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Telfer M, Zaslow R, Nalugo Mbalinda S, Blatt R, Kim D, Kennedy HP. A case study analysis of a successful birth center in northern Uganda. Birth 2024. [PMID: 38923627 DOI: 10.1111/birt.12837] [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] [Received: 07/17/2023] [Revised: 01/24/2024] [Accepted: 05/02/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Mothers and infants continue to die at alarming rates throughout the Global South. Evidence suggests that high-quality midwifery care significantly reduces preventable maternal and neonatal morbidity and mortality. This paper uses a case study approach to describe the social and institutional model at one birth center in Northern Uganda where, in over 20,000 births, there have been no maternal deaths and the neonatal mortality rate is 11/1000-a rate that is lower than many high-resource countries. METHODS This case study combined institutional ethnographic and narrative methods to explore key maternal and neonatal outcomes. The sample included birthing people who intended to or had given birth at the center, as well as the midwives, staff, stakeholders, and community health workers affiliated with the center. Data were collected through individual and small group interviews, participant observation, field notes, data and document reviews. Iterative and systematic analytical steps were followed, and all data were organized and managed with Atlas.ti software. RESULTS Findings describe the setting, an overview of the birth center's history, how it is situated within the community, its staffing, administration, clinical outcomes, and model of care. A synthesis of contextual variables and key outcomes as they relate to the components of the evidence-informed Quality Maternal and Newborn Care (QMNC) framework are presented. Three overarching themes were identified: (a) community knowledge and understanding, (b) community integrated care, and (c) quality care that is respectful, accessible, and available. CONCLUSIONS This birth center is an example of care that embodies the findings and anticipated outcomes described in the QMNC framework. Replication of this model in other childbearing settings may help alleviate unnecessary perinatal morbidity and mortality.
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Affiliation(s)
| | - Rachel Zaslow
- Mother Health International & Yale School of Nursing, Gulu & West Haven, Uganda
| | | | | | - Diane Kim
- Bronx Lebanon Hospital, The Bronx, New York, USA
| | - Holly Powell Kennedy
- Varney Professor of Midwifery Emeritus, Yale School of Nursing, West Haven, Connecticut, USA
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Koi-Larbi K, Obiri D, Browne JL, Fondjo LA, Katsande S, Garti I. Advancing hypertensive disorders of pregnancy management: insights from the 5th preeclampsia scientific symposium in Ghana. BMC Proc 2024; 18:12. [PMID: 38867245 PMCID: PMC11170767 DOI: 10.1186/s12919-024-00295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
The 5th Preeclampsia Scientific Symposium (PSS2023) organized by Action on Preeclampsia (APEC) Ghana was themed: 'Realign, Refocus: Improving outcomes of Hypertensive Disorders of Pregnancy through Shared Decision Making, Research & Quality of Care'. It took place on the 18th and 19th of May 2023 at the Ghana College of Physicians and Surgeons (GCPS), Accra Ghana. This transdisciplinary symposium brought together a national representation of experts, policy makers, scientists, and healthcare professionals to discuss key priorities, opportunities, approaches, and strategies to improve the maternal and perinatal outcomes of hypertensive disorders of pregnancy (HDP) in Ghana and the sub-region. The symposium centered around three key themes: realigning/refocusing patient-doctor decision making processes to improve outcomes of HDP; realigning/refocusing clinical care to improve outcomes of HDP; and leveraging on research to predict, recognize and manage high-risk women.This report summarizes insights from the diverse presentations and discussions held at the #PSS2023. This will form a roadmap for future research, policy, and interventions to improve outcomes of HDP in Ghana and the sub-region. The symposium provided a wealth of evidence and knowledge from various experts, highlighting the need for women-centered care, equitable re-allocation of resources, multi-sectoral and innovative approaches, capacity strengthening. Other highlights include knowledge base development and increased stakeholder and community engagement with an overall aim of improving outcomes of HDP. The symposium also fostered inclusivity, welcoming survivors of HDP and their families at a scientific platform. They provided invaluable insights into the challenges faced and the lived experiences of those affected by the disease. Trainees and students also benefited from the symposium as it provided networking opportunities with fellow researchers, and a front row to gaining insights into cutting-edge research in Ghana.
