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Bendix JM, Heinsen M, Backhausen MG. "But I'm not a professional" - How women with high-risk pregnancies voice the experiences of home-based telemonitoring; a qualitative interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:101015. [PMID: 39180933 DOI: 10.1016/j.srhc.2024.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/23/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES Telemonitoring of high-risk pregnancy complications is a new approach that offers remote obstetric caregiving using mobile and wireless technologies. New evidence shows that home-based obstetric telemonitoring is not only feasible but also a safe alternative to inpatient or frequent outpatient care. As little is known how performing obstetric telemonitoring is perceived, this study examined how women with pregnancy complications experienced performing home-based telemonitoring. METHODS A qualitative, semi-structured interview study was conducted with women with ongoing experience in performing home-based telemonitoring procedures for high-risk pregnancy complications. Purposeful sampling strategy and data saturation were applied followed by verbatim transcription. The data were analyzed using systematic text condensation. RESULTS Fifteen informants participated in the study and four major themes emerged. The study revealed that performing telemonitoring was overall positively experienced as an 'Empowering yet challenging responsibility' as well as an 'Extended patient-clinician partnership.' There were pros and cons as to the influence of telemonitoring in everyday life; 'Tele-comfort yet ambivalence' and that it could be accompanied by annoying practical issues; 'Accompanying remote issues.' CONCLUSIONS Performing obstetric telemonitoring was experienced as an empowering yet challenging responsibility as well as an extended partnership between the clinician and the pregnant woman. Pros and cons were voiced as to the influence and ambivalence of telemonitoring in everyday life, and that it could be accompanied by annoying practical issues. Patient aspects and experiences of telemonitoring are important clinical knowledge that must be considered when a telemonitoring plan is tailored preferably in a shared decision-making process.
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Affiliation(s)
- Jane M Bendix
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Dyrehavevej 29, 3400 Hilleroed, Denmark; Department of Clinical Research, Copenhagen University Hospital - North Zealand, Dyrehavevej 29, 3400 Hilleroed, Denmark.
| | - Mikala Heinsen
- University College Copenhagen, Department of Midwifery, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Mette G Backhausen
- Department of Gynaecology and Obstetrics, Zealand University Hospital, Sygehusvej 10, Roskilde, Denmark
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Hawke M, Considine J, Sweet L. "Ask for my ideas first": Experiences of antenatal care and shared decision-making for women with high body mass index. Women Birth 2024; 37:101646. [PMID: 39024983 DOI: 10.1016/j.wombi.2024.101646] [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: 05/05/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Shared decision-making supports women's choices in pregnancy. Women with high body mass index (≥35 kg/m2) experience a high rate of interventions in pregnancy, labour, and birth, providing an opportunity for clinicians to implement shared decision-making in practice. However, weight stigma may limit women's opportunities for shared decision-making. AIM To understand how pregnant women with high body mass index perceive their involvement in antenatal decision-making, including whether weight stigma influences their experience. METHODS Women with high body mass index were recruited via purposive sampling from two sites in Melbourne, Australia. Semi-structured interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. FINDINGS Ten pregnant women consented to participate. Three themes and six sub-themes were identified. These were: 1) Trusting the system, 2) Who takes the lead?, and 3) Defying disease. DISCUSSION Shared decision-making is limited for women with high body mass index in antenatal care, and weight stigma is experienced by women. Clinical practice recommendations relating to excess weight have the potential to further limit women's involvement in decision-making if adequate support is not provided to ensure women's understanding and involvement in care. CONCLUSION Women's involvement in care is a central component of shared decision-making and it is currently limited for women with high body mass index. Transparency regarding the rationale for recommendations is required, and further work must be done to address the influence and impact of weight stigma on the care of women with high body mass index.
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Affiliation(s)
- Madeline Hawke
- School of Nursing and Midwifery, Deakin University, Geelong, Australia.
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine, Australia
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Hawke M, Considine J, Sweet L. Maternity clinician use of shared decision-making in antenatal care: A scoping review. Birth 2024; 51:475-483. [PMID: 38100235 DOI: 10.1111/birt.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 08/13/2024]
Abstract
BACKGROUND Implementation of shared decision-making in antenatal care has had limited exploration. OBJECTIVE To assess what is known about shared decision-making in antenatal care. SEARCH STRATEGY Five databases were searched (1997-2022) limited to English language studies from OECD countries. DATA COLLECTION AND ANALYSIS A data collection table was constructed with findings from 32 papers. A narrative synthesis was conducted with subsequent thematic analysis of included papers. MAIN RESULTS Four areas of decision-making were identified with six themes revealing enablers and barriers to shared decision-making in antenatal care. CONCLUSION Implementation of shared decision-making requires continuity, time and personalisation of care.
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Affiliation(s)
- Madeline Hawke
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine, St Albans, Victoria, Australia
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George EK, Dominique S, Irie W, Edmonds JK. "It's my Home away from Home:" A hermeneutic phenomenological study exploring decision-making experiences of choosing a freestanding birth centre for perinatal care. Midwifery 2024; 139:104164. [PMID: 39236560 DOI: 10.1016/j.midw.2024.104164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 08/13/2024] [Accepted: 08/27/2024] [Indexed: 09/07/2024]
Abstract
PROBLEM The high-value, midwifery-led birth centre (BC) model of care is underutilized in the United States, a country with high rates of obstetric intervention and maternal morbidity and mortality. BACKGROUND Birth setting decision-making is a complex, preference-sensitive, and resource-dependent process. Understanding how people choose BCs for care may help increase the utilization of BCs and generate positive perinatal outcomes. AIM This study explores the decision-making experiences of people with Medicaid insurance who chose to give birth in a BC in Massachusetts by gathering interview data to interpret and provide meaning about their selection of birth setting. METHODS We employed a hermeneutic phenomenology study to interview people about their decision to give birth in a BC. Interview data were coded using a hybrid deductive-inductive approach and analyzed using reflexive thematic analysis to interpret and provide meaning. FINDINGS Twelve women participated in the study. Five themes emerged that described participants' decision-making processes: 1) Stepping Away from "the System," 2) Decision-Making with External Influences, 3) Accessing BC Care, 4) Finding a Home at the BC, and 5) Decision-Making as a Temporal Process. DISCUSSION The decision to choose a BC was a dynamic process that occurred over time and was influenced by factors such as the quality of care, accessibility, external influences, and the physical environment. CONCLUSION Prioritizing an individual's capacity to choose their birth setting and fostering awareness about options in the context of informed decision-making are pivotal steps toward attaining equity in perinatal health. Securing public insurance coverage and equitable reimbursement for BCs represent essential policies aimed at facilitating universal access to the BC model for all people.
