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Binfa L, Pantoja L, Valli L, Cillo A, Zapiola S, Peralta E, Solis M, Zagaceta Z, Salazar E, Mancía S, Cavada G, Foster J. Assessment of professional empowerment among midwives in selected LAC: A multisite descriptive study. Midwifery 2024; 138:104130. [PMID: 39137539 DOI: 10.1016/j.midw.2024.104130] [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: 01/14/2022] [Revised: 06/14/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE to identify the perception of professional empowerment among midwives in selected Latin American countries (LA). Specifically, this study aimed to compare i) the global level of empowerment among midwives in different LA countries, ii) the scores according to the different dimensions of the scale, and iii) scores according to area the of expertise. DESIGN A quantitative, observational, analytical, cross-sectional and multisite study using an adaptation of the Perceptions Midwifery Empowerment Scale (PEMS). SETTINGS Clinical, educational and managerial midwifery positions in 5 LA countries belonging to a Latin American Research Network in Midwifery. All the participating countries reported a similar profile regarding type of education, association and regulation procedures. PARTICIPANTS A total of 1127 responses from midwives with different professional backgrounds were included in the study. FINDINGS A total mean score of 73.28 (74.23-72.03) points was reported. Chile reported the lowest score of empowerment compared to the other countries, while Argentina reported the highest. Midwives' perceptions of empowerment within their area of expertise, primary health care (PHC) was the area of reference, and gynaecology reported a significantly lower score. Midwives working in management were significantly more empowered compared with those in other areas. Midwives who had continuous education and postgraduate studies were the most empowered. Regarding the provision of woman-centred Care, Chile and El Salvador differed significantly from Argentina (reference), while Uruguay reported a significantly higher score in this dimension. Midwives working in hospital wards reported significantly lower scores compared to those working in PHC. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This study suggests that midwifery programmes in the LA countries would benefit from prioritising professional empowerment, especially in the areas of hospital practice, where midwives' perceptions of empowerment were most limited.
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Affiliation(s)
- Lorena Binfa
- Departamento de Promoción de la Salud de la Mujer y el Recién Nacido, Facultad de Medicina, Universidad de Chile, Chile
| | - Loreto Pantoja
- Departamento de Promoción de la Salud de la Mujer y el Recién Nacido, Facultad de Medicina, Universidad de Chile, Chile.
| | | | | | | | | | | | | | | | | | - Gabriel Cavada
- Departamento de Promoción de la Salud de la Mujer y el Recién Nacido, Facultad de Medicina, Universidad de Chile, Chile; School of Public Health, Faculty of Medicine, University of Chile, Chile
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Brigante L, Christiansen MV, Maimburg RD. Midwifery research: A vital catalyst for addressing gaps in sexual and reproductive healthcare. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100954. [PMID: 38387246 DOI: 10.1016/j.srhc.2024.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- L Brigante
- King's College London, United Kingdom and Royal College of Midwives, United Kingdom
| | | | - R D Maimburg
- Occupational Health, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Midwifery Department at University College in Northern Denmark; School of Nursing and Midwifery, Western Sydney University, Australia.
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Bohren MA, Iyer A, Barros AJ, Williams CR, Hazfiarini A, Arroyave L, Filippi V, Chamberlain C, Kabakian-Khasholian T, Mayra K, Gill R, Vogel JP, Chou D, George AS, Oladapo OT. Towards a better tomorrow: addressing intersectional gender power relations to eradicate inequities in maternal health. EClinicalMedicine 2024; 67:102180. [PMID: 38314054 PMCID: PMC10837533 DOI: 10.1016/j.eclinm.2023.102180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 02/06/2024] Open
Abstract
An equity lens to maternal health has typically focused on assessing the differences in coverage and use of healthcare services and critical interventions. While this approach is important, we argue that healthcare experiences, dignity, rights, justice, and well-being are fundamental components of high quality and person-centred maternal healthcare that must also be considered. Looking at differences across one dimension alone does not reflect how fundamental drivers of maternal health inequities-including racism, ethnic or caste-based discrimination, and gendered power relations-operate. In this paper, we describe how using an intersectionality approach to maternal health can illuminate how power and privilege (and conversely oppression and exclusion) intersect and drive inequities. We present an intersectionality-informed analysis on antenatal care quality to illustrate the advantages of this approach, and what is lost in its absence. We reviewed and mapped equity-informed interventions in maternal health to existing literature to identify opportunities for improvement and areas for innovation. The gaps and opportunities identified were then synthesised to propose recommendations on how to apply an intersectionality lens to maternal health research, programmes, and policies.