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Affiliation(s)
- Koiwah Koi-Larbi
- Action On Preeclampsia Ghana (APEC-GH), Accra, Ghana.
- Severe Pre-Eclampsia Adverse Outcome Triage (SPOT) Study, Accra, Ghana.
| | - Dorotheah Obiri
- Action On Preeclampsia Ghana (APEC-GH), Accra, Ghana
- Severe Pre-Eclampsia Adverse Outcome Triage (SPOT) Study, Accra, Ghana
- Department of Immunology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joyce L Browne
- Severe Pre-Eclampsia Adverse Outcome Triage (SPOT) Study, Accra, Ghana
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda Ahenkorah Fondjo
- Action On Preeclampsia Ghana (APEC-GH), Accra, Ghana
- Severe Pre-Eclampsia Adverse Outcome Triage (SPOT) Study, Accra, Ghana
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Isabella Garti
- Action On Preeclampsia Ghana (APEC-GH), Accra, Ghana
- Faculty of Health, Charles Darwin University, Darwin, Australia
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Tan A, Blair A, Homer CS, Digby R, Vogel JP, Bucknall T. Pregnant and postpartum women's experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis. BMC Pregnancy Childbirth 2024; 24:262. [PMID: 38605319 PMCID: PMC11007880 DOI: 10.1186/s12884-024-06439-6] [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: 07/04/2023] [Accepted: 03/24/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Pregnant and postpartum women's experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic. METHODS A qualitative evidence synthesis of studies relating to women's experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings. RESULTS Sixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment. CONCLUSIONS The findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.
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Affiliation(s)
- Annie Tan
- School of Nursing and Midwifery, Deakin University, Geelong, Australia.
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.
- Centre for Quality and Patient Safety Research, Institute of Health Transformation, Geelong, Australia.
| | - Amanda Blair
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Caroline Se Homer
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Robin Digby
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research, Institute of Health Transformation, Geelong, Australia
- Alfred Health, Melbourne, Australia
| | - Joshua P Vogel
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research, Institute of Health Transformation, Geelong, Australia
- Alfred Health, Melbourne, Australia
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Hill CM, Fantasia HC, Burnette S. Implementing a Respectful Maternity Care Guideline During Childbirth Experiences. Nurs Womens Health 2024; 28:50-57. [PMID: 38228285 DOI: 10.1016/j.nwh.2023.09.006] [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: 04/17/2023] [Revised: 09/10/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To measure the impact of an evidence-based guideline on respectful maternity care on nurses' attitudes and beliefs about childbirth practices. DESIGN A quality improvement pilot project with a pretest/posttest design examining the attitudes and beliefs of intrapartum nurses about childbirth practices of respectful care. SETTING High-risk intrapartum unit at a tertiary care center in the southeastern United States. PARTICIPANTS A convenience sample of 130 registered nurses were invited to participate, and nine completed the pre- and posttests. INTERVENTION/MEASUREMENTS The intervention included a recorded webinar, access to printed and electronic copies of the guideline, discussions in daily huddles, and a virtual journal club. Data were collected using the 42-item Nurse Attitudes and Beliefs Questionnaire-Revised. Lower scores are reflective of attitudes and beliefs that support a medical model of care, whereas higher scores are reflective of a physiologic model of care. Descriptive statistics and the Wilcoxon signed rank test were used to analyze changes in attitudes and beliefs based on the aggregate scores of the nurse participants. RESULTS Although there was no change in nurse attitude and beliefs about childbirth practices after 3 months (p = .058), the aggregate scores on a scale of 42 to 168 increased by 5.6 points. Two subscales of the Nurse Attitudes and Beliefs Questionnaire-Revised-Medical Model of Conflict and Women's Autonomy-had the greatest increase in aggregate scores. CONCLUSION Understanding nurses' attitudes and beliefs can assist in identifying barriers to the provision of respectful care, particularly during labor and birth, when patients are most vulnerable. Measurement of nurse attitudes and beliefs regarding respectful maternity care may require a longer immersion in a respectful maternity care program to allow for changes over time.
