1
|
Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024; 4:CD004667. [PMID: 38597126 PMCID: PMC11005019 DOI: 10.1002/14651858.cd004667.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016. OBJECTIVES To compare the effects of midwife continuity of care models with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (17 August 2022), as well as the reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife continuity of care models or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion criteria, scientific integrity, and risk of bias, and carried out data extraction and entry. Primary outcomes were spontaneous vaginal birth, caesarean section, regional anaesthesia, intact perineum, fetal loss after 24 weeks gestation, preterm birth, and neonatal death. We used GRADE to rate the certainty of evidence. MAIN RESULTS We included 17 studies involving 18,533 randomised women. We assessed all studies as being at low risk of scientific integrity/trustworthiness concerns. Studies were conducted in Australia, Canada, China, Ireland, and the United Kingdom. The majority of the included studies did not include women at high risk of complications. There are three ongoing studies targeting disadvantaged women. Primary outcomes Based on control group risks observed in the studies, midwife continuity of care models, as compared to other models of care, likely increase spontaneous vaginal birth from 66% to 70% (risk ratio (RR) 1.05, 95% confidence interval (CI) 1.03 to 1.07; 15 studies, 17,864 participants; moderate-certainty evidence), likelyreduce caesarean sections from 16% to 15% (RR 0.91, 95% CI 0.84 to 0.99; 16 studies, 18,037 participants; moderate-certainty evidence), and likely result in little to no difference in intact perineum (29% in other care models and 31% in midwife continuity of care models, average RR 1.05, 95% CI 0.98 to 1.12; 12 studies, 14,268 participants; moderate-certainty evidence). There may belittle or no difference in preterm birth (< 37 weeks) (6% under both care models, average RR 0.95, 95% CI 0.78 to 1.16; 10 studies, 13,850 participants; low-certainty evidence). We arevery uncertain about the effect of midwife continuity of care models on regional analgesia (average RR 0.85, 95% CI 0.79 to 0.92; 15 studies, 17,754 participants, very low-certainty evidence), fetal loss at or after 24 weeks gestation (average RR 1.24, 95% CI 0.73 to 2.13; 12 studies, 16,122 participants; very low-certainty evidence), and neonatal death (average RR 0.85, 95% CI 0.43 to 1.71; 10 studies, 14,718 participants; very low-certainty evidence). Secondary outcomes When compared to other models of care, midwife continuity of care models likely reduce instrumental vaginal birth (forceps/vacuum) from 14% to 13% (average RR 0.89, 95% CI 0.83 to 0.96; 14 studies, 17,769 participants; moderate-certainty evidence), and may reduceepisiotomy 23% to 19% (average RR 0.83, 95% CI 0.77 to 0.91; 15 studies, 17,839 participants; low-certainty evidence). When compared to other models of care, midwife continuity of care models likelyresult in little to no difference inpostpartum haemorrhage (average RR 0.92, 95% CI 0.82 to 1.03; 11 studies, 14,407 participants; moderate-certainty evidence) and admission to special care nursery/neonatal intensive care unit (average RR 0.89, 95% CI 0.77 to 1.03; 13 studies, 16,260 participants; moderate-certainty evidence). There may be little or no difference in induction of labour (average RR 0.92, 95% CI 0.85 to 1.00; 14 studies, 17,666 participants; low-certainty evidence), breastfeeding initiation (average RR 1.06, 95% CI 1.00 to 1.12; 8 studies, 8575 participants; low-certainty evidence), and birth weight less than 2500 g (average RR 0.92, 95% CI 0.79 to 1.08; 9 studies, 12,420 participants; low-certainty evidence). We are very uncertain about the effect of midwife continuity of care models compared to other models of care onthird or fourth-degree tear (average RR 1.10, 95% CI 0.81 to 1.49; 7 studies, 9437 participants; very low-certainty evidence), maternal readmission within 28 days (average RR 1.52, 95% CI 0.78 to 2.96; 1 study, 1195 participants; very low-certainty evidence), attendance at