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Affiliation(s)
- Erin K George
- University of Arizona College of Nursing, 1305 N. Martin Avenue, Tuscon, AZ, 85721, United States.
| | - Sarah Dominique
- Boston College Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, United States
| | - Whitney Irie
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, United States
| | - Joyce K Edmonds
- ZHAW School of Health Sciences, Institute of Midwifery and Reproductive Health, Katharina-Sulzar Plaz 9, Postfach, 8401, Winterthur, Switzerland; Ariadne Labs, 401 Park Drive 3rd Floor, Boston, MA, 02215, United States
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Neergheen VL, Chaer LE, Plough A, Curtis E, Paterson VJ, Short T, Bright A, Lipsitz S, Murphy A, Miller K, Subramanian L, Radichel E, Ervin J, Castleman L, Brown E, Yeboah T, Simas TM, Terk D, Vedam S, Shah N, Weiseth A. Assessing patient autonomy in the context of TeamBirth, a quality improvement intervention to improve shared decision-making during labor and birth. Birth 2024. [PMID: 39140579 DOI: 10.1111/birt.12857] [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: 11/18/2023] [Revised: 06/10/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Respectful maternity care includes shared decision-making (SDM). However, research on SDM is lacking from the intrapartum period and instruments to measure it have only recently been developed. TeamBirth is a quality improvement initiative that uses team huddles to improve SDM during labor and birth. Team huddles are structured meetings including the patient and full care team when the patient's preferences, care plans, and expectations for when the next huddle will occur are reviewed. METHODS We used patient survey data (n = 1253) from a prospective observational study at four U.S. hospitals to examine the relationship between TeamBirth huddles and SDM. We measured SDM using the Mother's Autonomy in Decision-Making (MADM) scale. Linear regression models were used to assess the association between any exposure to huddles and the MADM score and between the number of huddles and the MADM score. RESULTS In our multivariable model, experiencing a huddle was significantly associated with a 3.13-point higher MADM score. When compared with receiving one huddle, experiencing 6+ huddles yielded a 3.64-point higher MADM score. DISCUSSION Patients reporting at least one TeamBirth huddle experienced significantly higher SDM, as measured by the MADM scale. Our findings align with prior research that found actively involving the patient in their care by creating structured opportunities to discuss preferences and choices enables SDM. We also demonstrated that MADM is sensitive to hospital-based quality improvement, suggesting that future labor and birth interventions might adopt MADM as a patient-reported experience measure.
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Affiliation(s)
- Vanessa L Neergheen
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lynn El Chaer
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Avery Plough
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Curtis
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Victoria J Paterson
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Trisha Short
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amani Bright
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Aizpea Murphy
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kate Miller
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Laura Subramanian
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Evelyn Radichel
- Hillcrest Medical Center, Peggy V. Helmerich Women's Health Center, Tulsa, Oklahoma, USA
| | - John Ervin
- Hillcrest Medical Center, Peggy V. Helmerich Women's Health Center, Tulsa, Oklahoma, USA
| | - Lindsay Castleman
- Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Erin Brown
- Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Tracy Yeboah
- Department of Obstetrics and Gynecology, Chan Medical School, University of Massachusetts, Worcester, Massachusetts, USA
- Department of Obstetrics and Gynecology, UMass Memorial Health-UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Tiffany Moore Simas
- Department of Obstetrics and Gynecology, Chan Medical School, University of Massachusetts, Worcester, Massachusetts, USA
- Department of Obstetrics and Gynecology, UMass Memorial Health-UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Daniel Terk
- Department of Obstetrics and Gynecology, UMass Memorial Health-HealthAlliance-Clinton Hospital, Clinton, Massachusetts, USA
| | - Saraswathi Vedam
- Birth Place Lab, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neel Shah
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amber Weiseth
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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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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Jacques M, Chantry AA, Evrard A, Lelong N, Le Ray C. Consent for interventions during childbirth: A national population-based study. Int J Gynaecol Obstet 2024. [PMID: 39092580 DOI: 10.1002/ijgo.15830] [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: 02/01/2024] [Revised: 05/15/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level. METHODS The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition. RESULTS Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96). CONCLUSION Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women's involvement in decision making during childbirth.
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Affiliation(s)
- Marianne Jacques
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Anne Alice Chantry
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
- Midwifery University Department, Université Paris Cité, Paris, France
| | - Anne Evrard
- Collectif Interassociatif Autour de la Naissance (CIANE), Paris, France
| | - Nathalie Lelong
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Camille Le Ray
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
- Maternité Port Royal, Hôpital Cochin Port Royal, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Pham A, Sardana A, Sparks AD, Gimovsky AC. The Association of Maternal Satisfaction with Childbirth by Length of Second Stage. Am J Perinatol 2024; 41:e369-e376. [PMID: 36170863 DOI: 10.1055/s-0042-1754412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of this study was to quantify patient satisfaction by hour of second stage of labor and subsequent delivery mode. STUDY DESIGN Pilot cross-sectional study of nulliparous women delivered at George Washington University Hospital between April 2018 and March 2019. Patients completed three survey questionnaires in the immediate postpartum period: Patient Perception Score (PPS), Consumer Satisfaction Questionnaire (CSQ), and Six Simple Questions (SSQ). Length of second stage was divided into 2 groups (≤3 hours and >3 hours). Data on maternal characteristics, maternal outcomes, and neonatal outcomes were collected in REDCap and statistical analysis was performed using SAS version 9.4. RESULTS Survey response rate was 100% (n = 100). Seventy-one patients had a normal second stage and 29 patients had a prolonged second stage. Prolonged second stage was significantly associated with a lower proportion of NSVD (65.5 vs. 90.1%; p <0.01) and a higher proportion of epidural (82.8 vs. 60.6%; p = 0.03) in comparison to a normal second stage. Length of second stage had a statistically significant negative correlation with overall PPS scores (ρ = - 0.25, p ≤0.01). Length of second stage was not correlated with the SSQ (ρ = 0.05, p = 0.25) or CSQ (ρ = - 0.18, p = 0.11) surveys. CSQ scores were statistically significantly lower in women who underwent second stage cesarean delivery. CONCLUSION Maternal satisfaction with childbirth and health care experience was high regardless of length of second stage. Only the PSS survey showed that shorter length of second stage was correlated with higher satisfaction. Cesarean delivery in the second stage was significantly associated with decreased maternal satisfaction. Future studies with larger cohorts are needed to confirm our findings. KEY POINTS · There is limited data on maternal satisfaction with childbirth.. · Mode of delivery may affect maternal satisfaction.. · Shared decision-making about delivery mode and timing is crucial..