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Steege R, Mwaniki H, Ogueji IA, Baraka J, Salimu S, Kumar MB, Kawaza K, Odedere O, Shamba D, Bokea H, Chiume M, Adudans S, Ezeaka C, Paul C, Banyira L, Lungu G, Salim N, Zimba E, Ngwala S, Tarus A, Bohne C, Gathara D, Lawn JE. Protecting small and sick newborn care in the COVID-19 pandemic: multi-stakeholder qualitative data from four African countries with NEST360. BMC Pediatr 2023; 23:572. [PMID: 37974092 PMCID: PMC10655439 DOI: 10.1186/s12887-023-04358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Health system shocks are increasing. The COVID-19 pandemic resulted in global disruptions to health systems, including maternal and newborn healthcare seeking and provision. Yet evidence on mitigation strategies to protect newborn service delivery is limited. We sought to understand what mitigation strategies were employed to protect small and sick newborn care (SSNC) across 65 facilities Kenya, Malawi, Nigeria and Tanzania, implementing with the NEST360 Alliance, and if any could be maintained post-pandemic. METHODS We used qualitative methods (in-depth interviews n=132, focus group discussions n=15) with purposively sampled neonatal health systems actors in Kenya, Malawi, Nigeria and Tanzania. Data were collected from September 2021 - August 2022. Topic guides were co-developed with key stakeholders and used to gain a detailed understanding of approaches to protect SSNC during the COVID-19 pandemic. Questions explored policy development, collaboration and investments, organisation of care, human resources, and technology and device innovations. Interviews were conducted by experienced qualitative researchers and data were collected until saturation was reached. Interviews were digitally recorded and transcribed verbatim. A common coding framework was developed, and data were coded via NVivo and analysed using a thematic framework approach. FINDINGS We identified two pathways via which SSNC was strengthened. The first pathway, COVID-19 specific responses with secondary benefit to SSNC included: rapid policy development and adaptation, new and collaborative funding partnerships, improved oxygen systems, strengthened infection prevention and control practices. The second pathway, health system mitigation strategies during the pandemic, included: enhanced information systems, human resource adaptations, service delivery innovations, e.g., telemedicine, community engagement and more emphasis on planned preventive maintenance of devices. Chronic system weaknesses were also identified that limited the sustainability and institutionalisation of actions to protect SSNC. CONCLUSION Innovations to protect SSNC in response to the COVID-19 pandemic should be maintained to support resilience and high-quality routine SSNC delivery. In particular, allocation of resources to sustain high quality and resilient care practices and address remaining gaps for SSNC is critical.
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Affiliation(s)
- Rosie Steege
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
- Liverpool School of Tropical Medicine, Liverpool, UK.
| | | | | | - Jitihada Baraka
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Sangwani Salimu
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Meghan Bruce Kumar
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Kenya Medical Research Institute, Wellcome Trust Research Program, Nairobi, Kenya
| | - Kondwani Kawaza
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Opeyemi Odedere
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Helen Bokea
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - Msandeni Chiume
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | - Steve Adudans
- Academy for Novel Channels in Health and Operations Research (ACANOVA Africa), Nairobi, Kenya
| | - Chinyere Ezeaka
- College of Medicine, University of Lagos, Lagos State, Nigeria
| | - Catherine Paul
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | | | - Gaily Lungu
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Evelyn Zimba
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - Samuel Ngwala
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alice Tarus
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Christine Bohne
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - David Gathara
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
- Kenya Medical Research Institute, Wellcome Trust Research Program, Nairobi, Kenya.