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Affiliation(s)
- Meghan A. Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Aditi Iyer
- Ramalingaswami Centre on Equity & Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Aluisio J.D. Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Caitlin R. Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS-Argentina), Buenos Aires, Argentina
| | - Alya Hazfiarini
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Luisa Arroyave
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Kaveri Mayra
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Roopan Gill
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada
- Vitala Global Foundation, Vancouver, British Columbia, Canada
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Asha S. George
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Western Cape, South Africa
- South African Medical Research Council, South Africa
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Aleshin O, Donnellan-Fernandez R. The role of part-time arrangements in the sustainability of midwifery continuity of care models in Australia: An integrative review. Eur J Midwifery 2023; 7:27. [PMID: 37840866 PMCID: PMC10571291 DOI: 10.18332/ejm/171359] [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: 07/17/2023] [Revised: 08/13/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION International maternity care experts have called for expanding midwiferyled continuity of care (MCoC) models. However, the number of models need augmentation as the number of women receiving this care is small. The majority of the midwifery workforce in Australian public health systems comprises women who work part-time. This aspect of the midwifery workforce demands careful consideration when attempting to change a maternity care system and sustain new models of care. Sparse research has been undertaken to explore whether part-time factors could play a role in the growth and sustainability of MCoC in Australia. This integrative review aims to analyze the role of parttime practice arrangements in the sustainability of MCoC models in Australia. METHODS Following a systematic search of research databases (CINAHL, ScienceDirect, Cochrane Database of Systematic Reviews, and Proquest) and screening the literature with eligibility criteria including keywords related to midwifery continuity of care, workforce arrangements and full-time equivalent (FTE), eight Australian research articles were identified for evaluation. The articles were appraised for bias using the Mixed Methods Appraisal Tool (MMAT) and data were analyzed using an integrated convergent narrative synthesis method. RESULTS The resulting themes from the synthesis suggest that part-time MCoC roles may support the sustainability of the MCoC workforce without reducing quality of care to women. In various studies, midwives reported that FTE (full-time equivalent) of 0.5 may not meet the job's demands. However, this is likely influenced by local context and caseload size rather than the quantum of each midwife's FTE. The quality of the studies is limited due to the small scale of the studies; however, the qualitative results give a depth of understanding to the strengths and challenges that part-time arrangements in MCoC add to the midwifery workforce. CONCLUSIONS This review recommends that part-time arrangements in MCoC models in Australia be evaluated in conjunction with other routinely analyzed workforce data. Further considerations should be made by midwifery managers, leaders, stakeholders, and decision makers responsible for developing and supporting part-time job arrangements in caseload models of care in Australia.
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Affiliation(s)
- Olga Aleshin
- The Royal Hospital for Women, Randwick, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
| | - Roslyn Donnellan-Fernandez
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Transforming Maternity Care Collaborative, Griffith University, Meadowbrook, Australia
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Mattison C, Ateva E, De Bernis L, Binfa L, Egal JA, Kaufman K, Klingberg-Allvin M, Maffioli EM, Renfrew M, Sharma P. Whose voice counts? Achieving better outcomes in global sexual and reproductive health and rights research. BMJ Glob Health 2023; 8:e012680. [PMID: 37848270 PMCID: PMC10583075 DOI: 10.1136/bmjgh-2023-012680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/29/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Cristina Mattison
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Elena Ateva
- The Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, DC, USA
| | - Luc De Bernis
- Independent Consultant in International Maternal and Perinatal Health, Bias, France
| | | | - Jama Ali Egal
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somalia
| | - Karyn Kaufman
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Mary Renfrew
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Pragati Sharma
- Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Hall H, Mahmood MA, Sitaing M, Aines PZ, Cant R, Crawford K. The PNG Midwifery Leadership Buddy Program: An evaluation. Women Birth 2023; 36:e536-e543. [PMID: 37149495 DOI: 10.1016/j.wombi.2023.04.004] [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: 06/29/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Abstract
PROBLEM Papua New Guinea (PNG) has a high rate of preventable maternal and neonatal deaths. BACKGROUND Developing midwifery leadership is vital to addressing the current deficits in health outcomes for women and their babies. The PNG Midwifery Leadership Buddy Program responds to this need through leadership training and partnering of midwives across PNG and Australia. Participants in the program undertake a workshop in Port Moresby and commit to a 12-month peer support relationship with a midwife 'buddy'. AIM To evaluate participants' experiences of the Buddy Program and the impact of the program on leadership skills. METHODS All 23 midwives who had completed the program were invited to participate in the evaluation. The study used a concurrent mixed methods approach. Qualitative data were collected via interviews and then thematically analysed. Quantitative data were collected via a survey and analysed with descriptive statistics, then findings were triangulated. FINDINGS Participants reported increased confidence for leadership, action and advocacy. Numerous quality improvement projects were implemented in health services in PNG. Challenges to the success of the program included technological limitations, cultural differences and the COVID-19 pandemic. DISCUSSION Participants reported the PNG Midwifery Leadership Buddy Program was successful in increasing their leadership skills and collaborative opportunities, as well as strengthening midwifery more broadly. While there were barriers, most participants valued the experience and believed it benefited them professionally and personally CONCLUSION: The Buddy Program provides a practical model for building midwifery leadership capacity that may be transferrable to other contexts.
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Affiliation(s)
- Helen Hall
- Institute of Health and Wellbeing, Federation University, Australia; School of Nursing & Midwifery, Latrobe University, Australia
| | - Mohammad Afzal Mahmood
- School of Public Health, University of Adelaide, SA, Australia; Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Mary Sitaing
- PNG Midwifery Society, Papua New Guinea; Port Moresby General Hospital, Papua New Guinea
| | | | - Robyn Cant
- Institute of Health and Wellbeing, Federation University, Australia
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Maregn RT, Bourret K, Egal JA, Esse A, Mattison C, Klingberg-Allvin M. Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system. BMJ Open 2023; 13:e067315. [PMID: 36921954 PMCID: PMC10030797 DOI: 10.1136/bmjopen-2022-067315] [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] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES To explore midwives' perspectives in providing sexual reproductive healthcare services in the Somaliland health system. METHODS An exploratory qualitative design using focus group discussions (n=6) was used. The study was conducted in the capital of Somaliland, Hargeisa, at six maternal and child healthcare centres that provide sexual and reproductive healthcare (SRH) services. Qualified midwives (n=44) who had been working in the maternal and child health centres for a minimum of 1 year were recruited to participate, and only one did not participate due to illness. RESULTS The results showed that Somaliland midwives face multiple challenges from a lack of formal arrangements, primarily written guidelines and policies, that explicitly define their role as healthcare professionals, which impact the quality of care they provide. They also reported feeling unsafe when practising according to their professional scope of practice due to challenging cultural norms, customary traditions and Somaliland's legal system. Finally, the midwives called for support, including training, institutional protection and psychological support, to enhance their ability and fulfil their role in SRH services in Somaliland. CONCLUSION Midwives are essential to the provision of equitable SRH services to women and girls, yet are not fully supported by policies, laws or institutions, often living in fear of the consequences of their behaviours. Our research highlights the importance of understanding the context of Somaliland midwifery in order to better support the development of the midwifery workforce, stronger governance structures and midwifery leadership. Appropriately addressing these challenges faced by midwives can better sustain the profession and help to improve the quality of care provided to women and girls and ultimately enhance their reproductive health outcomes.