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Affiliation(s)
- Amelie Pham
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aayushi Sardana
- Department of Obstetrics and Gynecology, Jamaica Hospital Medical Center, Queens, New York
| | - Andrew D Sparks
- Department of Surgery, George Washington University Medical Faculty Associates, Washington, Dist. of Columbia
| | - Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. J Obstet Gynecol Neonatal Nurs 2024; 53:e10-e48. [PMID: 38363241 DOI: 10.1016/j.jogn.2023.11.001] [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: 02/17/2024] Open
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Goh AH, Robinson K, Craddock JB, Breman RB. Birth Care Gaps in the Childbirth Options, Information, and Person-Centered Explanation (CHOICEs) Measure. MCN Am J Matern Child Nurs 2024; 49:165-171. [PMID: 38241005 DOI: 10.1097/nmc.0000000000001004] [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: 04/30/2024]
Abstract
PURPOSE The objective of this study was to revise and improve the intrapartum items of the shared decision-making (SDM) measure, CH ildbirth O ptions, I nformation and person- C entered E xplanation (CHOICEs). STUDY DESIGN AND METHODS Methodological sequential triangulation was used to select a purposive sample of 29 people who gave birth in the United States between August 2019 and June 2021. A qualitative descriptive approach was used to analyze and interpret the data. We used an interview guide with questions related to the nine intrapartum items in CHOICEs to address the question: How did decision-making occur during your most recent birth? RESULTS Four major themes were identified: provider told me what to do ; communication about interventions during labor and birth ; preferences overlooked ; multiple team members . Under the theme of provider told me what to do , there was one sub-theme of induction of labor . CLINICAL IMPLICATIONS Participants noted lack of shared decision-making, poor communication, and obstetric violence. We found the need for perinatal providers to improve communication with birthing people on topics such as fetal monitoring, induction of labor, and multiple team members who may participate in their care. Revisions of CHOICEs will include seven new items to further address birth preferences, feeling heard, and multiple team members.
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. Nurs Womens Health 2024; 28:e1-e39. [PMID: 38363259 DOI: 10.1016/j.nwh.2023.11.001] [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: 02/17/2024]
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Breman RB, Waddell A, Watkins V. Shared Decision Making in Perinatal Care. J Obstet Gynecol Neonatal Nurs 2024; 53:96-100. [PMID: 38403272 DOI: 10.1016/j.jogn.2024.02.003] [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: 02/27/2024] Open
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Hamm RF, McCoy JA, Clark RR, Parry S, Levine LD. Are Racial Disparities in Cesarean Due to Differences in Labor Induction Management? Am J Perinatol 2024:10.1055/a-2259-0409. [PMID: 38301721 PMCID: PMC11345886 DOI: 10.1055/a-2259-0409] [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] [Indexed: 02/03/2024]
Abstract
OBJECTIVE While there are known racial disparities in cesarean delivery (CD) rates, the exact etiologies for these disparities are multifaceted. We aimed to determine if differences in induction of labor (IOL) management contribute to these disparities. STUDY DESIGN This retrospective cohort study evaluated all nulliparous patients with an unfavorable cervix and intact membranes who underwent IOL of a term, singleton gestation at a single institution from October 1, 2018, to September 30, 2020. IOL management was at clinician discretion. Patients were classified as Black, Indigenous, and People of Color (BIPOC) or White based on self-report. Overall rates of CD were compared for BIPOC versus White race. Chart review then evaluated various IOL management strategies as possible contributors to differences in CD by race. RESULTS Of 1,261 eligible patients, 915 (72.6%) identified as BIPOC and 346 (27.4%) as White. BIPOC patients were more likely to be younger (26 years interquartile range (IQR) [22-30] vs. 32 years IQR [30-35], p < 0.001) and publicly insured (59.1 vs. 9.9%, p < 0.001). Indication for IOL and modified Bishop score also differed by race (p < 0.001; p = 0.006). There was 40% increased risk of CD for BIPOC patients, even when controlling for confounders (30.7 vs. 21.7%, p = 0.001; adjusted relative risk (aRR) 1.41, 95% confidence interval (CI) [1.06-1.86]). Despite this difference in CD, there were no identifiable differences in IOL management prior to decision for CD by race. Specifically, there were no differences in choice of cervical ripening agent, cervical dilation at or time to amniotomy, use and maximum dose of oxytocin, or dilation at CD. However, BIPOC patients were more likely to undergo CD for fetal indications and failed IOL. CONCLUSION BIPOC nulliparas are 40% more likely to undergo CD during IOL than White patients within our institution. These data suggest that the disparity is not explained by differences in IOL management prior to cesarean, indicating that biases outside of induction management may be important to target to reduce CD disparities. KEY POINTS · The etiologies for racial disparities in cesarean are likely multifaceted.. · In this work, there were no differences by race in measures of labor induction management.. · Biases outside of induction management during labor may be targeted to reduce CD disparities..
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Affiliation(s)
- Rebecca F. Hamm
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer A. McCoy
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rebecca R.S. Clark
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lisa D. Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
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Wadsworth P, Graves L, Pogula M, Duerst A, Southard J, Kothari C, Presberry J. Patients' Perspectives on Informational Support and Education in the Perinatal Period: "The Quicker They Could Be Done With Me, the Better". J Midwifery Womens Health 2024; 69:110-117. [PMID: 37486773 DOI: 10.1111/jmwh.13548] [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] [Revised: 05/24/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The overall purpose of this study was to elicit perspectives from a diverse group of postpartum individuals about their perinatal outpatient informational support and education. In addition, suggestions from participants are provided. Although informational support is crucial in the peripartum period, it is often inadequate or biased. Qualitative research, which offers a nuanced and patient-centered perspective, is limited. The qualitive research that does exist is limited to the prenatal period only, neglecting perspectives throughout the entire peripartum period. METHODS This qualitative descriptive study was part of a larger observational cross-sectional study of postpartum individuals in Kalamazoo, Michigan in 2017. Two years after the initial study (2019), participants were recruited into 8 focus groups. Trained facilitators guided focus group conversations using semistructured interview questions. The questions centered on overall experiences with perinatal outpatient health care experiences and informational support. Thematic analyses were used in data analysis. Interrater reliability between coders ranged from 92% to 100%. RESULTS Fifty-four individuals (22.1% response rate) participated in a total of 12 focus groups. The overarching theme was the need for recognition of individuality of patients. Three subthemes emerged, including time, multiple modalities of information support, and agency. DISCUSSION This study extended previous qualitative findings across the entire peripartum period and that individualized prenatal care is an important distinction in perceived quality of care. Health care organizations should consider allocating time differently for perinatal office visits, offer flexible visit times based on individualized needs, offer information in multiple modalities, and promote agency of patients. This study was strengthened by the community involvement, women of color only focus groups, and oversampling of Black women. This study was limited by the self-selected, homogenous sample and potential for recall bias.