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
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Datta V, Srivastava S, Lalwani K, Garde R, Patnaik SK, Venkatagiri P, Pradeep J, Bangal V, Pemde H, Kumar A, Sooden A, Vijayan S, Sawleshwarkar K, Mehta R, Raina N, Khanna R, Singh V, Singh P, Saha K, Sharma C, Jain S. Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic. BMJ Open Qual 2023; 12:e002370. [PMID: 37863508 PMCID: PMC10603542 DOI: 10.1136/bmjoq-2023-002370] [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: 04/11/2023] [Accepted: 06/11/2023] [Indexed: 10/22/2023] Open
Abstract
INTRODUCTION Ensuring quality of care in Low and Middle Income countries (LMICs) is challenging. Despite the implementation of various quality improvement (QI) initiatives in public and private sectors, the sustenance of improvements continues to be a major challenge. A team of healthcare professionals in India developed a digital community of practice (dCoP) focusing on QI which now has global footprints. METHODOLOGY The dCoP was conceptualised as a multitiered structure and is operational online at www.nqocncop.org from August 2020 onwards. The platform hosts various activities related to the quality of care, including the development of new products, and involves different cadres of healthcare professionals from primary to tertiary care settings. The platform uses tracking indicators, including the cost of sustaining the dCoP to monitor the performance of the dCoP. RESULT Since its launch in 2020, dCoP has conducted over 130 activities using 13 tools with 25 940 registration and 13 681 participants. From April 2021, it has expanded to countries across the South-East Asia region and currently has participants from 53 countries across five continents. It has developed 20 products in four thematic areas for a targeted audience. dCoP is supporting mentoring of healthcare professionals from five countries in the South-East Asia region in their improvement journey. Acquiring new knowledge and improvement in their daily clinical practice has been reported by 93% and 80% of participants, respectively. The dCoP and its partners have facilitated the publication of nearly 40 articles in international journals. CONCLUSION This dCoP platform has become a repository of knowledge for healthcare professionals in the South-East Asia region. The current paper summarises the journey of this innovative dCoP in an LMIC setting for a wider global audience.
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Affiliation(s)
- Vikram Datta
- Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Sushil Srivastava
- Pediatrics, University College of Medical Sciences, New Delhi, Delhi, India
| | | | - Rahul Garde
- Quality Improvement, NQOCN, New Delhi, Delhi, India
| | - Suprabha K Patnaik
- Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharastra, India
| | | | - Jeena Pradeep
- Nursing, Ministry of Health and Family Welfare, India, New Delhi, Delhi, India
- Pediatrics, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
| | - Vidhyadhar Bangal
- Obstetrics and Gynaecology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
- Centre for Social Medicine, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Harish Pemde
- Paediatrics, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Achala Kumar
- Nursing, Ministry of Health and Family Welfare, India, New Delhi, Delhi, India
| | - Ankur Sooden
- Private Sector Engagement, JSI India, New Delhi, Delhi, India
| | - Shreeja Vijayan
- Child Health Nursing, Choithram College of Nursing and Choithram Hospital & Research Centre, Indore, Madhya Pradesh, India
| | | | | | - Neena Raina
- World Health Organization - South East Asia Regional Office, New Delhi, Delhi, India
| | - Rajesh Khanna
- World Health Organization - South East Asia Regional Office, New Delhi, Delhi, India
| | - Vivek Singh
- Health Section, UNICEF India, New Delhi, Delhi, India
| | | | - Khushboo Saha
- The University of Texas Southwestern Medical Center at Dallas Library, Dallas, Texas, USA
| | - Chhavi Sharma
- Pediatrics, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
| | - Sonam Jain
- Quality Improvement, NQOCN, New Delhi, Delhi, India
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Midwives' experiences of providing maternity care to women and families during the COVID-19 pandemic in Northern Italy. Women Birth 2023; 36:e57-e64. [PMID: 35490090 PMCID: PMC9015962 DOI: 10.1016/j.wombi.2022.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 01/26/2023]
Abstract
PROBLEM The COVID-19 pandemic has significantly challenged maternity provision internationally. Rapid and radical changes were implemented, with midwives facing anxiety and moral distress if not able to provide optimal and woman-centred care in line with professional values. BACKGROUND Healthcare professionals' stress and burnout are commonly reported during other global emergencies, which may eventually contribute to reduced quality of care. There is lack of evidence of the challenges faced by midwives in Italy during the COVID-19 pandemic. AIM To explore midwives' experiences of providing care to women and families during the COVID-19 pandemic. METHODS Qualitative interpretive phenomenological approach, using semi-structured interviews and thematic analysis. The sample included 15 midwives. Ethical approval was obtained. FINDINGS Four themes were identified: 1) adjusting to the ever-evolving organisation of care; 2) physical, psychological and relational challenges; 3) support network; 4) deferred sense of awareness. DISCUSSION Midwives faced professional and personal challenges during the pandemic, displaying feelings of fear, anxiety, uncertainty, discomfort, lack of support and knowledge with potential long-term effects. Adjusting to the continuous, rapid and drastic re-organisation of maternity services was particularly challenging. Factors facilitating a safe, supportive and empowering workplace included support from colleagues and managers, access to appropriate PPE, reliable guidelines, good communication and emotional support. Positive aspects of personal and professional development included communication skills, establishment of trusting relationships, sense of empowerment and teamwork. CONCLUSION In the context of a pandemic, optimisation of midwives' physical, emotional and psychological wellbeing should be considered. Timely and comprehensive guidelines and appropriate resources should be provided to assist midwives in facilitating family-centred respectful maternity care and preserving childbirth as a bio-psychosocial event.
