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Kloester J, Brand G, Willey S. How midwives facilitate informed decisions in the third stage of labour - an exploration through portraiture. Midwifery 2023; 127:103868. [PMID: 37931464 DOI: 10.1016/j.midw.2023.103868] [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: 01/14/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
PROBLEM Midwifery philosophy promotes informed decision-making. Despite this, midwives report a lack of informed decision-making in standard maternity care systems. BACKGROUND Previous research has shown a woman's ability to make informed decisions within her maternity care significantly impacts her childbearing experience. When informed decision-making is facilitated, women report positive experiences, whereas when lacking, there is an increased potential for birth trauma. AIM To explore midwives' experiences of facilitating informed decision-making, using third-stage management as context. METHODS Five midwives from Victoria, Australia, were interviewed about their experiences with informed decision-making. These interviews were guided by portraiture methodology whereby individual narrative portraits were created. This paper explores the shared themes among these five portraits. FINDINGS Five individual narrative portraits tell the stories of each midwife, providing rich insight into their philosophies, practices, barriers and enablers of informed decision-making. These are then examined as a whole dataset to explore shared themes, and include; 'informed decision-making is fundamental to midwifery practice' 'the system', and 'navigating the system'. The system contained the sub-themes; hierarchy in hospitals, the medicalisation of birth, and the impact on midwifery practice, and 'navigating the system' - contained; safety of the woman and safety of the midwife, and the gold-standard of midwifery. DISCUSSION AND CONCLUSION Midwives in this study valued informed decision-making as fundamental to their philosophy but also faced barriers in their ability to facilitate it. Barriers to informed decision-making included: power-imbalances; de-skilling in physiological birth; fear of blame, and interdisciplinary disparities. Conversely enablers included continuity models of midwifery care, quality antenatal education, respectful interdisciplinary collaboration and an aim toward a resurgence of fundamental midwifery skills.
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Affiliation(s)
- Joy Kloester
- Monash Nursing and Midwifery, Monash University, Melbourne Victoria, Australia.
| | - Gabrielle Brand
- Monash Nursing and Midwifery, Monash University, Melbourne Victoria, Australia. https://twitter.com/https://twitter.com/GabbyBrand6
| | - Suzanne Willey
- Monash Nursing and Midwifery, Monash University, Melbourne Victoria, Australia. https://twitter.com/https://twitter.com/SueWilley5
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Garcia LM. Obstetric violence in the United States and other high-income countries: an integrative review. Sex Reprod Health Matters 2023; 31:2322194. [PMID: 38590127 PMCID: PMC11005882 DOI: 10.1080/26410397.2024.2322194] [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: 04/10/2024] Open
Abstract
Obstetric violence has been documented throughout the world, yet this human rights issue has mostly been investigated in middle- and low-income countries where the intensity and brutality of abuse and mistreatment is more easily recognised as problematic. This integrative review aimed to analyse sources about obstetric violence in high-income countries with the objective of identifying gaps in the research, challenges to the study of obstetric violence, and solutions to framing research that meets those challenges. A systematic search was conducted using the PubMed and CINAHL databases from February to June 2022. Empirical and non-empirical sources, published in English, with no date restrictions, were retrieved. Citation searching was also done. Forty-six sources were included. Identified gaps in the research were: (a) scarce attention to obstetric violence in most high-income countries; (b) most US sources are non-scientific and from outside the healthcare disciplines; (c) inconsistencies in terminology; (d) most studies were conducted with samples of women who had given birth, with scant research about healthcare providers and obstetric violence, and (e) the association between obstetric violence and traumatic birth was under-recognised. Identified challenges to the study of obstetric violence were: (1) factors that enable and perpetuate obstetric violence are multilevel and nonlinear; (2) the phenomenon is contextually complex; and (3) blind spots from routinised harmful practices and normalised mistreatment can prevent healthcare providers and birthing people from recognising obstetric violence. A systems approach and complexity theory are guiding frameworks recommended as solutions to the challenges of studying and correcting obstetric violence.