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Affiliation(s)
- Pamela Wadsworth
- Bronson School of Nursing, Western Michigan University, Kalamazoo, Michigan
| | - Lisa Graves
- Department of Family and Community Medicine, Western Michigan University Medical School, Kalamazoo, Michigan
| | - Mounika Pogula
- Western Michigan University Medical School, Kalamazoo, Michigan
| | - Abby Duerst
- Western Michigan University Medical School, Kalamazoo, Michigan
| | - James Southard
- Western Michigan University Medical School, Kalamazoo, Michigan
| | - Catherine Kothari
- Department of Biomedical Sciences, Western Michigan University Medical School, Kalamazoo, Michigan
| | - Joi Presberry
- Western Michigan University Medical School, Kalamazoo, Michigan
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Murugesu L, Damman OC, Timmermans DRM, de Wit S, Nieuwenhuijze M, Smets EMA, Fransen MP. Health literate-sensitive shared decision-making in maternity care: needs for support among maternity care professionals in the Netherlands. BMC Pregnancy Childbirth 2023; 23:594. [PMID: 37605153 PMCID: PMC10440871 DOI: 10.1186/s12884-023-05915-9] [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: 02/27/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) in maternity care is challenging when clients have insufficient health literacy (HL) skills. This study gained insight in how professionals apply HL-sensitive SDM in Dutch maternity care and their needs for support therein. METHODS Maternity care professionals (n = 30) completed a survey on SDM and the role of HL. Midwives (n = 13) were observed during simulated conversations discussing pain relief options and interviewed afterwards. The client-actors were instructed to portrait specific inadequate HL skills. Observation items focused on adapting communication to HL, and SDM (OPTION-5). RESULTS In the survey, professionals indicated experiencing most challenges when estimating clients' information comprehension. Observations showed that most midwives created choice awareness and informed clients about options, whereas exploring preferences and actual decision-making together with clients were observed less frequently. Their perceived HL-related obstacles and needs for support related to clients' information comprehension. In the interviews, midwives reported putting much effort into explaining available options in maternity care, but also that decisions about pain relief are often postponed until the moment of labour. CONCLUSION Professionals' self-reported needs focus on clients' information comprehension. However, observations indicate that it is not the stage of informing, but rather value clarification and actual decision-making that need improvement in HL-sensitive SDM.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Olga C Damman
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Danielle R M Timmermans
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Sanne de Wit
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, Maastricht, 6229 ER, the Netherlands
- CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Ellen M A Smets
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Mirjam P Fransen
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Waddell A, Goodwin D, Spassova G, Bragge P. "The Terminology Might Be Ahead of Practice": Embedding Shared Decision Making in Practice-Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care. MDM Policy Pract 2023; 8:23814683231199943. [PMID: 37743932 PMCID: PMC10517621 DOI: 10.1177/23814683231199943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/20/2023] [Indexed: 09/26/2023] Open
Abstract
Background. It is a patient's right to be included in decisions about their health care. Implementing shared decision making (SDM) is important to enable active communication between clinicians and patients. Although health policy makers are increasingly mandating SDM implementation, SDM adoption has been slow. This study explored stakeholders' organizational- and system-level barriers and facilitators to implementing policy mandated SDM in maternity care in Victoria, Australia. Method. Twenty-four semi-structured interviews were conducted with participants including clinicians, health service administrators and decision makers, and government policy makers. Data were mapped to the Theoretical Domains Framework to identify barriers and facilitators to SDM implementation. Results. Factors identified as facilitating SDM implementation included using a whole-of-system approach, providing additional implementation resources, correct documentation facilitated by electronic medical records, and including patient outcomes in measurement. Barriers included health service lack of capacity, unclear policy definitions of SDM, and policy makers' lack of resources to track implementation. Conclusion. This is the first study to our knowledge to explore barriers and facilitators to SDM implementation from the perspective of multiple actors following policy mandating SDM in tertiary health services in Australia. The primary finding was that there are concerns that SDM implementation policy is outpacing practice. Nonclinical staff play a crucial role translating policy to practice. Addressing organizational- and system-level barriers and facilitators to SDM implementation should be a key concern of health policy makers, health services, and staff. Highlights New government policies require shared decision making (SDM) implementation in hospitals.There is limited evidence for how to implement SDM in hospital settings.There are concerns SDM implementation policy is outpacing practice.Understanding and capacity for SDM varies considerably among stakeholders.Whole of system approaches and electronic medical records are seen to facilitate SDM.
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Affiliation(s)
- Alex Waddell
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
- Safer Care Victoria, Victorian Department of Health, Melbourne, VIC, Australia
| | - Denise Goodwin
- Behaviour Works Australia Health Programs, Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | - Gerri Spassova
- Department of Marketing, Monash Business School, Caulfield East, VIC, Australia
| | - Peter Bragge
- Monash Sustainable Evidence Review Service, Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
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Kalpakjian CZ, Haapala HJ, Ernst SD, Orians BR, Barber ML, Mulenga L, Bolde S, Kreschmer JM, Parten R, Carlson S, Rosenblum S, Jay GM. Development and pilot test of a pregnancy decision making tool for women with physical disabilities. Health Serv Res 2023; 58:223-233. [PMID: 36401816 PMCID: PMC9836953 DOI: 10.1111/1475-6773.14103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Design and pilot test a new decision making tool for women with physical disabilities (impairment of physical function due to chronic conditions) considering pregnancy. DATA SOURCES AND STUDY SETTING Quantitative surveys and qualitative interviews were collected from participants living in the community. STUDY DESIGN Clinical guidelines and survey and focus group data about pregnancy informational and decisional needs guided content development. The tool was pilot tested in a 12-week trial with participants with physical disabilities considering or actively planning a pregnancy. Feasibility outcomes were acceptability, implementation, and demand (collected at end of the trial); preliminary efficacy focused on decisional conflict and readiness (baseline, 6 weeks, and end of trial). DATA COLLECTION Survey data were collected using an online form. One-on-one interviews were conducted to learn more about experience using the tool. PRINCIPAL FINDINGS Thirty eight participants with mild, moderate, or severe physical disabilities participated. Feasibility outcomes indicated that the tool provided participants with information, guiding questions, and helped them to consider multiple aspects of the decision about pregnancy. Most participants responded positively to the new decision making tool, finding it easy to use and the information balanced. Feedback highlighted opportunity for improvement, such as more specific information, peer stories, and the limitations of a paper format. There was significant linear effect of time, with increased decisional certainty and readiness, values clarity, and decisional support (partial η2 [90% CI] = 0.310 [0.08, 0.46], 0.435 [0.19, 0.60], 0.134 [0, 0.29], 0.178 [0.01, 0.35], respectively). Decisional certainty and readiness had high observed power (96.7% and 99.3%, respectively) with lower observed power for clarity and support (60.6% and 75.1%, respectively). CONCLUSIONS The new tool shows promise for supporting women with physical disabilities in navigating pregnancy decision making. Future development of complementary strategies to support health care providers will help improve shared decision making and patient-centered care.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Heidi J. Haapala
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan D. Ernst