birth by a known midwife (average RR 9.13, 95% CI 5.87 to 14.21; 11 studies, 9273 participants; very low-certainty evidence), Apgar score less than or equal to seven at five minutes (average RR 0.95, 95% CI 0.72 to 1.24; 13 studies, 12,806 participants; very low-certainty evidence) andfetal loss before 24 weeks gestation (average RR 0.82, 95% CI 0.67 to 1.01; 12 studies, 15,913 participants; very low-certainty evidence). No maternal deaths were reported across three studies. Although the observed risk of adverse events was similar between midwifery continuity of care models and other models, our confidence in the findings was limited. Our confidence in the findings was lowered by possible risks of bias, inconsistency, and imprecision of some estimates. There were no available data for the outcomes: maternal health status, neonatal readmission within 28 days, infant health status, and birth weight of 4000 g or more. Maternal experiences and cost implications are described narratively. Women receiving care from midwife continuity of care models, as opposed to other care models, generally reported more positive experiences during pregnancy, labour, and postpartum. Cost savings were noted in the antenatal and intrapartum periods in midwife continuity of care models. AUTHORS' CONCLUSIONS Women receiving midwife continuity of care models were less likely to experience a caesarean section and instrumental birth, and may be less likely to experience episiotomy. They were more likely to experience spontaneous vaginal birth and report a positive experience. The certainty of some findings varies due to possible risks of bias, inconsistencies, and imprecision of some estimates. Future research should focus on the impact on women with social risk factors, and those at higher risk of complications, and implementation and scaling up of midwife continuity of care models, with emphasis on low- and middle-income countries.
Collapse
Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Declan Devane
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, School of Business and Economics, Institute for Lifecourse and Society, University of Galway, Galway, Ireland
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Leanne V Jones
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Hannah Rayment-Jones
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| |
Collapse
|
2
|
Heynen JP, McHugh RR, Boora NS, Simcock G, Kildea S, Austin MP, Laplante DP, King S, Montina T, Metz GAS. Urinary 1H NMR Metabolomic Analysis of Prenatal Maternal Stress Due to a Natural Disaster Reveals Metabolic Risk Factors for Non-Communicable Diseases: The QF2011 Queensland Flood Study. Metabolites 2023; 13:metabo13040579. [PMID: 37110237 PMCID: PMC10145263 DOI: 10.3390/metabo13040579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Prenatal stress alters fetal programming, potentially predisposing the ensuing offspring to long-term adverse health outcomes. To gain insight into environmental influences on fetal development, this QF2011 study evaluated the urinary metabolomes of 4-year-old children (n = 89) who were exposed to the 2011 Queensland flood in utero. Proton nuclear magnetic resonance spectroscopy was used to analyze urinary metabolic fingerprints based on maternal levels of objective hardship and subjective distress resulting from the natural disaster. In both males and females, differences were observed between high and low levels of maternal objective hardship and maternal subjective distress groups. Greater prenatal stress exposure was associated with alterations in metabolites associated with protein synthesis, energy metabolism, and carbohydrate metabolism. These alterations suggest profound changes in oxidative and antioxidative pathways that may indicate a higher risk for chronic non-communicable diseases such obesity, insulin resistance, and diabetes, as well as mental illnesses, including depression and schizophrenia. Thus, prenatal stress-associated metabolic biomarkers may provide early predictors of lifetime health trajectories, and potentially serve as prognostic markers for therapeutic strategies in mitigating adverse health outcomes.
