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Sheffield EC, Fritz AH, Interrante JD, Kozhimannil KB. The Availability of Midwifery Care in Rural United States Communities. J Midwifery Womens Health 2024. [PMID: 39044450 DOI: 10.1111/jmwh.13676] [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] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities. METHODS We developed and conducted a national survey of rural US hospitals with current or recently closed childbirth services. Maternity unit managers or administrators at 292 rural hospitals were surveyed from March to August 2021, with 133 hospitals responding (response rate 46%; 93 currently offering childbirth services, 40 recently closed childbirth services). This cross-sectional analysis describes whether rural hospitals with current or prior childbirth services had midwifery care with certified nurse-midwives available locally and whether rural communities with and without midwifery care differed by hospital-level and county-level characteristics. RESULTS Among hospitals surveyed, 55% of those with current and 75% of those with prior childbirth services reported no locally available midwifery care. Of the 93 rural communities with current hospital-based childbirth services, those without midwifery care were more likely to have lower populations (37% vs 33%); majority populations that were Black, Indigenous, and people of color (24% vs 10%); and hospitals where at least 50% of births were Medicaid funded (77% vs 64%), compared with communities with midwifery care. Conversely, communities with midwifery care more often had greater than 30% of patients traveling more than 30 miles for hospital-based childbirth services (38% vs 28%). DISCUSSION More than half of rural hospitals surveyed reported no locally available midwifery care, and availability differed by hospital-level and county-level characteristics. Efforts to ensure pregnancy and childbirth care access for rural birthing people should include attention to the availability of local midwifery care.
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Affiliation(s)
- Emily C Sheffield
- University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Alyssa H Fritz
- University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Julia D Interrante
- University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Katy Backes Kozhimannil
- University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Anyiam S, Woo J, Spencer B. Listening to Black Women's Perspectives of Birth Centers and Midwifery Care: Advocacy, Protection, and Empowerment. J Midwifery Womens Health 2024. [PMID: 38689459 DOI: 10.1111/jmwh.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/01/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Black women in Texas experience high rates of adverse maternal outcomes that have been linked to health inequities and structural racism in the maternal care system. Birth centers and midwifery care are highlighted in the literature as contributing to improved perinatal care experiences and decreased adverse outcomes for Black women. However, compared with White women, Black women underuse birth centers and midwifery care. Black women's perceptions in Texas of birth center and midwifery care are underrepresented in research. Thus, this study aimed to highlight the views of Black women residing in Texas on birth centers and midwifery care to identify their needs and explore ways to increasing access to perinatal care. METHODS Semistructured interviews were conducted with 10 pregnant and postpartum Black women residing in Texas. Questions focused on the women's access, knowledge, and use of birth centers and midwifery care in the context of their lived maternal care experiences. Interview transcripts were reviewed and analyzed using inductive, qualitative content analysis. RESULTS The Black women interviewed all shared experiences of discrimination and bias while receiving obstetric care that affected their interest in and overall perceptions of birth center and midwifery care. Participants also discussed financial and institutional barriers that impacted their ease of access to birth center and midwifery care services. Additionally, participants highlighted the need for culturally sensitive and respectful perinatal health care. DISCUSSION The Black women interviewed in this study emphasized the prevalence of racism and discrimination in perinatal health care encounters, a reflection consistent with current literature. Black women also expressed a desire to use birth centers and midwifery care but identified the barriers in Texas that impede access. Study findings highlight the need to address barriers to promote equitable perinatal health care access for Black women.