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Affiliation(s)
| | - Kirsty Bourret
- Department of Women and Children's Health, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Jama Ali Egal
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Faculty of Nursing and Midwifery, College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somalia
| | - Amina Esse
- Faculty of Nursing and Midwifery, College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somalia
| | - Cristina Mattison
- Department of Women and Children's Health, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Marie Klingberg-Allvin
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Women and Children's Health, Karolinska Institute, Stockholm, Sweden
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O'Connell MA, Sosa G. Midwifery in Abu Dhabi: A descriptive survey of midwives. Women Birth 2023:S1871-5192(23)00034-3. [PMID: 36822961 DOI: 10.1016/j.wombi.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Midwives of international standards may save lives on a scale unmatched by any other intervention. There are limited trained midwives in Abu Dhabi. Midwifery may be eroded or diminished if there is attrition and/ or no succession of trained midwives (Bharj et al., 2016). Therefore, high quality midwifery education is needed. AIM This study aimed to describe midwifery in Abu Dhabi to inform the development of a new midwifery education degree program. METHODS In 2022, midwives working in Abu Dhabi were invited to an anonymous online questionnaire. Data collected included characteristics such as age, qualification, duration of practice, practice setting, and skills used. Excel was used to perform descriptive statistics. FINDINGS Seventeen midwives participated (N = 17). The majority (58.8%, n = 10) work in Labour Ward, four midwives rotated to antenatal, labour, and postnatal areas (23.5%, n = 4). Midwives came from many countries, but there were no midwives of Emirati nationality. Seventy per cent held Undergraduate (70.5%, n = 12) and almost a third held Postgraduate (29.5%, n = 5) midwifery degrees. Skills commonly used included parentcraft (47.0%, n = 8), promoting physiologic labour and birth encouraging freedom of movement (93.8%, n = 15), facilitating safe spontaneous vaginal births (88.2%, n = 15), perineal and vaginal suturing (68.8%, n = 11) and immediate care of the newborn (100.0%, n = 17). Midwives less commonly led antenatal assessments (37.5%, n = 6) and worked in postnatal areas (31.3%, n = 4). CONCLUSION Understanding midwives' characteristics, where they work, and skills used may inform Midwifery education. Having more midwives will strengthen midwifery and increase women's choice for respectful, safe maternity care.
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Affiliation(s)
- Maeve Anne O'Connell
- School of Nursing and Midwifery, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates.
| | - Georgina Sosa
- School of Nursing and Midwifery, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
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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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Bourret K, Mattison C, Hebert E, Kabeya A, Simba S, Crangle M, Darling E, Robinson J. Evidence-informed framework for gender transformative continuing education interventions for midwives and midwifery associations. BMJ Glob Health 2023; 8:bmjgh-2022-011242. [PMID: 36634981 PMCID: PMC9843202 DOI: 10.1136/bmjgh-2022-011242] [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: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Continuing education for midwives is an important investment area to improve the quality of sexual and reproductive health services. Interventions must take into account and provide solutions for the systemic barriers and gender inequities faced by midwives. Our objective was to generate concepts and a theoretical framework of the range of factors and gender transformative considerations for the development of continuing education interventions for midwives. METHODS A critical interpretive synthesis complemented by key informant interviews, focus groups, observations and document review was applied. Three electronic bibliographic databases (CINAHL, EMBASE and MEDLINE) were searched from July 2019 to September 2020 and were again updated in June 2021. A coding structure was created to guide the synthesis across the five sources of evidence. RESULTS A total of 4519 records were retrieved through electronic searches and 103 documents were included in the critical interpretive synthesis. Additional evidence totalled 31 key informant interviews, 5 focus groups (Democratic Republic of Congo and Tanzania), 24 programme documents and field observations in the form of notes. The resulting theoretical framework outlines the key considerations including gender, the role of the midwifery association, political and health systems and external forces along with key enabling elements for the design, implementation and evaluation of gender transformative continuing education interventions. CONCLUSION Investments in gender transformative continuing education for midwives, led by midwifery associations, can lead to the improvement of midwifery across all United Nations' target areas including governance, health workforce, health system arrangements and education.