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | | | - Lukonde Mulenga
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Shannen Bolde
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jodi M. Kreschmer
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Rebecca Parten
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan Carlson
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Obstetrics and GynecologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Sara Rosenblum
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Gina M. Jay
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Yu T, Jin C, Wu X, Yue D. Implementation of Shared Decision-Making Within Internet Hospitals in China Based on Patients' Needs: Feasibility Study and Content Analysis. JMIR Form Res 2023; 7:e39965. [PMID: 36607710 PMCID: PMC9862330 DOI: 10.2196/39965] [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: 05/30/2022] [Revised: 09/19/2022] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Internet hospitals are developing rapidly in China, and their convenient and efficient medical services are being increasingly recognized by patients. Many hospitals have set up their own internet hospitals to provide web-based medical services. Tianjin Medical University General Hospital has established a multidisciplinary and comprehensive internet hospital to provide diversified medical services according to the needs of patients. A way to further improve web-based medical services is by examining how shared decision-making (SDM) can be carried out in internet hospital diagnosis and treatment services, thereby improving patients' medical experience. OBJECTIVE The aim of this study was to analyze the feasibility of implementing doctor-patient SDM in internet hospital diagnosis and treatment services based on patients' needs in China. METHODS In this study, the medical data of 10 representative departments in the internet hospital of Tianjin Medical University General Hospital from January 1 to January 31, 2022, were extracted as a whole; 25,266 cases were selected. After excluding 2056 cases with incomplete information, 23,210 cases were finally included in this study. A chi-square test was performed to analyze the characteristics and medical service needs of internet hospital patients in order to identify the strengths of SDM in internet hospitals. RESULTS The internet hospital patients from 10 clinical departments were significantly different in terms of gender (χ29=3425.6; P<.001), age (χ236=27,375.8; P<.001), mode of payment (χ29=3501.1; P<.001), geographic distribution (χ29=347.2; P<.001), and duration of illness (χ236=2863.3; P<.001). Patient medical needs included drug prescriptions, examination prescriptions, medical record explanations, drug use instructions, prehospitalization preparations, further consultations with doctors (unspecified purpose), treatment plan consultations, initial diagnoses based on symptoms, and follow-up consultations after discharge. The medical needs of the patients in different clinical departments were significantly different (χ272=8465.5; P<.001). CONCLUSIONS Our study provides a practical and theoretical basis for the feasibility of doctor-patient SDM in internet hospitals and offers some implementation strategies. We focus on the application of SDM in web-based diagnosis and treatment in internet hospitals rather than on a disease or a disease management software. The medical service needs of different patient groups can be effectively obtained from an internet hospital, which provides the practical conditions for the promotion of doctor-patient SDM. Our findings show that the internet hospital platform expands the scope of SDM and is a new way for the large-scale application of doctor-patient SDM.
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Affiliation(s)
- Tianzhi Yu
- Internet Hospital, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunjie Jin
- Internet Hospital, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaodan Wu
- School of Economics and Management, Hebei University of Technology, Tianjin, China
| | - Dianmin Yue
- School of Economics and Management, Hebei University of Technology, Tianjin, China
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ATASEVER İ, YÜCEL Ç. Öğrenci Hemşirelerin Gözüyle Perinatal Kliniklerde Hasta Mahremiyeti: Nitel Bir Çalışma. DOKUZ EYLÜL ÜNIVERSITESI HEMŞIRELIK FAKÜLTESI ELEKTRONIK DERGISI 2022. [DOI: 10.46483/deuhfed.969605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Giriş: Hemşirelik öğrencilerinin hasta mahremiyetine duyarlı olması, onların meslek yaşamında profesyonel bir duruş sergilemesi açısından oldukça önemlidir.
Amaç: Bu araştırmanın amacı, dördüncü sınıf hemşirelik öğrencilerinin perinatal kliniklerde hasta mahremiyetine yönelik görüşlerini belirlemektir.
Yöntem: Bu araştırmada, fenomenolojik nitel yöntem uygulanmıştır. Araştırmanın örneklemini, 2019-2020 Eğitim-Öğretim Yılı Güz Döneminde dördüncü sınıfta öğrenim gören 25 öğrenci oluşturmuştur. Veriler, Aralık 2019- Mart 2020 tarihleri arasında yarı yapılandırılmış derinlemesine bireysel görüşme yöntemi ile toplanmıştır. Görüşmede elde edilen veriler, içerik analizi yoluyla çözümlenmiştir.
Bulgular: Elde edilen veriler mahremiyetin tanımı, personelin hasta mahremiyetine yönelik tutumu mahremiyet ihlalinin hastaya yansıması hasta mahremiyetini korumada karşılaşılan güçlükler ve hasta mahremiyetini korumaya yönelik yapılması gerekenler şeklinde beş tema altında gruplandırılmıştır. Öğrencilerin çoğunluğu perinatal kliniklerde görev yapan personelin hasta mahremiyetini koruma konusunda özensiz davrandıklarını belirtmişlerdir. Öğrenciler, personelin hasta mahremiyeti konusunda eğitilmesi ve hastane ortamının fiziki koşullarında düzenleme yapılmasının mahremiyeti koruma konusunda faydalı olacağını söylemişlerdir.
Sonuç: Perinatal sağlık hizmetlerinde mahremiyet üzerinde yeterince durulmayan oldukça önemli bir konudur. Bu araştırmada; öğrenci hemşirelerin hasta mahremiyeti konusunda farkındalıklarının yüksek olduğu, konuyla ilgili yeni çalışmalara gereksinim duyulduğu belirlenmiştir.
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Affiliation(s)
- İlknur ATASEVER
- HACETTEPE ÜNİVERSİTESİ, HEMŞİRELİK FAKÜLTESİ, HEMŞİRELİK BÖLÜMÜ, HEMŞİRELİK PR
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Cavolo A. Embrace the Gray: How Tackling the Clinical Complexities of the Gray Zone Will Improve Decision-making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:40-43. [PMID: 36332041 DOI: 10.1080/15265161.2022.2123982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Schulz AA, Wirtz MA. Midwives' empathy and shared decision making from women's perspective - sensitivity of an assessment to compare quality of care in prenatal and obstetric care. BMC Pregnancy Childbirth 2022; 22:717. [PMID: 36127645 PMCID: PMC9487070 DOI: 10.1186/s12884-022-05041-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background For quality-oriented evaluation of prenatal and obstetric care, it is important to systematically consider the perspective of the women receiving care in order to comprehensively assess and optimize quality in a woman-centered manner. Empathy and Shared Decision Making (SDM) are essential components of woman-centered midwifery care. The aim of the study was to analyze measurement invariance of the items of the Consultation and Relational Empathy (CARE) and Shared Decision Making-Questionnaire (SDM-Q-9) scales depending on the prenatal versus obstetric care setting. Methods One hundred fifty women retrospectively assessed aspects of woman-centered midwifery care in both prenatal and obstetric care setting. The birth of the child was a maximum of 12 months ago. A structural equation modelling approach was adopted to separate true effects from response shift (RS) effects depending on care setting. The latter were analyzed in terms of recalibration (changing women’s internal measurement standards), Reprioritization (changing associations of items and construct) as well as Reconceptualization (redefining the target construct). Results A response shift model was identified for both assessments (pregnancy/birth: CFI = .96/.96; SRMR = .046/.051). At birth, both scales indicated lower quality of care compared with prenatal care (SDM-Q-9-M/CARE-8-M:|d| = 0.190/0.392). Although no reconceptualization is required for the items of both scales, RS effects are evident for individual items. Due to recalibration and reprioritization effects, the true differences in the items are partly underestimated (SDM-Q-9-M/CARE-8-M: 3/2 items) or overestimated (4/2 items). Conclusion The structure of the constructs SDM and Empathy, indicating woman-centered midwifery care, are moderated by the care settings. To validly assess midwives’ empathy and shared decision making from women’s perspective, setting-dependent response shift effects have to be considered. The proven item-specific response effects contribute to a better understanding of construct characteristics in woman-centered care by midwives during pregnancy and childbirth. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05041-y.
