditions and enabling practice environments will be key to successful integration of midwives in India.
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Affiliation(s)
- Saraswathi Vedam
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Reena Titoria
- Population Health Observatory, Fraser Health Authority, Suite 400, Central City Tower 13450 – 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Paulomi Niles
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010, USA
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Vishwajeet Kumar
- Community Empowerment Lab, 26/11 Wazir Hasan Road, Gokhale Marg, Lucknow, UP 226001, India
| | - Dinesh Baswal
- MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, New Delhi 110048, India
| | - Kaveri Mayra
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Inderjeet Kaur
- Fernandez Foundation, Fernandez Hospital, 4-1-120, Bogulkunta, Hyderabad 500001, India
| | - Pandora Hardtman
- Johns Hopkins Program for International Education in Gynecology and Obstetrics, John Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA
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Abstract
IMPORTANCE Preterm birth complications are the leading cause of death in children younger than 5 years worldwide. Despite advancing knowledge of risk factors and mechanisms related to preterm labor, the preterm birth rate has risen in most industrialized countries. Moreover, the burden of neonatal preterm birth remains unclear across the world. OBJECTIVE To determine the trends in incidence and mortality of neonatal preterm birth at the global, regional, and national levels to quantify its burden from 1990 to 2019 using data from the 2019 Global Burden of Disease study. DESIGN, SETTING, AND PARTICIPANTS Annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of neonatal preterm birth between 1990 and 2019 were collected from the 2019 Global Burden of Disease study. The percentage of relative changes in incident cases and deaths as well as the estimated annual percentage changes (EAPCs) of ASIRs and ASMRs were calculated to quantify their temporal trends. Correlations of EAPC of ASIRs and ASMRs with sociodemographic index (SDI) and universal health coverage index were evaluated by Pearson correlation analyses. EXPOSURES Infants born alive before 37 completed weeks of gestation between 1990 and 2019. MAIN OUTCOMES AND MEASURES Incident cases, deaths, ASIRs, and ASMRs of neonatal preterm birth. RESULTS Globally, the incident cases of neonatal preterm birth decreased by 5.26% from 16.06 million in 1990 to 15.22 million in 2019, and the deaths decreased by 47.71% from 1.27 million in 1990 to 0.66 million in 2019. The overall ASIR (EAPC = -0.19 [95% CI, -0.27 to -0.11]) and ASMR (EAPC = -2.09 [95% CI, -1.99 to -2.20]) decreased in this period. The ASIR of neonatal preterm birth increased by a mean of 0.25% (95% CI, 0.13%-0.38%) in high-SDI regions from 1990 to 2019. The ASMR of neonatal preterm birth increased by a mean of 2.09% (95% CI, 1.99%-2.20%) in Southern Sub-Saharan Africa in this period. A positive correlation was observed between EAPC of ASIR and SDI or universal health coverage index in 2019, while a negative correlation was observed between EAPC in ASMR and SDI or universal health coverage index in 2019 at national levels. CONCLUSIONS AND RELEVANCE Preterm birth remains a crucial issue in children worldwide, with an increasing trend in ASIR in high-SDI regions and in ASMR in Southern Sub-Saharan Africa between 1990 to 2019. Efforts to reduce both the incidence and mortality of preterm births are essential.