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Affiliation(s)
- Kirsty Bourret
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden .,McMaster Midwifery Research Center, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Cristina Mattison
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emmanuelle Hebert
- Bureau des relations internationales, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Ambrocckha Kabeya
- Société Congolaise de la Pratique Sage-femme, Kinshasa, Democratic Republic of the Congo
| | - Stephano Simba
- Tanzania Midwives Association (TAMA), Dar es Salaam, United Republic of Tanzania
| | - Moya Crangle
- Canadian Association of Midwives, Montreal, Quebec, Canada
| | - Elizabeth Darling
- Obstetrics and Gynecology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jamie Robinson
- Canadian Association of Midwives, Montreal, Quebec, Canada
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Mharapara TL, Clemons JH, Greenslade-Yeats J, Ewertowska T, Staniland NA, Ravenswood K. Toward a contextualized understanding of well-being in the midwifery profession: An integrative review. JOURNAL OF PROFESSIONS AND ORGANIZATION 2023. [DOI: 10.1093/jpo/joac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Our integrative review synthesizes and evaluates two decades of empirical research on well-being in the midwifery profession to reveal (1) how researchers have studied midwives’ well-being; (2) key findings of research on midwives’ well-being; (3) underlying assumptions of this research; and (4) limitations of this research. We find that research on midwives’ well-being is disproportionately focused on individual midwives, who are assumed to be largely responsible for their own well-being, and that well-being in the midwifery profession is generally equated with the absence of mental health problems such as burnout, anxiety, and stress. Researchers have largely taken a narrow and instrumental approach to study midwives’ well-being, focusing on work-related antecedents and consequences, and overlooking the influence of nonwork factors embedded in the broader socioeconomic and cultural environment. Drawing on more comprehensive and contextualized well-being frameworks, we propose a research model that (1) expands the well-being construct as it applies to midwives and (2) situates midwives’ well-being in broader social, economic, political, and cultural contexts. Although developed in the midwifery context, our proposed research model can be applied to a host of professions.
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Affiliation(s)
- Tago L Mharapara
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Janine H Clemons
- Midwifery Department , MH Building 640 Great South Road, Manukau, 2025 , New Zealand
| | - James Greenslade-Yeats
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Tanya Ewertowska
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Nimbus Awhina Staniland
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Katherine Ravenswood
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
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Pramono A, Smith J, Bourke S, Desborough J. "We All Believe in Breastfeeding": Australian Midwives' Experience of Implementing the Baby Friendly Hospital Initiative. J Hum Lact 2022; 38:780-791. [PMID: 35792378 DOI: 10.1177/08903344221106473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The education and support of new mothers during the in-hospital stay for childbirth is a critical time to establish breastfeeding. The Baby-Friendly Hospital Initiative was launched in 1991 to encourage maternity services to support and educate mothers to breastfeed by implementing Ten Steps to Successful Breastfeeding. RESEARCH AIM To explore midwives' experiences of implementing the Baby-Friendly Hospital Initiative in a Baby-Friendly accredited public hospital in Australia. METHODS In this prospective, cross-sectional qualitative study we used focus groups to explore midwives' experiences. Midwives (N = 26) participated in two focus groups conducted between October and November 2019. Data were analyzed using thematic analysis. RESULTS Time as a critical resource, and continuity of care, were crosscutting themes that framed midwives' experiences in supporting mothers to breastfeed their babies. Time constraints were experienced both through the health system structure and the BFHI accreditation process. Despite the challenges, the overarching theme-that we all believe in breastfeeding-fueled midwives' motivation. CONCLUSION Health services policy and practice need to consider ways to enable continuity of midwifery care and adequate time for midwives to support women to breastfeed their babies.
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Affiliation(s)
- Andini Pramono
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Julie Smith
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Siobhan Bourke
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
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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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Buchanan K, Newnham E, Ireson D, Davison C, Geraghty S. Care ethics framework for midwifery practice: A scoping review. Nurs Ethics 2022; 29:1107-1133. [PMID: 35395917 DOI: 10.1177/09697330221073996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: As a normative theory, care ethics has become widely theorized and accepted. However, there remains a lack of clarity in relation to its use in practice, and a care ethics framework for practice. Maternity care is fraught with ethical issues and care ethics may provide an avenue to enhance ethical sensitivity.Aim: The purpose of this scoping review is to determine how care ethics is used amongst health professions, and to collate the information in data charts to create a care ethics framework and definition for midwifery practice.Method: The scoping review was conducted according to the Preferred Reporting Items for Scoping reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) recommendations. The search was applied to the databases CINAHL, MEDLINE, PschInfo and Pubmed which were searched in September 2019 and again in July 2021. The inclusion criteria were guided by the mnemonic for search terms: Participants, Concept, and Context (PCC) and included variations of health care professionals, care ethics and utilization. The search was limited to qualitative studies published in English between 2010 and 2021. A data extraction tool was used to extract and synthesize data into categories. The articles were screened for eligibility by title, abstract and full text review, by two independent reviewers.Ethical Considerations: The scoping review was guided by ethical conduct respecting authorship and referencing sources.Results: Twelve of the initially identified 129 studies were included in the scoping review. Data synthesis yielded four categories of care ethics use by health professionals: relationship, context, attention to power and caring practices. In combination, the evidence forms a framework for care ethics use in midwifery practice.Conclusion: Care ethics use by health professionals enhances ethical sensitivity. A framework and definition for care ethics for midwifery practice is proposed. This review will be of interest to midwives and other health practitioners seeking to enhance ethical sensitivity.
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Affiliation(s)
- Kate Buchanan
- School of Nursing and Midwifery, 2498Edith Cowan University, Joondalup, WA, Australia; 3431The University of Notre Dame Australia, Fremantle, WA, Australia
| | | | - Deborah Ireson
- School of Nursing and Midwifery, 2498Edith Cowan University, Joondalup, WA, Australia
| | | | - Sadie Geraghty
- 3431The University of Notre Dame Australia, Fremantle, WA, Australia
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Ekström‐Bergström A, Thorstensson S, Bäckström C. The concept, importance and values of support during childbearing and breastfeeding - A discourse paper. Nurs Open 2022; 9:156-167. [PMID: 34741500 PMCID: PMC8685869 DOI: 10.1002/nop2.1108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing. AIM The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites. DESIGN Discourse paper. METHODS This discourse paper is based on our own experiences and is supported by literature and theory. RESULTS Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered.
