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Megregian M, Emeis CL, Tilden E. Antepartum Preparation and Consent for Intrapartum Events: An Ethical Gap. J Midwifery Womens Health 2024. [PMID: 39133163 DOI: 10.1111/jmwh.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/30/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Michele Megregian
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Cathy L Emeis
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Ellen Tilden
- School of Nursing, Oregon Health & Science University, Portland, Oregon
- The Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Collart C, Craighead C, Yao M, Chien EK, Rose S, Frankel RM, Coleridge M, Hu B, Edmonds BT, Ranzini AC, Farrell RM. Identifying Strategies to Improve Shared Decision Making for Pregnant Patients' Decisions about Prenatal Genetic Screens and Diagnostic Tests. Med Decis Making 2024; 44:689-704. [PMID: 39082665 DOI: 10.1177/0272989x241259016] [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: 08/27/2024]
Abstract
PURPOSE Prenatal genetic screens and diagnostic tests are vital components of prenatal care. The first prenatal visit is a critical time in the decision-making process when patients decide whether to use these tests in addition to address a series of other essential prenatal care aspects. We conducted this study to examine the role of a shared decision-making (SDM) instrument to support these discussions. METHODS We conducted a cluster randomized controlled trial of patients allocated to an SDM tool or usual care at their first prenatal visit. Participants completed a baseline survey to measure decision-making needs and preferences. Direct observation was conducted and analyzed using the OPTION scale to measure SDM during prenatal genetic testing discussions. RESULTS Levels of SDM were similar across groups (P = 0.081). The highest levels of SDM were observed during screening test discussions (NEST 2.4 ± 0.9 v. control 2.6 ± 1.0). Lowest levels were observed in discussions about patients' preference for risk versus diagnostic information (NEST 1.0 ± 1.1 v. control 1.2 ± 1.3). CONCLUSION Study findings demonstrate the need for targeted patient-focused and provider-focused efforts to improve SDM to enhance patients' informed decision making about these options. Importantly, patients' baseline knowledge and attitudes need to be considered given that patients with less knowledge may need more carefully crafted communication. HIGHLIGHTS Choices about whether, when, and how to use prenatal genetic tests are highly preference-based decisions, with patients' baseline attitudes about these options as a major driver in health care discussions.The decision-making process is also shaped by patient preferences regarding a shared or informed decision-making process for medical decisions that are highly personal and have significant ramifications for obstetric outcomes.There is a need to develop targeted efforts to improve decision making and enhance patients' ability to make informed decisions about prenatal genetic tests in early pregnancy.
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Affiliation(s)
- Christina Collart
- Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Caitlin Craighead
- Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Edward K Chien
- Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Susannah Rose
- Experience Safety, Quality and Patient Experience, Clinical Transformation, Cleveland Clinic, Cleveland, OH, USA
| | | | - Marissa Coleridge
- Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland OH, USA
| | - Bo Hu
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - Angela C Ranzini
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH, USA
| | - Ruth M Farrell
- Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland OH, USA
- Center for Bioethics, Clinical Transformation, Cleveland Clinic, Cleveland OH, USA
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Jose Henrique A, Rodney P, Hall W, Thorne S, Joolaee S. Women's autonomy for managing labour pain in a relational context: An interpretive description study. J Clin Nurs 2023; 32:7390-7401. [PMID: 37272285 DOI: 10.1111/jocn.16780] [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: 11/26/2022] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
AIM To describe how women perceived relational autonomy for decision-making during childbirth pain and illuminate influencing factors. BACKGROUND Most women report challenging pain during birth. Circumstances can affect their ability to engage in pain management decisions. DESIGN We used an interpretative description approach to conduct this study. METHOD A purposive sample of ten women who reported pain during childbirth participated in semi-structured interviews. The study was conducted between July 2019 and November 2020 and reported according to the COREQ checklist. RESULTS Circumstances during childbirth, such as women's expectations and relationships, influenced their efforts to engage in relational autonomy. Care providers dealt with the unpredictability of childbirth and challenges with pain management using decision-making practices that could disrupt women's expectations, undermine women's trust, demonstrate disrespect for women and rely on inadequate communication. Women who felt dependent on others were less likely to participate in decision-making. When care providers' perceptions about pain differed from women's reports of pain, participants became distressed because care providers did not acknowledge their subjective pain experiences. CONCLUSIONS Women regarded their relationships and communication with care providers as foundational to relational autonomy in decision-making about pain management during childbirth. RELEVANCE TO CLINICAL PRACTICE Study findings can support care providers' considerations of the complexity of childbirth pain and factors affecting women's relational autonomy in decision-making about pain. In particular, the findings highlight the importance of women's expectations and care providers' recognition of women's experiences of pain. PATIENT OR PUBLIC CONTRIBUTION Women who shared their stories of childbirth pain contributed to the data collected. The chief nursing officers in the data collection setting facilitated the recruitment and data collection.