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Actis Danna V, Bedwell C, Chimwaza A, Chisuse I, Lyangenda K, Petross C, Tuwele K, Taxiarchi VP, Lavender T. Promoting respectful maternal and newborn care using the Dignity game: A quasi-experimental study. Nurse Educ Pract 2023; 66:103519. [PMID: 36442392 PMCID: PMC9912051 DOI: 10.1016/j.nepr.2022.103519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
AIM This study assessed a) the impact of playing the Dignity board game on participants' understanding of respectful maternal and newborn care and b) participants' perceptions of how the game influenced their subsequent practice in Malawi and Zambia. BACKGROUND Nurse-midwives' poor understanding of respectful maternal and newborn care can lead to substandard practice; thus, effective education is pivotal. Used in several disciplines, game-based learning can facilitate skills acquisition and retention of knowledge. DESIGN a quasi-experimental study, using mixed-methods of data collection. METHODS Data were collected between January and November 2020. Nurse-midwives (N = 122) and students (N = 115) were recruited from public hospitals and nursing schools. Completion of paper-based questionnaires, before and after game-playing, assessed knowledge of respectful care principles and perceptions around behaviours and practice. Face-to-face interviews (n = 18) explored perceived impact of engaging with the game in clinical practice. Paired and unpaired t-test were used to compare scores. Qualitative data were analysed and reported thematically. RESULTS The study was completed by 215 (90.7 %) participants. Post-test scores improved significantly for both groups combined; from 25.91 (SD 3.73) pre-test to 28.07 (SD 3.46) post-test (paired t = 8.67, 95 % confidence interval 1.67-2.65), indicating an increased knowledge of respectful care principles. Nurse-midwives performed better than students, both before and after. In Malawi, the COVID pandemic prevented a third of nurse-midwives' from completing post-game questionnaires. Qualitative findings indicate the game functioned as a refresher course and helped nurse-midwives to translate principles of respectful care into practice. It was also useful for self-reflection. CONCLUSIONS The Dignity board game has the potential to enhance understanding and practice of respectful maternal and newborn care principles in low-resource settings. Integration into nursing and midwifery curricula and in-service training for students and healthcare workers should be considered.
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Affiliation(s)
- Valentina Actis Danna
- Centre for Childbirth, Women's and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, UK.
| | - Carol Bedwell
- Centre for Childbirth, Women's and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, UK.
| | | | | | | | | | - Khuzuet Tuwele
- University Teaching Hospital, University of Zambia, Lusaka, Zambia.
| | - Vicky P. Taxiarchi
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Tina Lavender
- Centre for Childbirth, Women's and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, UK.
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Lokugamage AU, Robinson N, Pathberiya SDC, Wong S, Douglass C. Respectful maternity care in the UK using a decolonial lens. SN SOCIAL SCIENCES 2022; 2:267. [PMID: 36531139 PMCID: PMC9734803 DOI: 10.1007/s43545-022-00576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Respectful maternity care (RMC) is part of a global movement addressing the previous absence of human rights in global safe maternal care guidance. RMC is grounded in kindness, compassion, dignity and respectful working conditions. The decolonisation movement in healthcare seeks to dismantle structural biases set up from a historically white, male, heteronormative Eurocentric medical system. This article applies a decolonising lens to the RMC agenda and examines barriers to its implementation in UK healthcare systems. Searches of peer-reviewed journals about decolonising maternity care in the UK revealed little. Drawing from wider information bases, we examine power imbalances constructed throughout a history of various colonial biases yet lingering in maternity care. The overarching findings of our analysis revealed 3 areas of focus: professional structures and institutional biases; power imbalances between types of staff and stakeholders of care; and person-centred care through a decolonial lens. To uproot inequity and create fairer and more respectful maternity care for women, birthing people and staff, it is vital that contemporary maternity institutions understand the decolonial perspective. This novel enquiry offers a scaffolding to undertake this process. Due to significant differences in colonial history between Western colonising powers, it is important to decolonise with respect to these different territories, histories and challenges.