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Dağlı E, Aktaş Reyhan F, Topkara FN, Moridi M. Turkish validity and reliability study of the "respectful maternity care" knowledge and practice scale of midwives. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100222. [PMID: 37600070 PMCID: PMC10432589 DOI: 10.1016/j.eurox.2023.100222] [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: 06/01/2023] [Revised: 07/20/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Objective Increasing cesarean rates in Turkey show that respectful maternity care services should be given priority and importance. It is difficult to achieve sustainable development goals without adopting a respectful maternity care approach, and there is no Turkish measurement tool to evaluate the knowledge and practices of midwives on "respectful maternity care". The aim of this study is to evaluate whether the "respectful maternity care knowledge and practice scale of midwives" is an appropriate measurement tool for Turkish women by conducting a Turkish validity and reliability study. Study design The methodological study was carried out by midwives working in three Public Hospitals. Data were collected face-to-face using the "introductory information form" and "the respectful maternity care knowledge and practice scale of midwives". Results The scale consists of two sections knowledge and practice. Both sections have three sub-dimensions: "providing emotional support", "providing safe care", and "preventing abuse". The cronbach alpha internal consistency coefficient value ranged between 0.76 and 0.95 for both sections.This study has determined that this scale, which was adapted, consists of three sub-dimensions and 46 items (23 items each) in both knowledge and application sections, is a highly valid and reliable scale compatible with Turkish culture, as a result of the validity and reliability findings.
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Affiliation(s)
- Elif Dağlı
- Çukurova University, Abdi Sütcü Vocational School of Health Services, Department of Health Care Services, Adana, Turkey
| | - Feyza Aktaş Reyhan
- Kütahya University of Health Sciences, Faculty of Health Sciences, Midwifery Department, Kütahya, Turkey
| | | | - Maryam Moridi
- Tehran University of Medical Sciences, School of Nursing and Midwifery, Department of Reproductive Health, Islamic Republic of Iran
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Shuman HL, Grupp AM, Robb LA, Akers KG, Bedi G, Shah MA, Janis A, Caldart CG, Gupta U, Vaghasia JK, Panneerselvam A, Kazeem AO, Amutah-Onukagha NN, Levine DL. Approaches and geographical locations of respectful maternity care research: A scoping review. PLoS One 2023; 18:e0290434. [PMID: 37616299 PMCID: PMC10449213 DOI: 10.1371/journal.pone.0290434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Peripartum mistreatment of women contributes to maternal mortality across the globe and disproportionately affects vulnerable populations. While traditionally recognized in low/low-middle-income countries, the extent of research on respectful maternity care and the types of mistreatment occurring in high-income countries is not well understood. We conducted a scoping review to 1) map existing respectful maternity care research by location, country income level, and approach, 2) determine if high-income countries have been studied equally when compared to low/low-middle-income countries, and 3) analyze the types of disrespectful care found in high-income countries. METHODS A systematic search for published literature up to April 2021 using PubMed/MEDLINE, EMBASE, CINAHL Complete, and the Maternity & Infant Care Database was performed. Studies were included if they were full-length journal articles, published in any language, reporting original data on disrespectful maternal care received from healthcare providers during childbirth. Study location, country income level, types of mistreatment reported, and treatment interventions were extracted. This study was registered on PROSPERO, number CRD42021255337. RESULTS A total of 346 included studies were categorized by research approach, including direct labor observation, surveys, interviews, and focus groups. Interviews and surveys were the most common research approaches utilized (47% and 29% of all articles, respectively). Only 61 (17.6%) of these studies were conducted in high-income countries. The most common forms of mistreatment reported in high-income countries were lack of informed consent, emotional mistreatment, and stigma/discrimination. CONCLUSIONS Mapping existing research on respectful maternity care by location and country income level reveals limited research in high-income countries and identifies a need for a more global approach. Furthermore, studies of respectful maternity care in high-income countries identify the occurrence of all forms of mistreatment, clashing with biases that suggest respectful maternity care is only an issue in low-income countries and calling for additional research to identify interventions that embrace an equitable, patient-centric empowerment model of maternity care.