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Affiliation(s)
| | - Patricia Rodney
- University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
| | - Wendy Hall
- University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sally Thorne
- University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
| | - Soodabeh Joolaee
- Iran University of Medical Sciences, Tehran, Iran
- Research Ethics & Regulatory Specialist, Fraser Health Authority, Vancouver, British Columbia, Canada
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Ruby E, McDonald SD, Berger H, Melamed N, Li J, Darling EK, Barrett J, G Ray J, Geary M, Murray-Davis B. Exploring patients' perspectives of gestational diabetes mellitus screening and counselling in Ontario: A grounded theory study. Health Expect 2023; 26:827-835. [PMID: 36651675 PMCID: PMC10010101 DOI: 10.1111/hex.13708] [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: 11/01/2022] [Revised: 12/29/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. Approaches to screening for GDM continue to evolve, introducing potential variability of care. This study explored the impact of these variations on GDM counselling and screening from the perspectives of pregnant individuals. METHODS Following a Corbin and Strauss approach to qualitative, grounded theory we recruited 28 individuals from three cities in Ontario, Canada who had a singleton pregnancy under the care of either a midwife, family physician or obstetrician. Convenience and purposive sampling techniques were used. Semi-structured telephone interviews were conducted and transcribed verbatim between March and December 2020. Transcripts were analysed inductively resulting in codes, categories and themes. RESULTS Three themes were derived from the data about GDM screening and counselling: 'informing oneself', 'deciding' and 'screening'. All participants, regardless of geographical region, or antenatal care provider, moved through these three steps during the GDM counselling and screening process. Differences in counselling approaches between pregnancy care providers were noted throughout the 'informing' and 'deciding' stages of care. Factors influencing these differences included communication, healthcare autonomy and patient motivation to engage with health services. No differences were noted within care provider groups across the three geographic regions. Participant experiences of GDM screening were influenced by logistical challenges and personal preferences towards testing. CONCLUSION Informing oneself about GDM may be a crucial step for facilitating decision-making and screening uptake, with an emphasis on information provision to facilitate patient autonomy and motivation. PATIENT OR PUBLIC CONTRIBUTION Participants of our study included patients and service users. Participants were actively involved in the study design due to the qualitative, patient-centred nature of the research methods employed. Analysis of results was structured according to the emergent themes of the data which were grounded in patient perspectives and experiences.
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Affiliation(s)
- Emma Ruby
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Sarah D McDonald
- Departments of Obstetrics and Gynecology Radiology and Clinical Epidemiology and Biostatistics, Division of Maternal-Fetal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Howard Berger
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nir Melamed
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer Li
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth K Darling
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Jon Barrett
- Departments of Obstetrics and Gynecology Radiology and Clinical Epidemiology and Biostatistics, Division of Maternal-Fetal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joel G Ray
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Geary
- Department of Obstetrics & Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Beth Murray-Davis
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
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Vasilevski V, Angel G, Mathison A, Teale G, Sweet L. Experiences and information needs of women who become pregnant after bariatric surgery: An interpretive descriptive qualitative study. Midwifery 2023; 121:103652. [PMID: 36931137 DOI: 10.1016/j.midw.2023.103652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 08/30/2022] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Obesity is known to negatively impact fertility and increase pregnancy related complications. Many women of childbearing age opt for bariatric surgery to lose weight in the preconception period. Physiological changes of bariatric surgery are associated with both benefits and risks for maternal and neonatal outcomes. How women understand these risks and experience pregnancy following bariatric surgery are largely unknown. OBJECTIVE To explore the information needs and experiences of Australian women who become pregnant following bariatric surgery. DESIGN An interpretive descriptive qualitative study of 11 Australian women with experiences of pregnancy following bariatric surgery participated in a private Facebook discussion group conducted in 2021. Women were recruited via targeted advertisements on social media. RESULTS Women identified several information gaps regarding the implications of having bariatric surgery for preconception, pregnancy, and postnatal periods. Family planning, pregnancy nutrition, and breastfeeding advice were key areas of information need. Women's experiences of pregnancy following bariatric surgery included attitudes of judgement and lack of knowledge from their healthcare providers. CONCLUSIONS Healthcare professionals caring for women who have had bariatric procedures need to ensure that all women are fully informed about the risks of becoming pregnant within the first 12-months post-surgery. They should also anticipate that despite recommendations, women will become pregnant earlier than advised, and can benefit from non-judgemental and supportive care to ensure risks of poor outcomes are minimised. The findings highlight that the provision of tailored resources and education for women and their healthcare teams are needed.