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Affiliation(s)
- Anja Alexandra Schulz
- Department of Research Methods in the Health Sciences, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany. .,Department of Research Methods, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.
| | - Markus Antonius Wirtz
- Department of Research Methods in the Health Sciences, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.,Department of Research Methods, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany
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Aiello E, Perera K, Ade M, Sordé-Martí T. A case study on the use of Public Narrative as a leadership development approach for Patient Leaders in the English National Health Service. Front Public Health 2022; 10:926599. [PMID: 36187684 PMCID: PMC9521407 DOI: 10.3389/fpubh.2022.926599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background In 2016 the National Health Service (NHS) England embraced the commitment to work for maternity services to become safer, more personalized, kinder, professional and more family-friendly. Achieving this involves including a service users' organizations to co-lead and deliver the services. This article explores how Public Narrative, a framework for leadership development used across geographical and cultural settings worldwide, can enhance the confidence, capability and skills of service-user representatives (or Patient Leaders) in the National Health Service (NHS) in England. Specifically, we analyse a pilot initiative conducted with one cohort of Patient Leaders, the Chairs of local Maternity Voices Partnerships (MVPs), and how they have used Public Narrative to enhance their effectiveness in leading transformation in maternity services as part of the NHS Maternity Transformation Programme. Methods Qualitative two-phase case study of a pilot training and coaching initiative using Public Narrative with a cohort of MVP Chairs. Phase 1 consisted of a 6-month period, during which the standard framework was adapted in co-design with the MVP Chairs. A core MVP Chair Co-Design Group underwent initial training and follow-up coaching in Public Narrative. Phase 2 consisted of qualitative data collection and data analysis. Results The study of this pilot initiative suggests two main ways in which Public Narrative can enhance the effectiveness of Patient Leaders in service improvement in general and maternity services in specific. First, training and coaching in the Public Narrative framework enables Patient Leaders to gain insight into, articulate and then craft their lived experience of healthcare services in a way that connects with and activates the underlying values of others ("shared purpose"), such that those experiences become an emotional resource on which Patient Leaders can draw to influence future service design and decision-making processes. Second, Public Narrative provides a simple and compelling structure through which Patient Leaders can enhance their skills, confidence and capability as "healthcare leaders," both individually and collectively. Conclusions The Public Narrative framework can significantly enhance the confidence, capability and skills of Patient Leaders, both to identify and coalesce around shared purpose and to advance genuine co-production in the design and improvement of healthcare services in general and maternity services in specific.
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Affiliation(s)
- Emilia Aiello
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain,*Correspondence: Emilia Aiello
| | - Kathryn Perera
- National Health Service (NHS) Horizons, London, United Kingdom
| | - Mo Ade
- Maternity Voices Partnership (MVP) Chair and Patient Public Voice, National Health Service, Ashford, United Kingdom
| | - Teresa Sordé-Martí
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain
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Labouring Together: Women's Experiences of “Getting the Care that I Want and Need” in Maternity Care. Midwifery 2022; 113:103420. [DOI: 10.1016/j.midw.2022.103420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/24/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
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Kloester J, Willey S, Hall H, Brand G. Midwives’ experiences of facilitating informed decision-making – a narrative literature review. Midwifery 2022; 109:103322. [DOI: 10.1016/j.midw.2022.103322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Keightley P, DiBella I, Sved Williams A. Seeing it clearly: How to use graphics to guide collaborative consultation in pregnancy. Australas Psychiatry 2022; 30:357-361. [PMID: 34809488 DOI: 10.1177/10398562211057067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to examine the use of decision aids which may improve shared decision making through an exploration of risk apprehension and modes of collaborative communication. CONCLUSIONS Decision aids such as graphics have a key role in facilitating shared treatment decision making, perhaps particularly in perinatal mental health care. They are most useful within a trusting, two-way conversation.
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Affiliation(s)
- Philip Keightley
- Perinatal and Infant Mental Health Consultation Service, Child and Adolescent Mental Health Service, Canberra Health Services, Garran, ACT, Australia; Australian National University Medical School, Garran, ACT, Australia
| | - Ilona DiBella
- Perinatal and Infant Mental Health Consultation Service, Child and Adolescent Mental Health Service, Canberra Health Services, Garran, ACT, Australia
| | - Anne Sved Williams
- Helen Mayo House, Perinatal and Infant Mental Health Services, Women's and Children's Health Network, Adelaide, SA, Australia; Department of Psychiatry, University of Adelaide, Adelaide, SA, Australia
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George EK, Mitchell S, Stacey D. Choosing a Birth Setting: A Shared Decision-Making Approach. J Midwifery Womens Health 2022; 67:510-514. [PMID: 35616249 DOI: 10.1111/jmwh.13377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/04/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
Perinatal outcomes vary widely depending on individual birth settings (birth center, home, and hospital). The purpose of this case study is to explore a patient-centered, shared decision-making approach to achieve an informed, values-based choice about birth settings. Engaging in a shared decision-making approach regarding birth setting options would support people to have the information and ability to judge for themselves how benefits and risks across birth center, home, and hospital settings would best fit with their values and personal health. A patient decision aid about birth setting options could facilitate increased equity regarding access to birth settings that offer improved perinatal health outcomes, helping to reduce perinatal health disparities in the United States.
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Affiliation(s)
- Erin K George
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | | | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Bączkowska M, Kosińska-Kaczyńska K, Zgliczyńska M, Brawura-Biskupski-Samaha R, Rebizant B, Ciebiera M. Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption-Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5148. [PMID: 35564543 PMCID: PMC9101673 DOI: 10.3390/ijerph19095148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 12/10/2022]
Abstract
Placental abruption (PA) is a separation of the placenta from the uterine wall occurring with the fetus still present in the uterine cavity. It contributes to numerous neonatal and maternal complications, increasing morbidity and mortality. We conducted a retrospective study at a tertiary perinatal care center, which included 2210 cases of labor that took place in 2015 with a PA occurrence of 0.7%. No maternal or fetal death during delivery was reported in this period. The identified PA risk factors were uterine malformations, pPROM, placenta previa spectrum, and oligohydramnios. The significant maternal PA complications identified were maternal anemia, uterine rupture, and HELLP syndrome. Preterm delivery occurred significantly more often in the PA group, and the number of weeks of pregnancy and the birth weight at delivery were both significantly lower in the PA group. PA is a relatively rare perinatal complication with very serious consequences, and it still lacks effective prophylaxis and treatment. Despite its rare occurrence, each center should develop a certain strategy for dealing with this pathology or predicting which patients are at risk. Much work is still needed to ensure the proper care of the mother and the baby in this life-threatening condition.