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Affiliation(s)
- Shalom Anyiam
- College of Nursing, Texas Woman's University, Dallas, Texas
| | - Jennifer Woo
- College of Nursing, Texas Woman's University, Dallas, Texas
| | - Becky Spencer
- College of Nursing, Texas Woman's University, Dallas, Texas
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Cignacco E, Schlenker A, Ammann-Fiechter S, Damke T, de Labrusse CC, Krahl A, Stocker Kalberer B, Weber-Käser A. Advanced Midwifery Practice in Switzerland: Development and challenges. Eur J Midwifery 2024; 8:EJM-8-15. [PMID: 38650967 PMCID: PMC11034162 DOI: 10.18332/ejm/185648] [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: 12/29/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/25/2024] Open
Abstract
Midwifery is undergoing increasing complexity attributed to global epidemiological, socio-economic and technological shifts. Coupled with a shortage of workforce and the imperative for cost-effectiveness and high-quality care, there is an ongoing international discourse and establishment of new care models and specialized roles, notably Advanced Midwifery Practice (AMP). While countries like the UK and Ireland have embraced AMP roles, Switzerland lags behind with only a few pioneering roles. The absence of regulatory frameworks for AMP within the Swiss legal and healthcare system, hinders the evolution of APM roles necessary to address contemporary needs in perinatal healthcare provision. To effectively harness the midwifery workforce and mitigate premature attrition, Switzerland must formulate distinct career trajectories for postgraduate midwives, particularly for Advanced Practice Midwives (APM). This involves establishing legal standards for educational and clinical prerequisites, delineating guidelines for APM responsibilities and competencies, and devising compensation schemes that mirror the autonomy and leadership competencies integral to these advanced roles within inpatient and outpatient perinatal care models. The incorporation of evaluation and research into AMP is indispensable, contributing to improved patient outcomes and the ongoing professionalization of midwifery. In conjunction with the Swiss Federation of Midwives, all Universities of Applied Sciences in Switzerland have collaboratively drafted a national position paper underscoring the significance of developing APM roles to ensure the provision of high-quality perinatal care. This article aims to elucidate current developments in perinatal care within the Swiss context, providing a comprehensive definition for AMP, delineating its contribution to enhancing and sustaining the quality of care.
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Affiliation(s)
- Eva Cignacco
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Anja Schlenker
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Silvia Ammann-Fiechter
- Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Therese Damke
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Claire C. de Labrusse
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Astrid Krahl
- Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
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Thompson-Lastad A, Harrison JM, Taiwo TK, Williams C, Parimi M, Wilborn B, Chao MT. Postpartum care for parent-infant dyads: A community midwifery model. Birth 2024. [PMID: 38590170 DOI: 10.1111/birt.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Postpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present community midwifery postpartum care in the United States as a model concordant with World Health Organization guidelines, describing this model of care and its potential to improve postpartum health for birthing people and babies. METHODS We conducted semi-structured interviews with 34 community midwives providing care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis. RESULTS A total of 24 participants were Certified Professional Midwives; 10 were certified nurse-midwives. A total of 14 midwives identified as people of color. Most spoke multiple languages. We describe six key elements of the community midwifery model of postpartum care: (1) multiple visits, including home visits; typically five to eight over six weeks postpartum; (2) care for the parent-infant dyad; (3) continuity of personalized care; (4) relationship-centered care; (5) planning and preparation for postpartum; and (6) focus on postpartum rest. CONCLUSION The community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad and may address rising pregnancy-related morbidity and mortality in the United States.
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Affiliation(s)
- Ariana Thompson-Lastad
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Jessica M Harrison
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | | | - Chanda Williams
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | - Mounika Parimi
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Briana Wilborn
- Department of Family Health Care Nursing (*alum), School of Nursing, University of California, San Francisco, California, USA
| | - Maria T Chao
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California, USA
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Hamilton FL, Pleasant V. Obstetrics and Gynecology Care in Latinx Communities. Obstet Gynecol Clin North Am 2024; 51:105-124. [PMID: 38267122 DOI: 10.1016/j.ogc.2023.11.007] [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] [Indexed: 01/26/2024]
Abstract
The Latinx community represents the largest racial minority population in the nation. There are significant barriers to care and treatment as it relates to obstetrics and gynecology. Understanding cultural considerations is essential to improving care in this community. Public health strategies as well as policies to address racial health disparities facing the Latinx community are explored in this article.