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Affiliation(s)
- Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Melbourne, VIC, Australia.
| | - Genevieve Angel
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | | | - Glyn Teale
- Western Health, Melbourne, VIC, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Melbourne, VIC, Australia
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Peterson K. Informed refusal: A patient's right? Nursing 2022; 52:15-20. [PMID: 36006745 DOI: 10.1097/01.nurse.0000853984.71390.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article discusses the principles of informed consent and informed refusal (IR) in the context of patient-centered care and evidence-based practice, the right of patients to refuse care when properly informed, and the implications of IR for nursing practice.
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Affiliation(s)
- Kathleen Peterson
- Kathleen Peterson is a professor and the chair of the Department of Nursing at SUNY Brockport, in Brockport, N.Y
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Valente EP, Mariani I, Covi B, Lazzerini M. Quality of Informed Consent Practices around the Time of Childbirth: A Cross-Sectional Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7166. [PMID: 35742415 PMCID: PMC9222941 DOI: 10.3390/ijerph19127166] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND Few studies have explored consent request practices during childbirth. OBJECTIVE We explored consent request practices during childbirth in a referral hospital and research centre in Italy, capturing both women and health workers' perspectives. METHODS Data were collected using self-administrated questionnaires between December 2016 and September 2018. Nine key maternal and newborn procedures were analysed. Associations between consent requests and women characteristics were explored by multiple logistic regression. RESULTS Among 1244 women, the rate of consent requests varied widely, with caesarean section (CS) showing the highest rate (89.1%) and neonatal conjunctivitis prophylaxis presenting the lowest rate (11.4%). Information provided on "risks/benefits" and "reasons" for procedures by health staff was most often not comprehensive for procedures of interest (range 18.6-87.4%). The lack of informed consent is not specifically linked to any pattern of women characteristics. According to 105 health workers, adequate protocols and standard forms for consent requests were available in 67.6% and 78.1% of cases, respectively, while less than one third (31.4%) reported having received adequate training and supportive supervision on how to deliver informed consent. CONCLUSIONS Study findings align with previous evidence showing that consent request practices during childbirth need to be largely improved. More research is needed to investigate effective strategies for improvement.
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Affiliation(s)
- Emanuelle Pessa Valente
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, WHO Collaborating Centre for Maternal and Child Health, Via dell’Istria 65/1, 34137 Trieste, Italy; (I.M.); (B.C.); (M.L.)
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Meyer S, Cignacco E, Monteverde S, Trachsel M, Raio L, Oelhafen S. 'We felt like part of a production system': A qualitative study on women's experiences of mistreatment during childbirth in Switzerland. PLoS One 2022; 17:e0264119. [PMID: 35180269 PMCID: PMC8856555 DOI: 10.1371/journal.pone.0264119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Mistreatment during childbirth is an issue of global magnitude that not only violates fundamental human rights but also seriously impacts women's well-being. The purpose of this study was to gain a better understanding of the phenomenon by exploring the individual experiences of women who reported mistreatment during childbirth in Switzerland. MATERIALS AND METHODS This project used a mixed methods approach to investigate women's experiences of mistreatment during childbirth in general and informal coercion specifically: The present qualitative study expands on the findings from a nationwide online survey on childbirth experience. It combines inductive with theoretical thematic analysis to study the 7,753 comments women wrote in the survey and the subsequent interviews with 11 women who reported being mistreated during childbirth. RESULTS The women described a wide range of experiences of mistreatment during childbirth in both the survey comments and the interviews. Out of all survey participants who wrote at least one comment (n = 3,547), 28% described one or more experiences of mistreatment. Six of the seven types of mistreatment listed in Bohren and colleagues' typology of mistreatment during childbirth were found, the most frequent of which were ineffective communication and lack of informed consent. Five additional themes were identified in the interviews: Informal coercion, risk factors for mistreatment, consequences of mistreatment, examples of good care, and what's needed to improve maternity care. CONCLUSION The findings from this study show that experiences of mistreatment are a reality in Swiss maternity care and give insight into women's individual experiences as well as how these affect them during and after childbirth. This study emphasises the need to respect women's autonomy in order to prevent mistreatment and empower women to actively participate in decisions. Both individual and systemic efforts are required to prevent mistreatment and guarantee respectful, dignified, and high-quality maternity care for all.