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Affiliation(s)
| | - Nathan Robinson
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
| | | | - Sarah Wong
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
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Heys S, Downe S, McKeown M, Thomson G. The design, delivery and evaluation of 'Human Perspectives VR': An immersive educational programme designed to raise awareness of contributory factors for a traumatic childbirth experience and PTSD. PLoS One 2022; 17:e0276263. [PMID: 36322586 PMCID: PMC9629609 DOI: 10.1371/journal.pone.0276263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A traumatic childbirth experience affects ~30% of women each year, with negative impacts on maternal, infant, and family wellbeing. Women classified as vulnerable or marginalised are those more likely to experience a psychologically traumatising birth. A key contributory factor for a traumatic childbirth experience is women's relationships with maternity care providers. AIMS To develop, design and evaluate an immersive educational programme for maternity care providers to raise awareness of traumatic childbirth experiences amongst vulnerable groups, and ultimately to improve women's experiences of childbirth. METHODS A critical pedagogical approach that utilised virtual reality (VR) underpinned the design and development of the educational programme. This involved: a) collecting vulnerable/disadvantaged women's experiences of birth via interviews; b) analysing data collected to identify key hotspots for traumatic experiences within interpersonal patient-provider relationships to develop a script; c) filming the script with professional actors creating a first person perspective via VR technology; d) using existing literature to inform the theoretical and reflective aspects of the programme; e) conducting an evaluation of the education programme using pre-and post-evaluation questionnaires and a follow-up focus group. FINDINGS Human Perspective VR was very well received. Participants considered the content to have enhanced their reflective practice and increased their knowledge base regarding contributory factors associated with a traumatic childbirth experience. A need for further work to implement learning into practice was highlighted. CONCLUSION While further research is needed to evaluate the impact of the programme, Human Perspective VR programme offers an innovative approach to reflective education and to enhance participants' care practices.
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Affiliation(s)
- Stephanie Heys
- Maternity Learning and Development Lead, Consultant Midwife, The Northwest Ambulance Service, The University of Central Lancashire, Preston, United Kingdom
- * E-mail:
| | - Soo Downe
- Professor of Midwifery Studies, The University of Central Lancashire, Preston, United Kingdom
| | - Mick McKeown
- Professor of Democratic Mental Health, The University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Professor of Perinatal Health, The University of Central Lancashire, Preston, United Kingdom
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Hughes CS, Kamanga M, Jenny A, Zieman B, Warren C, Walker D, Kazembe A. Perceptions and predictors of respectful maternity care in Malawi: A quantitative cross-sectional analysis. Midwifery 2022; 112:103403. [PMID: 35728299 DOI: 10.1016/j.midw.2022.103403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Access to high-quality, respectful care is a basic human right. A lack of respectful care during childbirth is associated with poor outcomes and can negatively influence care-seeking and maternal mental health. We aimed to describe how women perceive their experience of maternity care in Malawi. METHODS We implemented a cross-sectional survey of women (n = 660) who delivered in 25 birth facilities in four districts in Malawi in March 2020 using a validated 30-item, 90-point person-centered maternity care (PCMC) scale. We used descriptive statistics to examine women's experience of care and analyzed bivariable and multivariable mixed-effects models to evaluate predictors of PCMC. Statistical models accounted for clustering of women at the facility level and included maternal age, marital status, education, parity, mother or infant complications, timing of antenatal care (ANC), provider cadre and gender, facility type and sector, and district. RESULTS Mean PCMC score was 57.5 (range 21-84), with the lowest score (12.4 of 27 points) in communication and autonomy. Women reported: being prohibited from having a birth companion during labor (49.4%) or delivery (60.3%); providers did not introduce themselves (81.1%); providers did not ask consent before procedures/examinations (42.4%); women felt they could not ask questions (40.9%); and were not involved in care decisions (61.5%). Few women reported being frequently abused physically (2%) or verbally (3.5%); almost all had water/electricity available (>95%). In bivariate analyses, statistically significant positive associations were found between PCMC score and early ANC, male accompaniment to the facility, male provider, and a lack of complications; all associations remained at least potentially statistically significant in multivariable modeling. CONCLUSIONS Physical and verbal abuse and a lack of basic amenities were rare, while a lack of communication with patients and social support were common. Maternal characteristics (like timing of ANC and maternal or newborn complications) were predictors of RMC, while facility/system factors, like facility type and sector, were not. Continued efforts to improve respectful care will require strengthening provider communication skills and encouraging patient and companion involvement in care.