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Affiliation(s)
- Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Azarkish M, Malakouti J, Mirghafourvand M. Relationship Between Childbirth Experience and Sexual Function and Sleep Quality in Iranian Postpartum Women: A Cross-Sectional Study. J Psychosoc Nurs Ment Health Serv 2022; 60:49-55. [DOI: 10.3928/02793695-20220705-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shikuku DN, Nyaoke I, Maina O, Eyinda M, Gichuru S, Nyaga L, Iman F, Tallam E, Wako I, Bashir I, Allott H, Ameh C. The determinants of staff retention after Emergency Obstetrics and Newborn Care training in Kenya: a cross-sectional study. BMC Health Serv Res 2022; 22:872. [PMID: 35794569 PMCID: PMC9261014 DOI: 10.1186/s12913-022-08253-2] [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: 05/01/2021] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Kenya’s maternal mortality ratio is relatively high at 342/100,000 live births. Confidential enquiry into maternal deaths showed that 90% of the maternal deaths received substandard care with health workforce related factors identified in 75% of 2015/2016 maternal deaths. Competent Skilled Health Personnel (SHP) providing emergency obstetric and newborn care (EmONC) in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 – 5 years after EmONC training in Kenya. Methods A cross-sectional review of EmONC SHP in five counties (Kilifi, Taita Taveta, Garissa, Vihiga and Uasin Gishu) was conducted between January–February 2020. Data was extracted from a training database. Verification of current health facilities where trained SHP were deployed and reasons for non-retention were collected. Descriptive data analysis, transfer rate by county and logistic regression for SHP retention determinants was performed. Results A total of 927 SHP were trained from 2014–2019. Most SHP trained were nurse/midwives (677, 73%) followed by clinical officers (151, 16%) and doctors (99, 11%). Half (500, 54%) of trained SHP were retained in the same facility. Average trained staff transfer rate was 43%, with Uasin Gishu lowest at 24% and Garissa highest at 50%. Considering a subset of trained staff from level 4/5 facilities with distinct hospital departments, only a third (36%) of them are still working in relevant maternity/newborn/gynaecology departments. There was a statistically significant difference in transfer rate by gender in Garissa, Vihiga and the combined 5 counties (p < 0.05). Interval from training in years (1 year, AOR = 4.2 (2.1–8.4); cadre (nurse/midwives, AOR = 2.5 (1.4–4.5); and county (Uasin Gishu AOR = 9.5 (4.6- 19.5), Kilifi AOR = 4.0 (2.1–7.7) and Taita Taveta AOR = 1.9 (1.1–3.5), p < 0.05, were significant determinants of staff retention in the maternity departments. Conclusion Retention of EmONC trained SHP in the relevant maternity departments was low at 36 percent. SHP were more likely to be retained by 1-year after training compared to the subsequent years and this varied from county to county. County policies and guidelines on SHP deployment, transfers and retention should be strengthened to optimise the benefits of EmONC training.
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Affiliation(s)
- Duncan N Shikuku
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya.
| | - Irene Nyaoke
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | - Onesmus Maina
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | - Martin Eyinda
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | - Sylvia Gichuru
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | - Lucy Nyaga
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | | | | | - Ibrahim Wako
- Clinical Officers Council of Kenya, Nairobi, Kenya
| | - Issak Bashir
- Department of Family Health, Ministry of Health, Nairobi, Kenya
| | - Helen Allott
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Charles Ameh
- Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
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Grundström H, Malmquist A, Nieminen K, Alehagen S. Supporting women's reproductive capabilities in the context of childbirth: Empirical validation of a midwifery theory synthesis. Midwifery 2022; 110:103320. [DOI: 10.1016/j.midw.2022.103320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/01/2022] [Accepted: 03/20/2022] [Indexed: 11/24/2022]
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Mattison CA, Bourret K, Dion ML. Leveling up evidence syntheses: filling conceptual gaps of the role of midwifery in health systems through a network analysis. BMC Res Notes 2022; 15:216. [PMID: 35729666 PMCID: PMC9210622 DOI: 10.1186/s13104-022-06094-0] [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: 12/22/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE In the research note, our main objective is to explore the value of combining an evidence synthesis with a network analysis. The discussion is based on a critical interpretive synthesis, which combines systematic review methodology with qualitive inquiry, and 'research concept' network analysis focused on understanding the roles of midwives in health systems. The interpretative analytic approach of a critical interpretive synthesis has a high explanatory value by allowing for the review of a diverse body of literature and is well-suited to delving into areas that are not well understood, such as midwifery. RESULTS Network analyses use graphs to represent relationships between concepts and brought to light important additional insights into the literature that were not present in the evidence synthesis alone. Given the lack of theoretical development in the area of midwifery in health systems, the critical interpretive synthesis allowed for the generation of concepts used to inform a theoretical framework, while the novel application of an exploratory network analysis deepened understanding of conceptual areas of saturation within the field, as well as identifying critical gaps in the literature.