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Affiliation(s)
- Felicia L Hamilton
- Department of Obstetrics & Gynecology, OB/Gyn Practice Committee, MedStar Washington Hospital Center, Georgetown University Medical Center, 110 Irving Street, Northwest Room 5B-45A, Washington, DC 20010, USA.
| | - Versha Pleasant
- Department of Obstetrics and Gynecology, Cancer Genetics & Breast Health Clinic, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Pelak H, Dahlen HG, Keedle H. A content analysis of women's experiences of different models of maternity care: the Birth Experience Study (BESt). BMC Pregnancy Childbirth 2023; 23:864. [PMID: 38102547 PMCID: PMC10722666 DOI: 10.1186/s12884-023-06130-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Pregnancy, birth, and early parenthood are significant life experiences impacting women and their families. Growing evidence suggests models of maternity care impact clinical outcomes and birth experiences. The aim of this study was to explore the strengths and limitations of different maternity models of care accessed by women in Australia who had given birth in the past 5 years. METHODS The data analysed and presented in this paper is from the Australian Birth Experience Study (BESt), an online national survey of 133 questions that received 8,804 completed responses. There were 2,909 open-ended comments in response to the question on health care provider/s. The data was analysed using content analysis and descriptive statistics. RESULTS In models of fragmented care, including standard public hospital care (SC), high-risk care (HRC), and GP Shared care (GPS), women reported feelings of frustration in being unknown and unheard by their health care providers (HCP) that included themes of exhaustion in having to repeat personal history and the difficulty in navigating conflicting medical advice. Women in continuity of care (CoC) models, including Midwifery Group Practice (MGP), Private Obstetric (POB), and Privately Practising Midwifery (PPM), reported positive experiences of healing past birth trauma and care extending for multiple births. Compared across models of care in private and public settings, comments in HRC contained the lowest percentage of strengths (11.94%) and the highest percentage of limitations (88.06%) while comments in PPM revealed the highest percentage of strengths (95.93%) and the lowest percentage of limitations (4.07%). CONCLUSIONS Women across models of care in public and private settings desire relational maternity care founded on their unique needs, wishes, and values. The strengths of continuity of care, specifically private midwifery, should be recognised and the limitations for women in high risk maternity care investigated and prioritised by policy makers and managers in health services. TRIAL REGISTRATION The study is part of a larger project that has been retrospectively registered with OSF Registries Registration DOI https://doi.org/10.17605/OSF.IO/4KQXP .
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Affiliation(s)
- Helen Pelak
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 167 Great Western Highway, Blackheath, Penrith, NSW, 2751, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 167 Great Western Highway, Blackheath, Penrith, NSW, 2751, Australia
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 167 Great Western Highway, Blackheath, Penrith, NSW, 2751, Australia.
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Martin E, Ayoub B, Miller YD. A systematic review of the cost-effectiveness of maternity models of care. BMC Pregnancy Childbirth 2023; 23:859. [PMID: 38093244 PMCID: PMC10717830 DOI: 10.1186/s12884-023-06180-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES In this systematic review, we aimed to identify the full extent of cost-effectiveness evidence available for evaluating alternative Maternity Models of Care (MMC) and to summarize findings narratively. METHODS Articles that included a decision tree or state-based (Markov) model to explore the cost-effectiveness of an MMC, and at least one comparator MMC, were identified from a systematic literature review. The MEDLINE, Embase, Web of Science, CINAHL and Google Scholar databases were searched for papers published in English, Arabic, and French. A narrative synthesis was conducted to analyse results. RESULTS Three studies were included; all using cost-effectiveness decision tree models with data sourced from a combination of trials, databases, and the literature. Study quality was fair to poor. Each study compared midwife-led or doula-assisted care to obstetrician- or physician-led care. The findings from these studies indicate that midwife and doula led MMCs may provide value. CONCLUSION The findings of these studies indicate weak evidence that midwife and doula models of care may be a cost-effective or cost-saving alternative to standard care. However, the poor quality of evidence, lack of standardised MMC classifications, and the dearth of research conducted in this area are barriers to conclusive evaluation and highlight the need for more research incorporating appropriate models and population diversity.
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Affiliation(s)
- Elizabeth Martin
- Wesley Research Institute, Auchenflower, Qld, Australia.
- Mater Research Institute - University of Queensland, South Brisbane, Qld, Australia.
| | - Bassel Ayoub
- School of Public Health and Social Work, Faculty of Health, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Qld, Australia
| | - Yvette D Miller
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
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Hoehn-Velasco L, Jolles DR, Plemmons A, Silverio-Murillo A. Health outcomes and provider choice under full practice authority for certified nurse-midwives. JOURNAL OF HEALTH ECONOMICS 2023; 92:102817. [PMID: 37778146 DOI: 10.1016/j.jhealeco.2023.102817] [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: 07/01/2021] [Revised: 05/15/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
Full practice authority grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration. In this study, we consider whether full practice authority for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008-2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, full practice authority increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore the mechanisms behind the increase in CNM/CM-attended deliveries, demonstrating that the rise in CNM/CM-attended deliveries represents higher use of existing CNM/CMs and is not fully explainable by improved reporting of CNM/CM deliveries or changes in CNM/CM labor supply.