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Affiliation(s)
- Anette Ekström‐Bergström
- Department of Health SciencesUniversity WestTrollhättanSweden
- Research Group Family Centered Health (FamCeH)University of SkövdeSkövdeSweden
- School of Health SciencesUniversity of SkövdeSkövdeSweden
| | - Stina Thorstensson
- Research Group Family Centered Health (FamCeH)University of SkövdeSkövdeSweden
- School of Health SciencesUniversity of SkövdeSkövdeSweden
| | - Caroline Bäckström
- Research Group Family Centered Health (FamCeH)University of SkövdeSkövdeSweden
- School of Health SciencesUniversity of SkövdeSkövdeSweden
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Going viral - capacity strengthening in the context of pandemic(s). Best Pract Res Clin Obstet Gynaecol 2021; 80:39-48. [PMID: 34866002 PMCID: PMC8590612 DOI: 10.1016/j.bpobgyn.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/22/2022]
Abstract
Strengthening the capacity of midwives and nurses in low- and middle-income countries to lead research is an urgent priority in embedding and sustaining evidence-based practice and better outcomes for women and newborns during childbearing. International and local travel restrictions, and physical distancing resulting from the COVID-19 pandemic have compromised the delivery of many existing programmes and challenged international partnerships working in maternal and newborn health to adapt rapidly. In this paper, we share the experiences of a midwife-led research partnership between Kenya, Malawi, Tanzania, Uganda, the UK, Zambia and Zimbabwe in sustaining and enhancing capacity strengthening activities remotely in this period. Whilst considerable challenges arose, and not all were overcome, collectively, we gained new insights and important learning which have shifted perspectives and will impact future design and delivery of learning programmes.
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Mattison C, Bourret K, Hebert E, Leshabari S, Kabeya A, Achiga P, Robinson J, Darling E. Health systems factors impacting the integration of midwifery: an evidence-informed framework on strengthening midwifery associations. BMJ Glob Health 2021; 6:bmjgh-2020-004850. [PMID: 34083246 PMCID: PMC8174493 DOI: 10.1136/bmjgh-2020-004850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Midwifery associations are organisations that represent midwives and the profession of midwifery. They support midwives to reduce maternal and newborn mortality and morbidity by promoting the overall integration of midwifery in health systems. Our objective was to generate a framework for evidence-informed midwifery association strengthening. Methods A critical interpretive synthesis complemented by key informant interviews, focus groups, observations, and document review was used to inform the development of concepts and theory. Three electronic bibliographical databases (CINAHL, EMBASE and MEDLINE) were searched through to 2 September 2020. A coding structure was created to guide the synthesis across the five sources of evidence. Results A total of 1634 records were retrieved through electronic searches and 57 documents were included in the critical interpretive synthesis. Thirty-one (31) key informant interviews and five focus groups were completed including observations (255 pages) and audio recordings. Twenty-four (24) programme documents were reviewed. The resulting theoretical framework outlines the key factors by context, describes the system drivers that impact the sustainability of midwifery associations and identifies the key-enabling elements involved in designing programmes that strengthen midwifery associations. Conclusion Midwifery associations act as the web that holds the profession together and are key to the integration of the profession in health systems, supporting enabling environments and improving gender inequities. Our findings highlight that in order to strengthen midwifery (education, regulation and services), we have to lead with association strengthening. Building strong associations is the foundation necessary to create formal quality midwifery education systems and to support midwifery regulation and accreditation mechanisms.
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Affiliation(s)
- Cristina Mattison
- Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Kirsty Bourret
- Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Emmanuelle Hebert
- University of Quebec at Trois-Rivières, Trois-Rivieres, Quebec, Canada.,Congolese Society of Midwifery Practice, Kinshasa, Democratic Republic of Congo
| | - Sebalda Leshabari
- Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ambrocckha Kabeya
- Congolese Society of Midwifery Practice, Kinshasa, Democratic Republic of Congo
| | - Patrick Achiga
- Vice-secretary, South Sudan Nurses and Midwives Association, Juba, South Sudan
| | - Jamie Robinson
- Global Programs Manager, Canadian Association of Midwives, Montreal, Quebec, Canada
| | - Elizabeth Darling
- Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
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Midwives must, obstetricians may: An ethnographic exploration of how policy documents organise intrapartum fetal monitoring practice. Women Birth 2021; 35:e188-e197. [PMID: 34039518 DOI: 10.1016/j.wombi.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The capacity for midwifery to improve maternity care is under-utilised. Midwives have expressed limits on their autonomy to provide quality care in relation to intrapartum fetal heart rate monitoring. AIM To explore how the work of midwives and obstetricians was textually structured by policy documents related to intrapartum fetal heart rate monitoring. METHODS Institutional Ethnography, a critical qualitative approach was used. Data were collected in an Australian hospital with a central fetal monitoring system. Midwives (n=34) and obstetricians (n=16) with experience working with the central fetal monitoring system were interviewed and observed. Policy documents were collected and analysed. FINDINGS Midwives' work was strongly structured by policy documents that required escalation of care for any CTG abnormality. Prior to being able to escalate care, midwives were often interrupted by other clinicians uninvited entry into the room in response to the CTG seen at the central monitoring station. While the same collection of documents guided the work of both obstetricians and midwives, they generated the expectation that midwives must perform certain tasks while obstetricians may perform others. Midwifery work was textually invisible. DISCUSSION AND CONCLUSION Our findings provide a concrete example of the way policy documents both reflect and generate power imbalances in maternity care. Obstetric ways of knowing and doing are reinforced within these documents and continue to diminish the visibility and autonomy of midwifery. Midwifery organisations are well placed to co-lead policy development and reform in collaboration with maternity consumer and obstetric organisations.