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Affiliation(s)
| | | | | | | | | | - Michał Ciebiera
- Center of Postgraduate Medical Education, Second Department of Obstetrics and Gynecology, 01-813 Warsaw, Poland; (M.B.); (K.K.-K.); (M.Z.); (R.B.-B.-S.); (B.R.)
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Goldstein JT, Eden AR, Taylor MK, Dotson A, Barreto T. Impact of COVID-19 on perinatal care: Perceptions of family physicians in the United States. Birth 2022; 49:719-727. [PMID: 35396870 PMCID: PMC9111605 DOI: 10.1111/birt.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-centered care is the best practice in the care of pregnant and postpartum patients. The COVID-19 pandemic prompted changes in perinatal care policies, which were often reactive, resulting in unintended consequences, many of which made the delivery of patient-centered care more difficult. This study aimed to understand the impact of the COVID-19 pandemic on perinatal health care delivery from the perspective of family physicians in the United States. METHODS From October 5 to November 4, 2020, we surveyed mid- to late-career family physicians who provide perinatal care. We conducted descriptive analyses to measure the impact of COVID-19 on prenatal care, labor and delivery, postpartum care, patient experience, and patient volume. An immersion-crystallization approach was used to analyze qualitative data provided as open-text comments. RESULTS Of the 1518 survey respondents, 1062 (69.8%) stated that they currently attend births; 595 of those elaborated about the impact of COVID-19 on perinatal care in free-text comments. Eight themes emerged related to the impact of COVID-19 on perinatal care: visitation, patient decisions, testing, personal protective equipment, care continuity, changes in care delivery, reassignment, and volume. The greatest perceived impact of COVID-19 was on patient experience. CONCLUSIONS Family physicians who provided perinatal care during the COVID-19 pandemic noted a considerable impact on patient experience, which particularly affected the ability to deliver patient-centered and family-centered care. Continued research is needed to understand the long-term impact of policies affecting the delivery of patient-centered perinatal care and to inform more evidence-based, proactive policies to be implemented in future pandemic or disaster situations.
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Affiliation(s)
| | - Aimee R. Eden
- American Board of Family MedicineLexingtonKentuckyUSA
| | | | - Andrea Dotson
- Department of Family Medicine and Community HealthDuke University School of MedicineNorth Carolina
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Jolles DR, Montgomery TM, Blankstein Breman R, George E, Craddock J, Sanders S, Niemcyzk N, Stapleton S, Bauer K, Wright J. Place of Birth Preferences and Relationship to Maternal and Newborn Outcomes Within the American Association of Birth Centers Perinatal Data Registry, 2007-2020. J Perinat Neonatal Nurs 2022; 36:150-160. [PMID: 35476769 DOI: 10.1097/jpn.0000000000000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to describe sociodemographic variations in client preference for birthplace and relationships to perinatal health outcomes. METHODS Descriptive data analysis (raw number, percentages, and means) showed that preference for birthplace varied across racial and ethnic categories as well as sociodemographic categories including educational status, body mass index, payer status, marital status, and gravidity. A subsample of medically low-risk childbearing people, qualified for birth center admission in labor, was analyzed to assess variations in maternal and newborn outcomes by site of first admission in labor. RESULTS While overall clinical outcomes exceeded national benchmarks across all places of admission in the sample, disparities were noted including higher cesarean birth rates among Black and Hispanic people. This variation was larger within the population of people who preferred to be admitted to the hospital in labor in the absence of medical indication. CONCLUSION This study supports that the birth center model provides safe delivery care across the intersections of US sociodemographics. Findings from this study highlight the importance of increased access and choice in place of birth for improving health equity, including decreasing cesarean birth and increasing breastfeeding initiation.
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Affiliation(s)
- Diana R Jolles
- Frontier University, Tucson, Arizona (Dr Jolles); American Association of Birth Centers Research Committee, Perkiomenville, Pennsylvania (Drs Jolles, Niemcyzk, and Stapleton and Mss Sanders, Bauer, and Wright); Department of Nursing, Temple University College of Public Health, Philadelphia, Pennsylvania (Dr Montgomery); University of Maryland School of Nursing, Baltimore (Dr Blankstein Breman); Boston College Connell School of Nursing, Boston, Massachusetts (Ms George); University of Maryland College of Social Work, Baltimore (Dr Craddock); and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sanders and Dr Niemcyzk)
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30
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Dong K, Jameel B, Gagliardi AR. How is patient-centred care conceptualized in obstetrical health? comparison of themes from concept analyses in obstetrical health- and patient-centred care. Health Expect 2022; 25:823-839. [PMID: 35026046 PMCID: PMC9122412 DOI: 10.1111/hex.13434] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/24/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022] Open
Abstract
Background Due to gender inequities that exist for women of childbearing age, there exists a need to deliver care tailored to their needs and preferences. Patient‐centred care (PCC) can be used to meet these needs. This review aims to compare patient care delivery between PCC and obstetrical care. This can help us address how PCC should be delivered to women before, during and after pregnancy versus how it is delivered to patients regardless of sex. Methods A review of literature was conducted on MEDLINE, EMBASE, CINAHL and SCOPUS for English PCC and high‐quality perinatal reviews published between 2010 and 2021. The data were analysed using a modified Walker and Avant framework. Results A total of 2138 unique studies were identified, with 11 PCC and 9 high‐quality obstetrical care studies included. Common defining features between PCC and obstetrical care include respect and dignity, informed decision‐making, therapeutic alliance, effective communication, social relationships and autonomy. PCC‐specific features were holistic care, empowerment, individualized care, coordinated care and empathy. Unique high‐quality obstetrical care themes included continuity of care, privacy and confidentiality, provider education and status, physical environment and equitable maternal care. Conclusions There are shared defining attributes between PCC and obstetrical care, including respect and dignity, informed decision‐making, the therapeutic alliance, effective communication, social relationships and autonomy. However, there remain unique defining attributes for high‐quality obstetrical care and PCC. This highlights the need for a unique approach to obstetrical care. More research on care for different physiological conditions in women is needed to address patient care that addresses different parts of the lifespan and develop frameworks that can influence health policy, patient care and health system evaluation. Patient or Public Contribution This study was one part of a larger, multicomponent study of how to implement PCC for women across the lifespan. While we did not specifically consult or involve women in this dual concept analysis, our larger study (content analysis of clinical guidelines and government policies, qualitative interviews with women and clinicians, Delphi study to prioritize consensus recommendations for achieving PCC for women) was guided by the experiences and input of a 50+ women advisory panel.