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Affiliation(s)
- Lauren Hoehn-Velasco
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, United States of America.
| | | | - Alicia Plemmons
- Department of General Business, West Virginia University, United States of America
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McLean KA, Souter VL, Nethery E. Expanding midwifery care in the United States: Implications for clinical outcomes and cost. Birth 2023; 50:935-945. [PMID: 37449767 DOI: 10.1111/birt.12748] [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] [Received: 05/12/2022] [Revised: 07/22/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND This study compared clinical and financial outcomes for low-risk birthing people between those attended by midwives and those attended by obstetricians during hospital births. METHODS We conducted a retrospective cohort analysis of births from January 1, 2016 to December 31, 2020 at hospitals participating in a perinatal quality improvement collaborative, Obstetrical Care Outcomes Assessment Program (OB COAP), in the Northwest region of the United States and estimated risk ratios using a multivariate regression approach with a modified Poisson binomial for mode of delivery, labor interventions, and newborn outcomes comparing midwife-led to obstetrician-led care. Using publicly available data on average costs of vaginal and cesarean births, we then extrapolated the cost differences in care between midwives and obstetricians. RESULTS Births in the midwife group were less likely to be associated with induction (17.6% vs. 20.3% RR 0.74; 95% CI 0.70-0.78), epidural use (58.9% vs. 76.3% RR 0.78; 95% CI 0.77-0.80), and episiotomy (2.2% vs. 3.4% RR 0.68; 95% CI 0.58-0.81). Cesarean birth was also lower in the midwifery group (7.8% vs. 12.3% RR 0.68, 95% CI 0.62-0.73), without a corresponding increase in risk in adverse neonatal outcomes. We estimated that expanding midwifery care to 100% of low-risk births across the United States could save as much as $340 million per year. CONCLUSIONS Midwifery care is associated with a lower risk of cesarean birth and other interventions versus care provided by obstetricians and is therefore likely lower-cost.
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Affiliation(s)
| | | | - Elizabeth Nethery
- The School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Clark E, Solomon J, Cunningham SD, Bard K, Storey AS. Leadership Link: Evaluation of an Online Leadership Curriculum for Certified Midwives and Certified Nurse-Midwives. J Midwifery Womens Health 2023; 68:627-636. [PMID: 37202902 DOI: 10.1111/jmwh.13508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Midwifery leadership is vital for improving maternal health outcomes, yet limited leadership training opportunities exist. This study evaluated acceptability and preliminary outcomes of Leadership Link, a scalable online learning program that aims to increase midwives' leadership competencies. METHODS The program evaluation study enrolled early-career midwives (<10 years since certification) into an online leadership curriculum using the LinkedIn Learning platform. The curriculum consisted of 10 courses (approximately 11 hours) of self-paced, non-health care-specific leadership content supplemented with brief midwifery-specific introductions from midwifery leaders. A preprogram, postprogram, and follow-up study design was used to evaluate changes in 16 self-assessed leadership abilities, self-perception as a leader, and resilience. Data were also collected on the application of leadership skills acquired through, and career advancements attributed to, program participation. RESULTS A total of 186 individuals activated LinkedIn Learning accounts. Almost half (41.9%) completed the full curriculum. Satisfaction was high, with 83.3% of postprogram survey respondents reporting the program was "probably" or "definitely" worth the time invested. Seventy-six participants (40.9%) provided matched pre- and immediate postprogram survey data on at least some of the 16 self-assessed leadership abilities. All 16 abilities showed statistically significant increases in pre- to postprogram mean scores, ranging from 6.4% to 32.5%. Both self-perception as a leader and resilience scores significantly increased from baseline. More than 87% of postprogram and follow-up survey respondents reported having applied new or improved leadership abilities to at least a small degree. Fifty-eight percent of follow-up survey respondents reported at least one midwifery career advancement, of whom 43.6% attributed the advancement, at least in part, to Leadership Link. DISCUSSION The findings suggest that the online Leadership Link curriculum is acceptable and may be effective in improving midwives' leadership capacity, potentially enhancing career opportunities and engagement in system change.