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Mordal E, Hanssen I, Biratu AK, Vatne S. Providing safe maternity care under challenging conditions in rural Ethiopia: a qualitative study. BMC Health Serv Res 2021; 21:323. [PMID: 33836722 PMCID: PMC8033678 DOI: 10.1186/s12913-021-06324-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Women’s health and the reduction in the global maternal mortality rate is a research priority worldwide. The aim of this study was to investigate the structural conditions that influence the maternity care provided for women in rural Ethiopia. Methods A qualitative descriptive study was conducted, composed of 28 individual in-depth interviews with midwives and women who had given birth during the past 8 months, and observations of maternity care at health centres and a primary hospital. A thematic analysis was conducted. Results The midwives do their utmost to save the lives of mothers and prioritise saving lives over providing compassionate care. Inadequate resources, such as equipment, medicine and water, affect the quality of care they provide for the birthing women. This creates a conflict between the midwives’ ideals and what conditions allow them to do. Families and the women’s network play important roles in providing care and support to the women who give birth in health facilities. Conclusions Structural conditions make it difficult for Ethiopian midwives in rural areas to provide optimal maternity care. In addition to the availability of professional midwifery care, the expectant mothers’ families and networks also tend to provide important support and care. Further studies on how to improve the quality of maternity care from the women’s perspective are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06324-4.
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Affiliation(s)
- Elin Mordal
- Molde University College, Specialized University in Logistics, Faculty of Health Sciences and Sociale Care, Britvegen 2, 6410, Molde, Norway.
| | - Ingrid Hanssen
- Lovisenberg Diaconal University College, Centre of clinical nursing research Lovisenberggata, 15b, 0456, Oslo, Norway
| | | | - Solfrid Vatne
- Molde University College, Specialized University in Logistics, Faculty of Health Sciences and Sociale Care, Britvegen 2, 6410, Molde, Norway
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20
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Marriott R, Reibel T, Barrett TL, Bowen A, Bradshaw S, Kendall S, Kotz J, Martin T, Monterosso L, Robinson M. Midwifery knowledge of equitable and culturally safe maternity care for Aboriginal women. Birth 2021; 48:132-138. [PMID: 33377233 DOI: 10.1111/birt.12525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Birthing on Noongar Boodjar project (NHMRC Partnership Project #GNT1076873) investigated Australian Aboriginal women and midwives' views of culturally safe care during childbearing. This paper reports on midwifery knowledge of Aboriginal women's cultural needs, their perceptions of health systems issues, and their ability to provide equitable and culturally safe care. METHOD A qualitative study framed by an Indigenous methodology and methods which supported inductive, multilayered analyses and consensus-driven interpretations for two clinical midwife data groups (n = 61) drawn from a larger project data set (n = 145) comprising Aboriginal women and midwives. FINDINGS Midwives demonstrated limited knowledge of Aboriginal women's cultural childbearing requirements, reported inadequate access to cultural education, substituted references to women-centered care in the absence of culturally relevant knowledge and consistently expressed racialized assumptions. Factors identified by midwives as likely to influence the midwifery workforce enabling them to provide culturally safe care for Aboriginal women included more professional development focused on improving understandings of cultural birth practices and health system changes which create safer maternal health care environments for Aboriginal women. CONCLUSIONS Individual, workforce, and health systems issues impact midwives' capability to meet Aboriginal women's cultural needs. An imperative exists for effective cultural education and improved professional accountability regarding Aboriginal women's perinatal requirements and significant changes in health systems to embed culturally safe woman-centered care models as a means of addressing racism in health care.
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Affiliation(s)
- Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - Tracy Reibel
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - Terri-Lee Barrett
- WA Government Department of Health, Child and Adolescent Health Service, Community Health, Perth, Western Australia, Australia
| | - Angela Bowen
- College of Medicine, University of Saskatchewan, Saskatchewan, Saskatoon, Canada
| | - Sue Bradshaw
- Midwifery Services, St John of God, Murdoch Hospital, Murdoch, Western Australia, Australia
| | - Sally Kendall
- Community Nursing and Public Health, University of Kent, Kent, UK
| | - Jayne Kotz
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - Tracy Martin
- Clinical Excellence Division, WA Government Department of Health, Perth, Western Australia, Australia
| | - Leanne Monterosso
- Notre Dame University, Fremantle, Western Australia, Australia.,St John of God, Murdoch Hospital, Murdoch, Western Australia, Australia
| | - Melanie Robinson
- WA Government Department of Health, Child and Adolescent Health Service, Community Health, Perth, Western Australia, Australia
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21
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Rocca-Ihenacho L, Yuill C, McCourt C. Relationships and trust: Two key pillars of a well-functioning freestanding midwifery unit. Birth 2021; 48:104-113. [PMID: 33314346 DOI: 10.1111/birt.12521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite strong evidence supporting the expansion of midwife-led unit provision, as a result of optimal maternal and perinatal outcomes, cost-effectiveness, and positive service user and staff experiences, scaling-up has been slow. Systemic barriers associated with gender, professional, economic, cultural, and social factors continue to constrain the expansion of midwifery as a public health intervention globally. This article aimed to explore relationships and trust as key components of a well-functioning freestanding midwifery unit (FMU). METHOD(S) A critical realist ethnographic study of an FMU located in East London, England, was conducted over a period of 15 months. Recruitment of the 82 participants was purposive. Data collection included participant observation and semi-structured interviews, and data were analyzed thematically along with relevant local guidelines and documents. RESULTS Twelve themes emerged. Relationships and Trust were identified as a core theme. The other 11 themes were grouped into six families, three of which: Ownership, Autonomy, and Continuous Learning; Team Spirit, Interdependency, and Power Relations; and Salutogenesis will be covered in this paper. The remaining three families: Friendly Environment; Having Time and Mindfulness; and Social Capital, will be covered in a separate paper. CONCLUSIONS A relationship-based model of care was crucial for both the functioning of the FMU and service users' satisfaction and may offer a compelling response to high levels of stress and burnout among midwives.