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Affiliation(s)
- Hannah L. Shuman
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Annika M. Grupp
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Lauren A. Robb
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Katherine G. Akers
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Gurbani Bedi
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Miloni A. Shah
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Andrea Janis
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Caroline G. Caldart
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Urvashi Gupta
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Janki K. Vaghasia
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Aishwarya Panneerselvam
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Aisha O. Kazeem
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Ndidiamaka N. Amutah-Onukagha
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Diane L. Levine
- Department of Public Health and Community Medicine, Tufts University, Boston, Massachusetts, United States of America
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Ottosen M, Eloi H, Lyons M. Engaging patients as teachers in a baccaulaureate nursing reproductive health care course: A qualitative study. NURSE EDUCATION TODAY 2023; 128:105859. [PMID: 37348405 DOI: 10.1016/j.nedt.2023.105859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/01/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Teaching nursing students about the principles and practical application of person-centered care is an essential yet challenging component of nursing education. Integrating patients as teachers to share their personal stories of maternity care can elicit positive outcomes toward students achieving course objectives. OBJECTIVES To determine how the educational experience of having patients as teachers in the classroom could influence students' awareness of patients' perceptions of their maternity care, delivering person-centered care and the roles of nursing in their future practice. DESIGN Retrospective qualitative study of student reflections. SETTINGS Reproductive health course within a BSN program. PARTICIPANTS Ninety-nine second semester BSN student reflections. METHODS Two course faculty and a qualitative nurse researcher conducted a thematic content analysis of written student reflections. RESULTS Three primary themes emerged from the students' reflections of hearing patient and family advisors describe their maternity experiences: 1) awareness of the impact of nursing practice on patient and family well-being, 2) awareness of personal biases and emotions about difficulties in maternity care, and 3) appreciation to hear from patients directly as part of didactic coursework. CONCLUSIONS Including patients as teachers is an enhanced method to aid nursing students in understanding the humanistic and impactful roles of nursing in the clinical setting.
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Affiliation(s)
- Madelene Ottosen
- Department of Graduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 681, Houston, TX 77030, United States of America.
| | - Hildreth Eloi
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 787, Houston, TX 77030, United States of America.
| | - Mandi Lyons
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 764, Houston, TX 77030, United States of America.
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Firoozehchian F, Zareiyan A, Geranmayeh M, Behboodi Moghadam Z. Domains of competence in midwifery students: a basis for developing a competence assessment tool for iranian undergraduate midwifery students. BMC MEDICAL EDUCATION 2022; 22:704. [PMID: 36199088 PMCID: PMC9533548 DOI: 10.1186/s12909-022-03759-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/02/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Current study was conducted with the aim of explaining domains of clinical competence in undergraduate midwifery students so that it addresses the challenges in midwifery curriculum and improving clinical assessment methods in Iranian undergraduate midwifery students. METHODS Qualitative approach and conventional content analysis were used in the design of the present study. The research setting included midwifery and nursing schools and hospitals and health centers affiliated to Tehran and Guilan universities of medical sciences in Iran. The target population consisted of undergraduate midwifery students in the fourth to eighth semesters of school, midwives working in hospitals and health centers, midwifery faculty members, and obstetricians. The participants were selected through purposive maximum variation sampling, which continued until data saturation. After in-depth semi-structured interviews, the content of the interviews was analyzed according to the steps proposed by Zhang & Wildemuth. RESULTS Twenty-four people participated in this study, including seven midwifery students, seven midwives, nine midwifery and reproductive and sexual health faculty members, and one obstetrician. The participants were aged 20-56 years and their mean age was 39.75 years. Their level of education varied from midwifery student to PhD. The mean work experience of the participants was 13.62 years and the mean duration of the interviews was 48 min. The analysis of the data obtained from the experiences of the participants led to the formation of the four categories of ethical and professional function in midwifery, holistic midwifery care, effective interaction, and personal and professional development, along with ten subcategories. CONCLUSION The findings of the present study showed that clinical competence in midwifery students involves different domains that correspond well overall to the general definitions of clinical competence in different sources. These findings can be used as a basis for the design and psychometric assessment of a clinical competence assessment tool for undergraduate midwifery students.