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Affiliation(s)
- Emma Clark
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Julie Solomon
- J. Solomon Consulting, LLC, Mountain View, California
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Kristin Bard
- J. Solomon Consulting, LLC, Mountain View, California
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Katinaitė-Vaitkevičienė J, Patapas A. Assessment of the Quality of Obstetric Services From the Perspective of Maternity Patients and Service Providers in a Tertiary Care Obstetric Unit in Lithuania. Health Serv Insights 2023; 16:11786329231180790. [PMID: 37377885 PMCID: PMC10291411 DOI: 10.1177/11786329231180790] [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: 04/13/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Although largely focused on the patient, the provision of healthcare services is a 2-way process and its success hinges on the interactions between patients and physicians. Given the growing role of subjective, patient-dependent assessment of the quality of care received, which is increasingly influenced by the individual aspects of the interaction between patients and care providers, in addition to the explicitly measurable, objective assessment of the quality of care received based on clinical indicators, quality assessment of services should especially consider and explore the attitudes, needs and dynamics of all the parties involved in the healthcare process. This study was designed to assess the attitudes of maternity patients and healthcare providers towards the quality of obstetric care. A quantitative questionnaire survey was conducted in a tertiary level healthcare facility providing obstetric services in Lithuania. Research findings suggested that maternity patients rate both the technical and functional quality of obstetric services higher than the staff providing it. Midwives and obstetricians-gynaecologists view quality assurance as a complex process, rather than focus solely on quantitative indicators. Since midwives were rated slightly higher than physicians in terms of services they provide, it may be appropriate to ensure and encourage a wider use of midwife-only deliveries in low-risk births. A comprehensive assessment of the quality assurance aspects as viewed by the patients and the staff should be included in the regular quality assessments of healthcare facilities as one of the most informative assessment tools on the service quality.
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Mahsa KR, Shahla K, Mosadeghrad AM, Elham EC, Mirmolaei ST. Challenges of midwifery staff at Tehran hospitals: A qualitative study from the midwifery managers perspective. Nurs Open 2023. [PMID: 37144358 DOI: 10.1002/nop2.1778] [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: 07/01/2022] [Revised: 03/02/2023] [Accepted: 04/16/2023] [Indexed: 05/06/2023] Open
Abstract
AIM This study aimed to investigate the challenges faced by midwifery staff working in hospitals from midwifery manager's perspectives and provide suggestions to solve them. DESIGN Descriptive qualitative study. METHODS The study was conducted in Tehran in 2021. Data were collected using fifteen semi-structured interviews conducted with hospitals' clinical midwifery managers over 7 months. The interview data were grouped into three themes: recruitment, development, and maintenance. RESULTS The midwifery workforce would face significant challenges in training hospitals. Lack of suitable patterns of midwifery workforce management, the non-optimal midwives' utilization and deployment, unclear job boundaries, weak training programs for the midwives' professional development, and unpleasant working atmosphere were the main challenges. A well-defined task description for midwives to determine their position in all spheres of reproductive health service provision, create training courses based on skill gaps, and focus on improving labour relations and organizational culture are suggested. PATIENT OR PUBLIC CONTRIBUTION Midwifery managers were interviewed. They talked about their experience with midwifery workforce challenges.