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Affiliation(s)
- Lucia Rocca-Ihenacho
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Cassandra Yuill
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Christine McCourt
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
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Hamlin L, Grunwald L, Sturdivant RX, Koehlmoos TP. Comparison of Nurse-Midwife and Physician Birth Outcomes in the Military Health System. Policy Polit Nurs Pract 2021; 22:105-113. [PMID: 33615908 DOI: 10.1177/1527154421994071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America's largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012-2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women's health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.
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Affiliation(s)
- Lynette Hamlin
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Lindsay Grunwald
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | | | - Tracey P Koehlmoos
- Health Services Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
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How maternity waiting home use influences attendance of antenatal and postnatal care. PLoS One 2021; 16:e0245893. [PMID: 33481942 PMCID: PMC7822518 DOI: 10.1371/journal.pone.0245893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022] Open
Abstract
As highlighted in the International Year of the Nurse and the Midwife, access to quality nursing and midwifery care is essential to promote maternal-newborn health and improve survival. One intervention aimed at improving maternal-newborn health and reducing underutilization of pregnancy services is the construction of maternity waiting homes (MWHs). The purpose of this study was to assess whether there was a significant change in antenatal care (ANC) and postnatal care (PNC) attendance, family planning use, and vaccination rates before and after implementation of the Core MWH Model in rural Zambia. A quasi-experimental controlled before-and-after design was used to evaluate the impact of the Core MWH Model by assessing associations between ANC and PNC attendance, family planning use, and vaccination rates for mothers who gave birth to a child in the past 13 months. Twenty health care facilities received the Core MWH Model and 20 were identified as comparison facilities. Before-and-after community surveys were carried out. Multivariable logistic regression were used to assess the association between Core MWH Model use and ANC and PNC attendance. The total sample includes 4711 mothers. Mothers who used the Core MWH Model had better ANC and PNC attendance, family planning use, and vaccination rates than mothers who did not use a MWH. All mothers appeared to fare better across these outcomes at endline. We found an association between Core MWH Model use and better ANC and PNC attendance, family planning use, and newborn vaccination outcomes. Maternity waiting homes may serve as a catalyst to improve use of facility services for vulnerable mothers.
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Donnellan-Fernandez RE, Creedy DK, Callander EJ, Gamble J, Toohill J. Differential access to continuity of midwifery care in Queensland, Australia. AUST HEALTH REV 2021; 45:28-35. [DOI: 10.1071/ah19264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/17/2020] [Indexed: 11/23/2022]
Abstract
ObjectiveTo determine maternal access to continuity of midwifery care in public maternity hospitals across the state of Queensland, Australia.
MethodsMaternal access to continuity of midwifery care in Queensland was modelled by considering the proportion of midwives publicly employed to provide continuity of midwifery care alongside 2017 birth data for Queensland Hospital and Health Services. The model assumed an average caseload per full-time equivalent midwife working in continuity of care with 35 women per annum, based on state Nursing and Midwifery Award conditions. Hospitals were grouped into five clusters using standard Australian hospital classifications.
ResultsTwenty-seven facilities (out of 39, 69%) across all 15 hospital and health services in Queensland providing a maternity service offered continuity of midwifery care in 2017 (birthing onsite). Modelling applying the assumed caseload of 35 women per full-time equivalent midwife found wide variations in the percentage of women able to access continuity of midwifery care, with access available for an estimated 18% of childbearing women across the state. Hospital classifications with higher clinical services capability and birth volume did not equate with higher access to continuity of midwifery care in metropolitan areas. Regional health services with level 3 district hospitals assisting with <500 births showed higher levels of access, potentially due to additional challenges to meet local population needs to those of a metropolitan service. Access to full continuity of midwifery care in level 3 remote hospitals (<500 births) was artificially inflated due to planned pre-labour transfers for women requiring specialised intrapartum care and women who planned to birth at other hospitals.
ConclusionsDespite strong evidence that continuity of midwifery care offers optimal care for women and their babies, there was significant variation in implementation and scale-up of these models across hospital jurisdictions.
What is known about the topic?Access to continuity of midwifery care for pregnant women within the public health system varies widely; however, access variation among different hospital classification groups in Australian states and territories has not been systematically mapped.
What does this paper add?This paper identified differential access to continuity of midwifery care among hospital classifications grouped for clinical services capability and birth volume in one state, Queensland. It shows that higher clinical services capability and birth volume did not equate with higher access to continuity of midwifery care in metropolitan areas.
What are the implications for practitionersScaling up continuity of midwifery care among all hospital classification groups in Queensland remains an important public health strategy to address equitable service access.