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Affiliation(s)
- Firoozeh Firoozehchian
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Armin Zareiyan
- Department of Public Health, Department of Health in Disaster & Emergencies, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Geranmayeh
- Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Behboodi Moghadam
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Ashley R, Goodarzi B, Horn A, de Klerk H, Ku SE, Marcus JK, Mayra K, Mohamied F, Nayiga H, Sharma P, Udho S, Vijber MR, van der Waal R. A call for critical midwifery studies: Confronting systemic injustice in sexual, reproductive, maternal, and newborn care: Critical Midwifery Collective Writing Group. Birth 2022; 49:355-359. [PMID: 35727708 PMCID: PMC9543423 DOI: 10.1111/birt.12661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca Ashley
- Department of Anthropology, School of Global StudiesUniversity of SussexBrightonUK
| | - Bahareh Goodarzi
- Department of Midwifery ScienceAVAG/APH/VUmc/Amsterdam UMCAmsterdamNetherlands
| | - Anna Horn
- Centre for Maternal and Child Health Research, School of Health SciencesCity, University of LondonLondonUK
| | - Hannah de Klerk
- Department of Midwifery ScienceAVAG/APH/VUmc/Amsterdam UMCAmsterdamNetherlands
| | - Susana E. Ku
- Midwifery Services of Lambton KentDepartment of Global HealthMcMaster UniversityHamiltonONCanada
| | - Jason K. Marcus
- Department of Obstetrics and GynaecologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Kaveri Mayra
- Human Rights in ChildbirthSan FrancisCaliforniaUSA
| | - Fatimah Mohamied
- Women and Child ServicesQueen Mary Maternity UnitWest Middlesex HospitalLondonUK
| | - Harriet Nayiga
- Midwife‐led Community Transformation (MILCOT) Center, Marginalized Adolescents/young Adults Sexual and Reproductive Health and RightsKampalaUganda
| | - Priya Sharma
- Department of Humanities and Social SciencesIndian Institute of Technology BombayMumbaiMaharashtraIndia
| | - Samson Udho
- Department of Health and Rehabilitation SciencesFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
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9
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Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Midwives' perspectives on person-centred maternity care in public hospitals in South-east Nigeria: A mixed-method study. PLoS One 2021; 16:e0261147. [PMID: 34890420 PMCID: PMC8664165 DOI: 10.1371/journal.pone.0261147] [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: 06/07/2020] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background Person-centred maternity care (PCMC) is acknowledged as essential for achieving improved quality of care during labour and childbirth. Yet, evidence of healthcare providers’ perspectives of person-centred maternity care is scarce in Nigeria. This study, therefore, examined the perceptions of midwives on person-centred maternity care (PCMC) in Enugu State, South-east Nigeria. Materials and methods This study was conducted in seven public hospitals in Enugu metropolis, Enugu State, South-east Nigeria. A mixed-methods design, involving a cross-sectional survey and focus group discussions (FGDs) was used. All midwives (n = 201) working in the maternity sections of the selected hospitals were sampled. Data were collected from February to May 2019 using a self-administered, validated PCMC questionnaire. A sub-set of midwives (n = 56), purposively selected using maximum variation sampling, participated in the FGDs (n = 7). Quantitative data were entered, cleaned, and analysed with SPSS version 20 using descriptive and bivariate statistics and multivariate regression. Statistical significance was set at alpha 0.05 level. Qualitative data were analysed thematically. Results The mean age of midwives was 41.8 years ±9.6 years. About 53% of midwives have worked for ≥10 years, while 60% are junior midwives. Overall, the prevalence of low, medium, and high PCMC among midwives were 26%, 49% and 25%. The mean PCMC score was 54.06 (10.99). High perception of PCMC subscales ranged from 6.5% (dignity and respect) to 19% (supportive care). Midwives’ perceived PCMC was not significantly related to any socio-demographic characteristics. Respectful care, empathetic caregiving, prompt initiation of care, paying attention to women, psychosocial support, trust, and altruism enhanced PCMC. In contrast, verbal and physical abuses were common but normalised. Midwives’ weakest components of autonomy and communication were low involvement of women in decision about their care and choice of birthing position. Supportive care was constrained by restrictive policy on birth companion, poor working conditions, and cost of childbirth care. Conclusion PCMC is inadequate in public hospitals as seen from midwives’ perspectives. Demographic characteristics of midwives do not seem to play a significant role in midwives’ delivery of PCMC. The study identified areas where midwives must build competencies to deliver PCMC.