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Affiliation(s)
- Khoshnam Rad Mahsa
- Ph.D. in Reproductive Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosravi Shahla
- Department of Community Medicine, Faculty Member of Medicine School, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohamad Mosadeghrad
- Professor of Health Policy, Management, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsani-Chimeh Elham
- National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Tahereh Mirmolaei
- Department of Midwifery and Reproductive Health, Tehran University of Medical Sciences, Tehran, Iran
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Sampurna MTA, Handayani KD, Utomo MT, Angelika D, Etika R, Harianto A, Mapindra MP, Mahindra MP, Efendi F, Kaban RK, Rohsiswatmo R, Visuddho V, Permana PBD. Determinants of neonatal deaths in Indonesia: A national survey data analysis of 10,838 newborns. Heliyon 2023; 9:e12980. [PMID: 36820170 PMCID: PMC9938489 DOI: 10.1016/j.heliyon.2023.e12980] [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: 03/19/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Background Neonatal mortality is one of the key impediments in achieving global sustainable development goals, especially in lower middle income countries (LMICs). As an LMIC with the highest reported neonatal mortality rate in Southeast Asia, Indonesia faces inequitable distribution of health facilities across the archipelago. Therefore, in this paper, we aim to evaluate the determinants of neonatal mortality rate in Indonesia to search for better strategies to overcome this problem. Methods We conducted an analysis of the 2017 Indonesia Demographic Health Survey dataset of 10,838 live-born infants born from singleton pregnancies in 2017. Using a hierarchical approach, multivariate analysis was conducted to identify potential factors (including socioeconomic, household, and proximate determinants) that contributed to neonatal mortality. Results The lack of participation in postnatal care [odds ratio (OR) = 20.394, p = 0.01)] and delivery complications other than prolonged labour (OR = 2.072, p = 0.02) were the maternal factors that significantly associated with increased risk of neonatal death. Regarding neonatal factors, low-birth-weight infants appeared to be more vulnerable to neonatal death (OR = 12.489, p = 0.01). Conclusion Low participation in postnatal care, development of labour complications, and low birth weight were associated with higher neonatal mortality. It implies that in a limited resource and geographically challenging country such as Indonesia, improving the quality and optimizing services of public hospitals with equitable distribution of quality health care services in all regions should be prioritized in the efforts of reducing neonatal mortality rate.
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Affiliation(s)
- Mahendra Tri Arif Sampurna
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia,Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia,Corresponding author. Jl. Mayjen Prof. Dr. Moestopo No. 47, Pacar Kembang, Kec. Tambaksari, Kota Surabaya, Jawa Timur, 60132, Indonesia.
| | - Kartika Dharma Handayani
- Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Martono Tri Utomo
- Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Dina Angelika
- Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Risa Etika
- Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Agus Harianto
- Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Pradhika Mapindra
- Neonatology Department, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Muhammad Pradhiki Mahindra
- Maternal-Fetal Medicine Department, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Ferry Efendi
- Nursing Faculty, Universitas Airlangga, Indonesia
| | - Risma Kerina Kaban
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rinawati Rohsiswatmo
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Visuddho Visuddho
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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CNM/CMs Fill the Gap in Rural Maternal Care. Clin Obstet Gynecol 2022; 65:808-816. [PMID: 36162088 DOI: 10.1097/grf.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The United States is in the midst of a maternity care crisis. A key driver is workforce shortages, which impacts maternity care service delivery in rural areas significantly. The midwifery model of care remains underutilized. Midwifery care delivered by certified nurse-midwives and certified midwives is heavily endorsed and supported in the extant literature, but no firm national actions have been taken to move recommendations into funding or practice. Certified nurse-midwives and Certified Midwives are able to care for low-risk pregnancies and are uniquely situated to address factors associated with social determinants of health in rural areas. One of the solutions to the rural maternity care crisis is scaling up the midwifery workforce. Individual, institutional, state, and federal factors are discussed.
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15
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Grayson N, Quinones N, Oseguera T. A Model of True CHOICES: Learnings from a Comprehensive Sexual and Reproductive Health Clinic in Tennessee that Provides Abortions and Opened the City's First Birth Center. J Midwifery Womens Health 2022; 67:689-695. [PMID: 36471539 DOI: 10.1111/jmwh.13448] [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: 03/02/2022] [Revised: 08/16/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
Abstract
CHOICES Memphis Center for Reproductive Health staff is passionate about ensuring that everyone has access to the full continuum of comprehensive reproductive health care (including abortion, gender-affirming care, miscarriage management, and community birth) regardless of race, gender identity, sexual orientation, HIV status, economic status, or religious beliefs. Memphis, Tennessee, has a history of limited community birth options (birthing outside of hospital walls). In 2017, when home birth services were added to CHOICES and plans for opening Memphis' first freestanding birth center were being imagined, it was intentional to create a model in which midwifery care could be accessible for patients who may be eligible for state-funded health care services, those considered at higher health risk than traditional low-risk midwifery patients, or both. In fact, individuals and their families with limited out-of-pocket funds and those historically marginalized would purposely receive holistic, individualized care based on their unique health care needs and personal desires, driven by a reproductive justice framework. In this article, we outline the success and challenges of addressing the reproductive health needs of marginalized communities, including the benefits of a nonprofit business model, operationalizing reproductive justice concepts, and the reclamation of Black midwifery. We also discuss the challenges of caring for Black birthing people and providing abortion and gender-affirming care in a politically hostile environment. Although individuals have complex needs, at its core, CHOICES believes that every person must be seen as whole human beings and that each can be cared for by a midwife. The CHOICES approach is informed by evidence-based information, clinical judgment, and an intentional partnership with and investment in a people who have historically been and are presently pushed to the margins, neglected, and blamed for poor health outcomes and demise. Striving to adapt the CHOICES model of care in other parts of the country is important now more than ever following the Supreme Court decision to overturn Roe v. Wade.