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Affiliation(s)
- Carolyn Smith Hughes
- University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA.
| | - Martha Kamanga
- University of Malawi Kamuzu College of Nursing, P/Bag 1, Lilongwe, Malawi
| | - Alisa Jenny
- University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA
| | - Brady Zieman
- Population Council, One Dag Hammarskjold Plaza, 3rd Floor, New York, NY 10017, USA
| | - Charlotte Warren
- Population Council, One Dag Hammarskjold Plaza, 3rd Floor, New York, NY 10017, USA
| | - Dilys Walker
- University of California San Francisco, 550 16th St, 3rd Floor, San Francisco, CA 94158, USA
| | - Abigail Kazembe
- University of Malawi Kamuzu College of Nursing, P/Bag 1, Lilongwe, Malawi
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Dzomeku VM, Mensah ABB, Nakua EK, Agbadi P, Okyere J, Donkor P, Lori JR. Promoting respectful maternity care: challenges and prospects from the perspectives of midwives at a tertiary health facility in Ghana. BMC Pregnancy Childbirth 2022; 22:451. [PMID: 35641939 PMCID: PMC9153163 DOI: 10.1186/s12884-022-04786-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Evidence shows that women in Ghana experience disrespectful care (slapping, pinching, being shouted at, etc.) from midwives during childbirth. Hence, evidence-based research is needed to advance the adoption of respectful maternity care (RMC) by midwives. We therefore sought to explore and document midwives’ perspectives concerning challenges faced and prospects available for promoting RMC in a tertiary health facility. Methods We employed an exploratory descriptive qualitative study design. In total, we conducted 12 interviews with midwives educated on RMC. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. We relied on the Consolidated Criteria for Reporting Qualitative Research guideline in reporting this study. Results The findings were broadly categorised into three themes: emotional support, dignified care and respectful communication which is consistent with the WHO’s quality of care framework. For each theme, the current actions that were undertaken to promote RMC, the challenges and recommendations to improve RMC promotion were captured. Overall, the current actions that promoted RMC included provision of sacral massages and reassurance, ensuring confidentiality and consented care, and referring clients who cannot pay to the social welfare unit. The challenges to providing RMC were logistical constraints for ensuring privacy, free movement of clients, and alternative birthing positions. Poor attitudes from some midwives, workload and language barrier were other challenges that emerged. The midwives recommended the appointment of more midwives, as well as the provision of logistics to support alternative birthing positions and privacy. Also, they recommended the implementation of continuous training and capacity building. Conclusion We conclude that in order for midwives to deliver RMC services that include emotional support, dignified care, and respectful communication, the government and hospital administration must make the required adjustments to resolve existing challenges while improving the current supporting activities. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04786-w.