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Affiliation(s)
- Stephanie Meyer
- Department of Health Professions, Applied Research & Development in Midwifery, Bern University of Applied Sciences, Bern, Switzerland
| | - Eva Cignacco
- Department of Health Professions, Applied Research & Development in Midwifery, Bern University of Applied Sciences, Bern, Switzerland
| | - Settimio Monteverde
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
- Department of Health Professions, School of Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Manuel Trachsel
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
- Clinical Ethics Unit, University Hospital of Basel and Psychiatric University Clinics Basel, Basel, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Switzerland
| | - Stephan Oelhafen
- Department of Health Professions, Applied Research & Development in Midwifery, Bern University of Applied Sciences, Bern, Switzerland
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Chepulis L, Morison B, Tamatea J, Paul R, Wolmarans L, Martis R. Midwifery awareness of diabetes in pregnancy screening guidelines in Aotearoa New Zealand. Midwifery 2021; 106:103230. [PMID: 35016073 DOI: 10.1016/j.midw.2021.103230] [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: 12/07/2020] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Effective and timely management of gestational diabetes mellitus (GDM) requires early detection. However, screening rates have been shown to be relatively low in New Zealand, despite the introduction of national screening guidelines in 2014 which indicate that all pregnant women should be screened. Thus, the aim of this study was to explore the awareness of the New Zealand Ministry of Health Diabetes in Pregnancy screening guidelines by New Zealand midwives. DESIGN A 24-question online survey based upon the New Zealand screening guidelines was distributed via New Zealand midwifery social media groups to explore the awareness of New Zealand midwives with regard to screening for diabetes in pregnancy. Free text comments were also allowed, these were broadly categorized and reviewed. PARTICIPANTS 174 registered midwives in Aotearoa New Zealand completed the survey. MEASUREMENTS AND FINDINGS All participants responded that they routinely offer glycated haemoglobin screening for detection of undiagnosed pre-gestational diabetes, and 92.9% identified that this should occur prior to 20 weeks gestation (as per the national guidelines). However, less than two thirds of midwives thought that all women should be screened for GDM, with 18.2% indicating they would only do this if immediate risk factors were present. There also appeared to be some confusion over the time period for screening for GDM with 22.9% indicating that this should occur later than the guideline-recommended timepoint of 24-28 weeks gestation. Participants who identified as Māori and community-based midwives were most likely to screen for GDM 'only if risk factors were present'. Participants practicing for more than 6 years, those aged 45-54 years, and midwives identifying as Māori were most likely to screen for GDM after 28 weeks (though these did not reach statistical significance). KEY CONCLUSIONS The New Zealand Diabetes in Pregnancy screening guidelines do not appear to be well implemented in our sample group, particularly with regard to screening for GDM. This needs to be evaluated in a larger group of midwives, as education around the timeliness and importance of screening for all women may be required. IMPLICATIONS FOR PRACTICE A lack of appropriate or timely screening for GDM may mean that women are not being diagnosed or managed appropriately, which in turn may have implications for both mother and child.