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Affiliation(s)
- Nikia Grayson
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
| | - Nicole Quinones
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
| | - Talita Oseguera
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
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16
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Bradford H, Hines HF, Labko Y, Peasley A, Valentin-Welch M, Breedlove G. Midwives Mentoring Midwives: A Review of the Evidence and Best Practice Recommendations. J Midwifery Womens Health 2021; 67:21-30. [PMID: 34736294 DOI: 10.1111/jmwh.13285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/20/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
Mentoring involves a reciprocal relationship between a more experienced person (mentor) who offers guidance and counsel to a less experienced person (mentee). Reported benefits of mentoring among students of varying health professions include skill acquisition, understanding of the professional role, acclimation to the culture of the health profession, and personal and professional development. Globally, the midwifery profession has a long-standing history of mentoring students and new graduate midwives. However, only one study has described a formal mentoring program within the US midwifery profession. Therefore, to inform best practice for both formal and informal mentoring programs, current mentoring programs are summarized and a state of the science review on mentoring within midwifery in the United States and internationally was conducted. Three types of mentoring relationships are discussed: (1) student to student (peer), (2) midwife to student, and (3) midwife to new graduate midwife. Effective models and recommended approaches for the development and expansion of mentoring are discussed, to sustain, diversify, and scale up the midwifery workforce. Personal attributes and action steps of effective mentors and mentees are provided.
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Affiliation(s)
- Heather Bradford
- Department of Advanced Practice Nursing, Georgetown University School of Nursing and Health Studies, Washington, DC
| | - Heather Findletar Hines
- Department of Graduate Studies in Advanced Practice Nursing, State of New York Stony Brook School of Nursing, Stony Brook, New York
| | | | | | - Maria Valentin-Welch
- The A.C.N.M. Foundation, Inc., Cambridge, Massachusetts.,Maria's Dime, LLC, Pittsboro, North Carolina
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17
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Preis H, Mahaffey B, Lobel M. The role of pandemic-related pregnancy stress in preference for community birth during the beginning of the COVID-19 pandemic in the United States. Birth 2021; 48:242-250. [PMID: 33677838 PMCID: PMC8250474 DOI: 10.1111/birt.12533] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic introduced unparalleled uncertainty into the lives of pregnant women, including concerns about where it is the safest to give birth, while preserving their rights and wishes. Reports on the increased interest in community births (at home or in birth centers) are emerging. The purpose of this project was to quantitatively investigate psychological factors related to this birth preference. METHODS This study included 3896 pregnant women from the COVID-19 Pregnancy Experiences (COPE) Study who were anticipating a vaginal birth. COPE Study participants were recruited online between April 24 and May 15, 2020, and completed a questionnaire that included preference with respect to place of birth and psychological constructs: fear of childbirth, basic beliefs about birth, pandemic-related preparedness stress, and pandemic-related perinatal infection stress. RESULTS Women who preferred a community birth, on average, had less childbirth fear, had stronger beliefs that birth is a natural process, were less likely to see birth as a medical process, and were less stressed about being unprepared for birth and being infected with COVID-19. In multivariate models, higher stress about perinatal COVID-19 infection was associated with greater likelihood of preferring a community birth. The effect of perinatal infection stress on preference was stronger when preparedness stress was high. DISCUSSION Women's birth preferences during the COVID-19 pandemic are associated with psychological processes related to risk perception. Community births are more appealing to women who view being in a hospital as hazardous because of the pandemic. Policies and prenatal care aimed to increase access to safe in-hospital and out-of-hospital birth services should be encouraged.