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Kiewan R, Gharaibeh M, Alnuaimi K, Abuhammad S, Aladwan H. Attitudes of midwives and obstetricians towards midwives practiced roles in hospitals: A national study in Jordan. Int J Clin Pract 2021; 75:e14891. [PMID: 34541750 DOI: 10.1111/ijcp.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS The aims of this study were to identify midwives' and obstetricians' attitudes towards midwives practised roles in hospitals and to identify the differences in their attitudes towards midwives practiced roles. MATERIALS AND METHODS A descriptive, cross-sectional, study design was used. A convenience sample of 303 midwives and 143 obstetricians were recruited. Participants were from 12 Ministry of Health (MOH) and Royal Medical Services (RMS) hospitals distributed across seven governorates. Two reliable and valid self-administered questionnaires were used to collect data including socio-demographic data-related characteristics of participants and obstetricians' and midwives' attitudes towards midwives' practiced role in hospitals. RESULTS There were significant differences between obstetricians in the three subscales of attitudes: midwives women relationship attitude subscale, midwives trust and mutual respect subscale and work environment attitudes subscale. A significant difference by the institution was reported: obstetricians and midwives who worked in MOH reported more positive attitudes than those who worked in RMS. CONCLUSION The results show that obstetricians recognise that midwives are qualified and competent professionals but still lack the competencies/skills to make them independent practitioners. The findings also confirm the need to improve midwives' practices by moving from being able to perform a specific task to possess all three attributes of "competencies," where they can intervene, manage and make decisions with confidence in each situation. IMPLICATION FOR PRACTICE Based on the current study findings, parallel cooperation between educational/academic policymakers from both midwives and obstetricians may re-evaluate and upgrade the midwifery curriculum to meet the ICM competencies and health sector needs as a step to graduate competent midwives where their responsibility is recognised and organised.
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Affiliation(s)
- Reema Kiewan
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Muntaha Gharaibeh
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
- Al Ahlyyah Amman University, Faculty of Nursing, Amman, Jordan
| | - Karimeh Alnuaimi
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Sawsan Abuhammad
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Hala Aladwan
- Royal Services of Maternal and Child Health Department, Amman, Jordan
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Jolivet RR, Gausman J, Kapoor N, Langer A, Sharma J, Semrau KEA. Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review. Reprod Health 2021; 18:194. [PMID: 34598705 PMCID: PMC8485458 DOI: 10.1186/s12978-021-01241-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ensuring the right to respectful care for maternal and newborn health, a critical dimension of quality and acceptability, requires meeting standards for Respectful Maternity Care (RMC). Absence of mistreatment does not constitute RMC. Evidence generation to inform definitional standards for RMC is in an early stage. The aim of this systematic review is clear provider-level operationalization of key RMC principles, to facilitate their consistent implementation. METHODS Two rights-based frameworks define the underlying principles of RMC. A qualitative synthesis of both frameworks resulted in seven fundamental rights during childbirth that form the foundation of RMC. To codify operational definitions for these key elements of RMC at the healthcare provider level, we systematically reviewed peer-reviewed literature, grey literature, white papers, and seminal documents on RMC. We focused on literature describing RMC in the affirmative rather than mistreatment experienced by women during childbirth, and operationalized RMC by describing objective provider-level behaviors. RESULTS Through a systematic review, 514 records (peer-reviewed articles, reports, and guidelines) were assessed to identify operational definitions of RMC grounded in those rights. After screening and review, 54 records were included in the qualitative synthesis and mapped to the seven RMC rights. The majority of articles provided guidance on operationalization of rights to freedom from harm and ill treatment; dignity and respect; information and informed consent; privacy and confidentiality; and timely healthcare. Only a quarter of articles mentioned concrete or affirmative actions to operationalize the right to non-discrimination, equality and equitable care; less than 15%, the right to liberty and freedom from coercion. Provider behaviors mentioned in the literature aligned overall with seven RMC principles; yet the smaller number of available research studies that included operationalized definitions for some key elements of RMC illustrates the nascent stage of evidence-generation in this area. CONCLUSIONS Lack of systematic codification, grounded in empirical evidence, of operational definitions for RMC at the provider level has limited the study, design, implementation, and comparative assessment of respectful care. This qualitative systematic review provides a foundation for maternity healthcare professional policy, training, programming, research, and program evaluation aimed at studying and improving RMC at the provider level.