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Affiliation(s)
- Kelly Dong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bismah Jameel
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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31
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Dumont A, de Loenzien M, Nhu HMQ, Dugas M, Kabore C, Lumbiganon P, Torloni MR, Gialdini C, Carroli G, Hanson C, Betrán AP. Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001264. [PMID: 36962691 PMCID: PMC10022020 DOI: 10.1371/journal.pgph.0001264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/13/2022] [Indexed: 11/16/2022]
Abstract
Women's fear and uncertainty about vaginal delivery and lack of empowerment in decision-making generate decision conflict and is one of the main determinants of high caesarean section rates in low- and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burkina Faso. The DAT targets low-risk pregnant women with a healthy, singleton foetus, without any medical or obstetric disorder, no previous caesarean scarring, and eligibility for labour trials. We conducted a systematic review to determine the short- and long-term maternal and offspring risks and benefits of planned caesarean section compared to planned vaginal delivery. We carried out individual interviews and focus group discussions with key informants to capture informational needs for decision-making, and to assess the acceptability of the DAT in participating hospitals. The DAT meets 20 of the 22 Patient Decision Aid Standards for decision support. It includes low- to moderate-certainty evidence-based information on the risks and benefits of both modes of birth, and helps pregnant women clarify their personal values. It has been well accepted by women and health care providers. Adaptations have been made in each country to fit the context and to facilitate its implementation in current practice, including the development of an App. DAT is a simple method to improve communication and facilitate shared decision-making for planned modes of birth. It is expected to build trust and foster more effective, satisfactory dialogue between pregnant women and providers. It can be easily adapted and updated as new evidence emerges. We encourage further studies in LMICs to assess the impact of DAT on quality decision-making for the appropriate use of caesarean section in these settings.
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Affiliation(s)
- Alexandre Dumont
- Research Institute for Sustainable Development, Paris University, Paris, France
| | - Myriam de Loenzien
- Research Institute for Sustainable Development, Paris University, Paris, France
| | | | - Marylène Dugas
- Interdisciplinary Chair in Health and Social Services for Rural Populations, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Charles Kabore
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Maria Regina Torloni
- Evidence Based Healthcare Post-Graduate Program, São Paulo Federal University, São Paulo, Brazil
| | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | | | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Genève, Switzerland
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Erickson EN, Bailey JM, Colo SD, Carlson NS, Tilden EL. Induction of labor or expectant management? Birth outcomes for nulliparous individuals choosing midwifery care. Birth 2021; 48:501-513. [PMID: 34047405 PMCID: PMC9123647 DOI: 10.1111/birt.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 05/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Induction of labor (IOL) has been studied as a strategy to reduce rates of cesarean birth (CB). Midwifery care models are also associated with lower CB rates, even considering that midwives perform fewer IOLs. In this study, we examined childbirth outcomes among individuals undergoing IOL in certified nurse-midwifery (CNM) care as compared to two categories of expectant management (EM). METHODS Data were from two CNM practices in the United States (2007-2018). The sample was limited to term nulliparous, nondiabetic, singleton, vertex pregnancies. Individuals having an IOL in each week of gestation (37th, 38th, etc) were compared with those having EM. Two methods for defining EM were considered as each method when used alone limits interpretation. Inclusive EM included all births starting in the same week as IOL. The exclusive EM group was comprised of all births occurring in the next gestational age week relative to the IOL cases (ie, 39th week IOL versus all births occurring at 40 weeks or later). Adjusted regression models were used to examine differences in CB by IOL versus EM (inclusive or exclusive) at each week of gestation. RESULTS Among 4057 CNM-attended pregnancies, the overall rate of IOL was 28.9% (95% CI 27.5%-30.3%) and CB was 19.4% (95% CI 18.1%-20.6%). Most IOLs involved obstetric indications. CB rates did not differ by IOL versus inclusive EM when performed between 37 and 40 weeks, though post hoc power calculations indicate these comparisons were low-powered. In multivarable models, IOL in the 40th week was associated with lower odds for CB versus exclusive EM definition (ie, births occurring at 41 0/7 weeks or later, OR (95% CI) = 0.57 (0.36-0.90)). This finding is explained by the large increase in CB rates after IOL during the 41st week (34.3%, up from 21.9% in the 40th week). Furthermore, the adjusted odds for CB in the 41st week were 55% higher relative to inclusive EM (all labors 41st week and later), OR (95% CI) = 1.55(1.11-2.15). Neonatal outcomes (aside from macrosomia) did not differ by IOL/EM at any gestational age. DISCUSSION Outcomes for nulliparous individuals having IOL or EM in the context of a midwifery model of care include low overall use of CB and low frequency of IOL before 41 weeks. In this model, IOL in the 40th week may lower CB odds, especially in comparison to those who do not have spontaneous labor and later undergo an IOL in the 41st week.
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Affiliation(s)
- Elise N Erickson
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Joanne M Bailey
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Shanti D Colo
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Nicole S Carlson
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Ellen L Tilden
- School of Nursing, Oregon Health & Science University, Portland, Oregon
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Ueno Y, Kako M, Ohira M, Okamura H. Shared decision-making for women facing an unplanned pregnancy: A qualitative study. Nurs Health Sci 2021; 22:1186-1196. [PMID: 33159478 DOI: 10.1111/nhs.12791] [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: 07/02/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
This study aimed to explore the competencies of health care practitioners who promote shared decision-making (SDM)-based care for women facing an unplanned pregnancy in Japan. We conducted semistructured interviews with 12 care providers who are pioneers in care for women facing an unplanned pregnancy and adopted a modified grounded theory approach for data analysis. A three-step model for shared decision making in practice (team talk, option talk, and decision talk) was used as a reference. The answers given by the care providers were analyzed to identify the competencies involved in shared decision making. We identified three stages: (i) building trust and promoting women's expression; (ii) discussing women's real needs; and (iii) exploring the intentions and goals expressed by women and finding the best choices while promoting women's autonomy in decision-making. The coordination between the support of partners, families, and professionals, and the care provided to strengthen women's identities facilitated shared decision making. Women facing an unplanned pregnancy can benefit from interventions designed to improve shared decision making. A key component of shared decision making-based care relates to practitioners' raised awareness toward their roles and responsibilities: developing good communication skills and fostering collaboration between all stakeholders.
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Affiliation(s)
- Yoko Ueno
- Graduate School of Biomedical and Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayumi Kako
- Graduate School of Biomedical and Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuko Ohira
- Graduate School of Biomedical and Sciences, Hiroshima University, Hiroshima, Japan
| | - Hitoshi Okamura
- Graduate School of Biomedical and Sciences, Hiroshima University, Hiroshima, Japan
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