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Affiliation(s)
- Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Private Bag 3105, Hamilton, New Zealand.
| | - Brittany Morison
- Waikato Medical Research Centre, University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | - Jade Tamatea
- Te Kupenga Hauora Māori, University of Auckland, New Zealand; Department of Medicine, University of Auckland, New Zealand; Waikato Regional Diabetes Service, Waikato District Health Board, New Zealand
| | - Ryan Paul
- Waikato Medical Research Centre, University of Waikato, Private Bag 3105, Hamilton, New Zealand; Waikato Regional Diabetes Service, Waikato District Health Board, New Zealand
| | - Louise Wolmarans
- Department of Medicine, University of Auckland, New Zealand; Waikato Regional Diabetes Service, Waikato District Health Board, New Zealand
| | - Ruth Martis
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
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Sanders SA, Niemczyk NA, Burke JG, McCarthy AM, Terry MA. Exploring Why Birth Center Clients Choose Hospitalization for Labor and Birth. Nurs Womens Health 2021; 25:30-42. [PMID: 33453158 DOI: 10.1016/j.nwh.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/03/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify demographic and clinical factors associated with birth center clients electing hospitalization for labor and birth and to explore the timing and rationale for elective hospitalization via health records. DESIGN A secondary analysis of multiyear data from a quality assurance project at a single birth center. We compared two subsamples-birth center preference group and hospital preference group-and described the apparent rationale for transfers among clients in the latter group. SETTING A single freestanding birth center where all midwives have admitting privileges at a local hospital and can accompany labor transfers. PARTICIPANTS All cases included in the analytic sample represent women with low-risk pregnancies who were eligible for birth center birth. The birth center preference group represents clients planning to give birth at the center, and the hospital preference group consists of clients who elected for hospitalization. MEASUREMENTS Relevant demographic and clinical information was provided for the entire analytic sample and was matched with available data collected systematically by birth center staff via chart review. The data set also included anonymous responses to an e-mailed questionnaire from clients identified by birth center staff. RESULTS Approximately 56.1% (N = 1,155) of the cases in the data set were eligible for comparative analysis. The birth center preference and hospital preference groups included 899 (77.8%) and 256 (22.2%) individuals, respectively. In the hospital preference group, Black clients (n = 23), those who were publicly insured (n = 49), and primiparas (n = 101) were significantly overrepresented. Chart review data and questionnaire responses highlighted insurance restrictions, family preferences, pain relief options, and postpartum care as influential factors among members of the hospital preference subsample. CONCLUSION The present analysis shows associations between certain individual characteristics and elective hospitalization during labor for birth center clients. Health record data and questionnaire responses indicated a variety of reasons for electing hospitalization, illustrating the complexity of clients' decision-making during pregnancy and birth.
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Kennedy K, Adelson P, Fleet J, Steen M, McKellar L, Eckert M, Peters MDJ. Shared decision aids in pregnancy care: A scoping review. Midwifery 2019; 81:102589. [PMID: 31790856 DOI: 10.1016/j.midw.2019.102589] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/11/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shared decision making in pregnancy, labour, and birth is vital to woman-centred care and despite strong evidence for the effectiveness of shared decision making in pregnancy care, practical uptake has been slow. DESIGN AND AIM This scoping review aimed to identify and describe effective and appropriate shared decision aids designed to be provided to women in the antenatal period to assist them in making informed decisions for both pregnancy and birth. Two questions guided the enquiry: (i) what shared decision aids for pregnancy and perinatal care are of appropriate quality and feasibility for application in Australia? (ii) which of these decision aids have been shown to be effective and appropriate for Aboriginal and Torres Strait Islander peoples, culturally diverse women, or those with low literacy? METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) was used to conduct the review. Five key databases and selected grey literature sources were examined. English language evidence from Australia, Europe, Canada, United Kingdom, New Zealand, and United States of America produced from 2009 was eligible for inclusion, checked against apriori inclusion criteria, and assessed for quality and usability using the International Patient Decision Aid Standards. RESULTS From a total of 5,209 search results, 35 sources of evidence reporting on 27 decision aids were included following title/abstract and full-text review. Most of the decision aids concerned decisions around birth (52%, n = 14) or antenatal screening 37% (n = 10). The quality of the decision aids was moderate to high, with most communicating risks, benefits, and choice pathways via a mix of Likert-style scales, quizzes, and pictures or graphs. Use of decision aids resulted in significant reductions in decisional conflict and increased knowledge. The format of decision aids appeared to have no effect on these outcomes, indicating that paper-based are as effective as video- or audio-based decision aids. Eleven decision aids were suitable for low literacy or low health literacy women, and six were either developed for culturally diverse groups or have been translated into other languages. No decision aids found were specific to Aboriginal and Torres Strait Islander peoples. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The 27 decision aids are readily adoptable into westernised healthcare settings and can be used by midwives or multidisciplinary teams in conjunction with women. Decision aids are designed to support women, and families to arrive at informed choices and supplement the decision-making process rather than to replace consumer-healthcare professional interaction. If given before an appointment, high quality decision aids can increase a woman's familiarity with medical terminology, options for care, and an insight into personal values, thereby decreasing decisional conflict and increasing knowledge.