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Affiliation(s)
- Veronica Millicent Dzomeku
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Adwoa Bemah Boamah Mensah
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Kweku Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Agbadi
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Joshua Okyere
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jody R Lori
- University of Michigan School of Nursing, Ann Arbor, USA
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Sethi R, Hill K, Stalls S, Moffson S, de Tejada SS, Gomez L, Marroquin MA. An exploratory study of client and provider experience and perceptions of facility-based childbirth care in Quiché, Guatemala. BMC Health Serv Res 2022; 22:591. [PMID: 35505322 PMCID: PMC9066966 DOI: 10.1186/s12913-022-07686-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Respectful maternity care (RMC) is fundamental to women's and families' experience of care and their decision about where to give birth. Studies from multiple countries describe the mistreatment of women during facility-based childbirth, though only a small number of studies from Guatemala have been published. Less information is available on women's negative and positive experiences of childbirth care and health workers' perceptions and experiences of providing maternity care. METHODS As part of a program implemented in the Western Highlands of Guatemala to improve quality of reproductive maternal newborn and child health care, a mixed methods assessment was conducted in three hospitals and surrounding areas to understand women's and health workers' experience and perceptions of maternity care. The quantitative component included a survey of 31 maternity health workers and 140 women who had recently given birth in these hospitals. The qualitative component included in-depth interviews (IDIs) and focus group discussions (FGDs) with women and maternity health workers and managers. RESULTS Women reported a mix of positive and negative experiences of childbirth care related to interpersonal and health system factors. 81% of surveyed women reported that health workers had treated them with respect while 21.4% of women reported verbal abuse. Fifty-five percent and 12% of women, respectively, reported not having access to a private toilet and bath or shower. During IDIs and FGDs, many women described higher rates of verbal abuse directed at women who do not speak Spanish. A regression analysis of survey results indicated that speaking Ixil or K'iche at home was associated with a higher likelihood of women being treated negatively during childbirth in a facility. Health worker survey results corroborated negative aspects of care described by women and also reported mistreatment of health workers by clients and families (70.9%) and colleagues (48.2%). CONCLUSIONS This study adds to the literature on women's experience of institutional childbirth and factors that influence this experience by triangulating experience and perceptions of both women and health workers. This assessment highlights opportunities to address mistreatment of both women and health workers and to build on positive care attributes to strengthen RMC for all women.
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Affiliation(s)
| | | | | | - Susan Moffson
- Momentum Country and Global Leadership, Washington, USA.
| | | | - Leonel Gomez
- Reproductive Health Independent Researcher/Consultant, Guatemala City, Guatemala
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Hameed W, Khan B, Siddiqi S, Asim M, Avan BI. Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000550. [PMID: 36962395 PMCID: PMC10021678 DOI: 10.1371/journal.pgph.0000550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/09/2022] [Indexed: 11/19/2022]
Abstract
Mistreatment with women during childbirth is prevalent in many in low- and middle-income countries. There is dearth of evidence that informs development of health system interventions to promote supportive and respectful maternity care in facility-based settings. We examined health systems bottlenecks that impedes provision of supportive and respectful maternity care in secondary-level public healthcare system of Pakistan. Using a qualitative exploratory design, forty in-depth interviews conducted with maternity care staff of six public health facilities in southern Pakistan. Development of interview guide and data analyses were guided by the WHO's six health system building blocks. A combination of inductive and deductive approach was used for data analyses. Our study identified range of bottlenecks impeding provision of RMC. In terms of leadership/governance, there was lack of institutional guidelines, supervision and monitoring, and patient feedback mechanism. No systematic mechanism existed to screen and record patient psychosocial needs. Health workforce lacked training opportunities on RMC that resulted in limited knowledge and skills; there were also concerns about lack of recognition from leadership for good performers, and poor relationship and coordination between clinical and non-clinical staff. Regarding the domain of service delivery, we found that patients were perceived as un-cooperative, non-RMC manifestations were acceptable and normalized under certain conditions, and restrictive policies for active engagement of companions. Finally, lack of cleanliness, curtains for privacy, seating arrangement for companion were the identified issues infrastructural issues. A service-delivery intervention package is needed that effectively uses all six components of the health system: from investments in capacity building of maternity teams to creating a conducive facility environment via proper governance and accountability mechanisms. Such interventions should not only focus on provision of maternity care in a respectful and dignified manner, but also ensure that care is responsive to the psychosocial needs of pregnant women without any discrimination.
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Affiliation(s)
- Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bilal Iqbal Avan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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The impact of COVID-19 on the provision of respectful maternity care: Findings from a global survey of health workers. Women Birth 2021; 35:378-386. [PMID: 34531166 PMCID: PMC9179099 DOI: 10.1016/j.wombi.2021.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/20/2022]
Abstract
Background Significant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care. Aim To explore how the COVID-19 pandemic negatively affected frontline health workers’ ability to provide respectful maternity care globally. Methods We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses. Findings Health workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers’ fear of getting infected and measures taken to minimise COVID-19 transmission. Discussion Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term. Conclusions The measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care.
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