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Affiliation(s)
- Cristina A Mattison
- Department of Women and Children's Health, 2Karolinska Institutet, Tomtebodavägen 18A, Solna, 171 77, Sweden. .,Department of Obstetrics and Gynecology, McMaster University, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, L8S 4K1, Hamilton, Canada.
| | - Kirsty Bourret
- Department of Women and Children's Health, 2Karolinska Institutet, Tomtebodavägen 18A, Solna, 171 77, Sweden.,Department of Obstetrics and Gynecology, McMaster University, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, L8S 4K1, Hamilton, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
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Tallhage S, Årestedt K, Schildmeijer K, Oscarsson M. Prevalence of amniotomy in Sweden: a nationwide register study. BMC Pregnancy Childbirth 2022; 22:486. [PMID: 35701766 PMCID: PMC9195378 DOI: 10.1186/s12884-022-04805-w] [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: 03/09/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amniotomy is a commonly used labor intervention with uncertain evidence, and there are complications connected to the intervention. Yet, the Swedish prevalence of amniotomy is unknown. The aim of the study was therefore to describe the prevalence of amniotomy in Sweden. METHODS This nationwide register-based study included 330,913 women giving birth in 2017-2020. Data were collected from the Swedish Pregnancy Register in which the majority of data is collected via direct transfer from medical records. Prevalence of amniotomy was described for all births, for nulliparous and multiparous women with spontaneous onset of labour, and at the hospital level. Descriptive statistics and chi-square test were used to analyse the data. RESULTS For all births, the prevalence of amniotomy was 40.6%. More amniotomies were performed in Robson group 1 compared to Robson group 3; 41.1% vs 32.3% (p < 0.001). The prevalence for all births remained the same during the study period; however, a decrease from 37.5 to 34.1%, was seen in Robson group 1 and Robson group 3 (p < 0.001). Variations in the prevalence between hospitals were reported. The hospitals with the fewest number of births annually had the highest prevalence of amniotomy (45.0%), and the lowest prevalence was reported at the University hospitals (40.4%) (p < 0.001). CONCLUSIONS Amniotomy is a common labor intervention in Sweden, given that almost half of the laboring women underwent the intervention. Our results, regarding variations in the prevalence between hospitals, could imply a potential for fewer amniotomies in Swedish childbirth care.
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Affiliation(s)
- Sofia Tallhage
- Faculty of Health and Life Sciences, Linnaeus University, 391 82, Kalmar, Sweden. .,Department of Obstetrics and Gynecology, Region Kalmar County, 392 44, Kalmar, Sweden.
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, 391 82, Kalmar, Sweden.,Department of Research, Region Kalmar County, 392 44, Kalmar, Sweden
| | | | - Marie Oscarsson
- Faculty of Health and Life Sciences, Linnaeus University, 391 82, Kalmar, Sweden
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Grépin KA, Chukwuma A, Holmlund M, Vera-Hernandez M, Wang Q, Rosa-Dias P. Estimating the impact of trained midwives and upgraded health facilities on institutional delivery rates in Nigeria using a quasi-experimental study design. BMJ Open 2022; 12:e053792. [PMID: 35613794 PMCID: PMC9125714 DOI: 10.1136/bmjopen-2021-053792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Studies have shown that demand-side interventions, such as conditional cash transfers and vouchers, can increase the proportion of women giving birth in a health facility in low-income and middle-income countries, but there is limited evidence of the effectiveness of supply-side interventions. We evaluated the impact of the Subsidy Reinvestment and Empowerment Programme Maternal and Child Health Project (SURE-P MCH) on rates of institutional delivery and antenatal care. DESIGN, SETTING AND PARTICIPANTS We used a differences-in-differences study design that compared changes in rates of institutional delivery and antenatal care in areas that had received additional support through the SURE-P MCH programme relative to areas that did not. Data on outcomes were obtained from the 2013 Nigerian Demographic and Health Survey. RESULTS We found that the programme significantly increased the proportion of women giving birth in a health facility by approximately 7 percentage points (p=0.069) or approximately 10% relative to the baseline after 9 months of implementation. The programme, however, did not significantly increase the use of antenatal care. CONCLUSION The findings of this study suggest there could be important improvements in institutional delivery rates through greater investment in supply-side interventions.
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Affiliation(s)
- Karen Ann Grépin
- School of Public Health, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Adanna Chukwuma
- Health, Nutrition, and Population Global Practice, World Bank Group, Washington, DC, USA
| | - Marcus Holmlund
- Development Impact Evaluation (DIME), World Bank, Washington, District of Columbia, USA
| | | | - Qiao Wang
- Water Global Practice, World Bank Group, Washington, District of Columbia, USA
| | - Pedro Rosa-Dias
- Department of Economics and Public Policy and CHEPI, Imperial College Business School, Imperial College London, London, UK
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