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Affiliation(s)
- Heidi Preis
- Department of PsychologyStony Brook UniversityStony BrookNew YorkUSA
- Department of PediatricsRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Brittain Mahaffey
- Department of Psychiatry and Behavioral HealthRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Marci Lobel
- Department of PsychologyStony Brook UniversityStony BrookNew YorkUSA
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18
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Węgrzynowska M, Doroszewska A, Witkiewicz M, Baranowska B. Polish maternity services in times of crisis: in search of quality care for pregnant women and their babies. Health Care Women Int 2020; 41:1335-1348. [PMID: 33048638 DOI: 10.1080/07399332.2020.1830096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current COVID-19 pandemic put a burden on healthcare services around the globe and impacted many areas of care delivery, including maternity services. Prioritizing ringfenced community care to keep women away from hospitals may be the best strategic response to ensure pregnant and laboring women receive optimal care. By analyzing the structure of maternity services in Poland and their response to the current crisis, we show that while the available model allows to provide large share of prenatal services outside hospital settings, it allows no alternative to hospital births. In addition, medicalization, inequalities in access and fragmentation of care hinder services' ability to respond in a way it ensures best possible care.
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Affiliation(s)
- Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Antonina Doroszewska
- Department of Medical Communication, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Witkiewicz
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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19
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Romano A, Kennedy HP, Avery MD. Improving US Maternity Care: A 2020 Call to Action to Scale Up Midwifery. J Midwifery Womens Health 2020; 65:595-604. [PMID: 32979000 DOI: 10.1111/jmwh.13158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Amy Romano
- Independent consultant, Milford, Connecticut
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20
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Sakala C. Toward a Workforce That Reliably Delivers High‐Value Maternity Care in the United States. J Midwifery Womens Health 2020; 65:605-608. [DOI: 10.1111/jmwh.13099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Carol Sakala
- National Partnership for Women & Families Washington DC
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21
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Keedle H, Peters L, Schmied V, Burns E, Keedle W, Dahlen HG. Women's experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia. BMC Pregnancy Childbirth 2020; 20:381. [PMID: 32605586 PMCID: PMC7325036 DOI: 10.1186/s12884-020-03075-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women but internationally VBAC rates remain low. In Australia women planning a VBAC may experience different models of care including continuity of care (CoC). There are a limited number of studies exploring the impact and influence of CoC on women's experiences of planning a VBAC. Continuity of care (CoC) with a midwife has been found to increase spontaneous vaginal birth and decrease some interventions. Women planning a VBAC prefer and benefit from CoC with a known care provider. This study aimed to explore the influence, and impact, of continuity of care on women's experiences when planning a VBAC in Australia. METHODS The Australian VBAC survey was designed and distributed via social media. Outcomes and experiences of women who had planned a VBAC in the past 5 years were compared by model of care. Standard fragmented maternity care was compared to continuity of care with a midwife or doctor. RESULTS In total, 490 women completed the survey and respondents came from every State and Territory in Australia. Women who had CoC with a midwife were more likely to feel in control of their decision making and feel their health care provider positively supported their decision to have a VBAC. Women who had CoC with a midwife were more likely to have been active in labour, experience water immersion and have an upright birthing position. Women who received fragmented care experienced lower autonomy and lower respect compared to CoC. CONCLUSION This study recruited a non-probability based, self-selected, sample of women using social media. Women found having a VBAC less traumatic than their previous caesarean and women planning a VBAC benefited from CoC models, particularly midwifery continuity of care. Women seeking VBAC are often excluded from these models as they are considered to have risk factors. There needs to be a focus on increasing shared belief and confidence in VBAC across professions and an expansion of midwifery led continuity of care models for women seeking a VBAC.
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Affiliation(s)
- Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Lilian Peters
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Amsterdam University Medical Centers, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Elaine Burns
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Warren Keedle
- School of Environmental Sciences, Charles Sturt University, Bathurst, Australia
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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