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Geleto A, Chojenta C, Taddele T, Loxton D. Perceptions of midwives on the quality of emergency obstetric care at hospitals in Ethiopia: A qualitative explanatory study. Midwifery 2020; 90:102814. [PMID: 32763670 DOI: 10.1016/j.midw.2020.102814] [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: 11/21/2019] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Ethiopia, maternal mortality remains an important public health concern. High maternal mortality is attributed in part to the poor quality of obstetric care. This study was designed to investigate perceptions of midwives about the quality of emergency obstetric care provided at hospitals in the Harari region of Ethiopia. METHODS An explanatory qualitative study was conducted from December 2018 to February 2019 at public and private hospitals in the Harari region, Ethiopia. The data were obtained through in-depth interviews with 12 midwives working in maternity units. The interviewers took notes and audio-recorded the respondents' descriptions. Braun and Clarke's thematic analysis method was employed to analyse the data using Nvivo 12 qualitative data analysis software. RESULTS Poorly designed infrastructure, including a scarcity of beds, rooms and ambulances challenged the provision of quality obstetric services. Midwives working at hospitals were inadequate in number and training opportunities were scarce. Language barriers affected effective communication between patients and caregivers. Frequent disruptions to medical supplies resulted in the provision of suboptimal obstetric care as it created an inability to provide appropriate medications. A lack of treatment protocols, poor supportive supervision, and poor staff motivation impaired the provision of quality obstetric care at hospitals, although disparities were observed among hospitals in this regard. CONCLUSIONS Several interdependent factors limited the quality of emergency obstetric care at hospitals in the region. Quality improvement initiatives and equitable resource distribution for hospitals need to be enhanced while the existing health infrastructure, resources and service delivery management need to be strengthened.
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Affiliation(s)
- Ayele Geleto
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
| | - Tefera Taddele
- Health System and Reproductive Health Directorate, the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
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Mattison CA, Lavis JN, Wilson MG, Hutton EK, Dion ML. A critical interpretive synthesis of the roles of midwives in health systems. Health Res Policy Syst 2020; 18:77. [PMID: 32641053 PMCID: PMC7346500 DOI: 10.1186/s12961-020-00590-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwives' roles in sexual and reproductive health and rights continues to evolve. Understanding the profession's role and how midwives can be integrated into health systems is essential in creating evidence-informed policies. Our objective was to develop a theoretical framework of how political system factors and health systems arrangements influence the roles of midwives within the health system. METHODS A critical interpretive synthesis was used to develop the theoretical framework. A range of electronic bibliographic databases (CINAHL, EMBASE, Global Health database, HealthSTAR, Health Systems Evidence, MEDLINE and Web of Science) was searched through to 14 May 2020 as were policy and health systems-related and midwifery organisation websites. A coding structure was created to guide the data extraction. RESULTS A total of 4533 unique documents were retrieved through electronic searches, of which 4132 were excluded using explicit criteria, leaving 401 potentially relevant records, in addition to the 29 records that were purposively sampled through grey literature. A total of 100 documents were included in the critical interpretive synthesis. The resulting theoretical framework identified the range of political and health system components that can work together to facilitate the integration of midwifery into health systems or act as barriers that restrict the roles of the profession. CONCLUSIONS Any changes to the roles of midwives in health systems need to take into account the political system where decisions about their integration will be made as well as the nature of the health system in which they are being integrated. The theoretical framework, which can be thought of as a heuristic, identifies the core contextual factors that governments can use to best leverage their position when working to improve sexual and reproductive health and rights.
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Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, 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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Cadée F, Nieuwenhuijze MJ, Lagro-Janssen ALM, de Vries R. Paving the way for successful twinning:: Using grounded theory to understand the contribution of twin pairs in twinning collaborations. Women Birth 2020; 34:14-21. [PMID: 32089457 DOI: 10.1016/j.wombi.2020.01.013] [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: 12/10/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Twinning collaborations, where two groups - from educational institutions, hospitals or towns - work together cross-culturally on joint goals, are increasingly common worldwide. Pairing up individuals, so-called twin pairs, is thought to contribute to successful collaboration in twinning projects, but as yet, there is no empirical evidence or theory that offers insight into the value of the pair relationship for twinning. AIM To explore the contribution of one-to-one relationships between twins to twinning projects, as exemplified in projects between Dutch and Moroccan, and Dutch and Sierra Leone midwives. METHODS We conducted thirteen in-depth interviews with midwives from two twinning collaborations. Interviews were transcribed and analysed using an iterative, grounded theory process, yielding a theoretical understanding of one-to-one twinning relationships for twinning collaborations. FINDINGS Participant comments fell into four substantive categories: 1) Being named a twin, 2) moving beyond culture to the personal level, 3) searching for common ground to engage, 4) going above and beyond the twinning collaboration. Their interplay demonstrates the value of twin pairs in paving the way for successful twinning. DISCUSSION A complex combination of contextual inequities, personality, and cultural differences affect the twin relationship. Trusting relationships promote effective collaboration, however, as 'trust' cannot be mandated, it must be built by coaching twins in personal flexibility and (cultural) communication. CONCLUSION By offering original insights into the ways twinning relationships are built, our research explores how twin pairs can enhance the success of twinning projects.
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Affiliation(s)
- Franka Cadée
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands.
| | - Marianne J Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
| | - A L M Lagro-Janssen
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Raymond de Vries
- Center for Bioethics and Social Sciences in Medicine University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, 419W, Ann Arbor, MI 48109-2800, USA
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