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Affiliation(s)
- Kate Kennedy
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia. GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Pamela Adelson
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia. GPO Box 2471, Adelaide, SA 5001, Australia; Mothers, Babies and Families: Health Research Group, Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia
| | - Julie Fleet
- Mothers, Babies and Families: Health Research Group, Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia
| | - Mary Steen
- Mothers, Babies and Families: Health Research Group, Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia
| | - Lois McKellar
- Mothers, Babies and Families: Health Research Group, Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia. GPO Box 2471, Adelaide, SA 5001, Australia
| | - Micah D J Peters
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia. GPO Box 2471, Adelaide, SA 5001, Australia
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Escobar M, Shearin S. Immediate Postpartum Contraception: Intrauterine Device Insertion. J Midwifery Womens Health 2019; 64:481-487. [PMID: 31206967 DOI: 10.1111/jmwh.12984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 11/29/2022]
Abstract
Insertion of an intrauterine device (IUD) in the immediate postpartum period is a safe, evidence-based form of contraception appropriate for most women. Despite the higher risk of expulsion as compared with interval insertion, the benefits of insertion in the immediate postpartum period are significant and include improved rates of contraception continuance and reduced instances of short interval birth. Through shared decision making, midwives and other clinicians can assist women in clarifying their reproductive goals and understanding of contraceptive options, including this method. In response to identified gaps in knowledge and insertion technique among midwives, this article provides an overview of immediate postpartum IUD insertion, risks and benefits, and eligibility criteria and describes preinsertion, insertion, and postinsertion care.
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Affiliation(s)
- Melicia Escobar
- Department of Advanced Practice Nursing, Georgetown University, Washington, District of Columbia
| | - Stacey Shearin
- Department of Obstetrics & Gynecology, Naval Medical Center Portsmouth, Portsmouth, Virginia
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van der Garde M, Hollander M, Olthuis G, Vandenbussche F, van Dillen J. Women desiring less care than recommended during childbirth: Three years of dedicated clinic. Birth 2019; 46:262-269. [PMID: 30734365 DOI: 10.1111/birt.12419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some women decline recommended care during pregnancy and birth. This can cause friction between client and provider. METHODS A designated outpatient clinic was started for women who decline recommended care in pregnancy. All women who attended were analyzed retrospectively. The clinic used a systematic multidisciplinary approach. During the first visit, women told their stories and explained the reasoning behind their birth plan. The second visit was used to present the evidence underpinning recommendations and attempt to reach a compromise if care within recommendations was still not acceptable to the woman. During the third visit, a final birth plan was decided on. RESULTS From January 1, 2015, until December 31, 2017, 55 women were seen in the clinic, 29 of whom declined items of recommended care during birth and were included in the study. After discussions had been completed, 38% of birth plans were within recommendations, 38% were a compromise, in which both the woman and the care provider had made certain concessions, and 24% did not reach an agreement and delivered with another provider either at home or elsewhere. All maternal and perinatal outcomes were good. CONCLUSIONS Using a respectful and systematic multidisciplinary approach, in which women feel heard and are invited to explain their motivations for their birth plans, we are able to arrive at a plan either compatible with or much closer to recommendations than the woman's initial intentions in most cases, thereby preventing negative choices.
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Affiliation(s)
- Matthijs van der Garde
- Obstetrics and Gynaecology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martine Hollander
- Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Olthuis
- Department of Medical Ethics, IQ Healthcare, Radboud University, Nijmegen, The Netherlands
| | - Frank Vandenbussche
- Maternal-Fetal Medicine, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen van Dillen
- Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
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King TL, Likis FE, Wilson-Liverman AM. Shared Decision Making: Misconstrued and Misused. J Midwifery Womens Health 2018; 63:257-258. [DOI: 10.1111/jmwh.12763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 03/30/2018] [Indexed: 12/01/2022]
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