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Affiliation(s)
- R Rima Jolivet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jewel Gausman
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Neena Kapoor
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Jigyasa Sharma
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Katherine E A Semrau
- BetterBirth Program, Ariadne Labs
- Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
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Emeis CL, Jolles DR, Perdion K, Collins-Fulea C. The American College of Nurse-Midwives' Benchmarking Project: A Demonstration of Professional Preservation and Improvement. J Perinat Neonatal Nurs 2021; 35:210-220. [PMID: 34330132 DOI: 10.1097/jpn.0000000000000576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Maternal and newborn outcomes in the United States are suboptimal. Care provided by certified nurse-midwives and certified midwives is associated with improved health outcomes for mothers and newborns. Benchmarking is a process of continuous quality assurance providing opportunities for internal and external improvement. Continuous quality improvement is a professional standard and expectation for the profession of midwifery. The American College of Nurse-Midwives Benchmarking Project is an example of a long-standing, midwifery-led quality improvement program. The project demonstrates a program for midwifery practices to display and compare their midwifery processes and outcomes of care. Quality metrics in the project reflect national quality measures in maternal child health while intentionally showcasing the contributions of midwives. The origins of the project and the outcomes for data submitted for 2019 are described and compared with national rates. The American College of Nurse-Midwives Benchmarking Project provides participating midwifery practices with information for continuous improvement and documents the high quality of care provided by a sample of midwifery practices.
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Affiliation(s)
- Cathy L Emeis
- Oregon Health & Science University, School of Nursing, Portland (Dr Emeis); Frontier Nursing University, Lexington, Kentucky (Drs Jolles and Collins-Fulea); and University of California San Diego, La Jolla (Ms Perdion)
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Mayra K, Matthews Z, Padmadas SS. Why do some health care providers disrespect and abuse women during childbirth in India? Women Birth 2021; 35:e49-e59. [PMID: 33678563 DOI: 10.1016/j.wombi.2021.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Disrespect and abuse during childbirth can result in fear of childbirth. Consequently, women may be discouraged to seek care, increasing the likelihood for women to choose elective cesarean section in order to avoid humiliation, postnatal depression and even maternal mortality. This study investigates the causes underlying mistreatment of women during childbirth by health care providers in India, where evidence of disrespect and abuse has been reported. METHODS Qualitative research was undertaken involving 34 in-depth interviews with midwifery and nursing leaders from India who represent administration, advocacy, education, regulation, research and service provision at state and national levels. Data are analysed thematically with NVivo12. The analysis added value by bringing an international perspective from interviews with midwifery leaders from Switzerland and the United Kingdom. FINDINGS The factors leading to disrespect and abuse of women relate to characteristics of both women and their midwives. Relevant woman-related attributes include her age, gender, physical appearance and education, extending to the social environment including her social status, family support, culture of abuse, myths around childbirth and sex-based discrimination. Midwife-related factors include gender, workload, medical hierarchy, bullying and powerlessness. DISCUSSION The intersectionality of factors associated with mistreatment during childbirth operate at individual, infrastructural, social and policy levels for both the women and nurse-midwives, and these factors could exacerbate existing gender-based inequalities. Maternal health policies should address the complex interplay of these factors to ensure a positive birthing experience for women in India. CONCLUSION Maternal health interventions could improve by integrating women-centred protocols and monitoring measures to ensure respectful and dignified care during childbirth.
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Affiliation(s)
- Kaveri Mayra
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, United Kingdom. https://www.twitter.com/myheroistrane
| | - Zoë Matthews
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, United Kingdom.
| | - Sabu S Padmadas
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, United Kingdom.
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