Collapse
Affiliation(s)
- Joshua P Heynen
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| | - Rebecca R McHugh
- Department of Chemistry and Biochemistry, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| | - Naveenjyote S Boora
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
- Department of Chemistry and Biochemistry, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| | - Gabrielle Simcock
- Midwifery Research Unit, Mater Research Institute, University of Queensland, Brisbane, QLD 4072, Australia
- School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia
| | - Sue Kildea
- Midwifery Research Unit, Mater Research Institute, University of Queensland, Brisbane, QLD 4072, Australia
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Alice Springs, NT 0870, Australia
| | - Marie-Paule Austin
- Perinatal and Woman's Health Unit, University of New South Wales, Sydney, NSW 2052, Australia
| | - David P Laplante
- Centre for Child Development and Mental Health, Lady Davis Institute for Medical Research, Jewish General Hospital, 4335 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E4, Canada
| | - Suzanne King
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montreal, QC H4H 1R3, Canada
| | - Tony Montina
- Southern Alberta Genome Sciences Centre, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
- Department of Chemistry and Biochemistry, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
| |
Collapse
|
3
|
Ambeskovic M, Laplante DP, Kenney T, Elgbeili G, Beaumier P, Azat N, Simcock G, Kildea S, King S, Metz GAS. Elemental analysis of hair provides biomarkers of maternal hardship linked to adverse behavioural outcomes in 4-year-old children: The QF2011 Queensland Flood Study. J Trace Elem Med Biol 2022; 73:127036. [PMID: 35841837 DOI: 10.1016/j.jtemb.2022.127036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 06/07/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Exposure to adverse experiences during pregnancy, such as a natural disaster, can modify development of the child with potential long-term consequences. Elemental hair analysis may provide useful indicators of cellular homeostasis and child health. The present study investigated (1) if flood-induced prenatal maternal stress is associated with altered hair elemental profiles in 4-year-old children, and (2) if hair elemental profiles are associated with behavioural outcomes in children. METHODS Participants were 75 children (39 boys; 36 girls) whose mothers were exposed to varying levels of stress due to a natural disaster (2011 Queensland Flood, Australia) during pregnancy. At 4 years of age, language development, attention and internalizing and externalizing problems were assessed and scalp hair was collected. Hair was analyzed by inductively coupled plasma mass spectrometry (ICP-MS) for 28 chemical elements. RESULTS A significant curvilinear association was found between maternal objective hardship and copper levels in boys, as low and high maternal objective hardship levels were associated with the highest hair copper levels. Mediation analysis revealed that low levels of maternal objective hardship and high levels of copper were associated with lower vocabulary scores. Higher levels of maternal objective hardship were associated with higher magnesium levels, which in turn were associated with attention problems and aggression in boys. In girls, high and low maternal objective hardship levels were associated with high calcium/potassium ratios. CONCLUSION Elemental hair analysis may provide a sensitive biomonitoring tool for early identification of health risks in vulnerable children.
Collapse
Affiliation(s)
- Mirela Ambeskovic
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AL, Canada.
| | - David P Laplante
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Thomas Kenney
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AL, Canada
| | - Guillaume Elgbeili
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
| | | | - Nagy Azat
- CanAlt Health Laboratories, Concord, ON, Canada
| | - Gabrielle Simcock
- Thompson Institute, University of the Sunshine Coast, QL, Australia; Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia; Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Suzanne King
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada; Department of Psychology, McGill University, Montreal, QC, Canada.
| | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AL, Canada; Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, AL, Canada.
| |
Collapse
|
4
|
Mills TA, Roberts SA, Camacho E, Heazell AEP, Massey RN, Melvin C, Newport R, Smith DM, Storey CO, Taylor W, Lavender T. Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study. BMC Pregnancy Childbirth 2022; 22:634. [PMID: 35948884 PMCID: PMC9363262 DOI: 10.1186/s12884-022-04925-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Around 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS). Methods A prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks’ gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8). Results Overall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited. Conclusions Women and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities. Trial registration ISRCTN17447733 first registration 13/02/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04925-3.
Collapse
Affiliation(s)
- Tracey A Mills
- Department of International Public Health, Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine. Pembroke Place, Liverpool, L3 5QA, UK.
| | - Stephen A Roberts
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Elizabeth Camacho
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Alexander E P Heazell
- Division of Developmental Biology and Medicine, School of Medical Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Rachael N Massey
- East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, BB2 3HH, England
| | - Cathie Melvin
- East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, BB2 3HH, England
| | - Rachel Newport
- Northern Care Alliance NHS Trust, Royal Oldham Hospital, Oldham, OL1 2JH, England
| | - Debbie M Smith
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | | | - Wendy Taylor
- Division of Nursing Midwifery and Social Work, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Tina Lavender
- Department of International Public Health, Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine. Pembroke Place, Liverpool, L3 5QA, UK
| |
Collapse
|
5
|
Catling C, Donovan H, Phipps H, Dale S, Chang S. Group Clinical Supervision for midwives and burnout: a cluster randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:309. [PMID: 35410189 PMCID: PMC8999988 DOI: 10.1186/s12884-022-04657-4] [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: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background There are major shortfalls in the midwifery workforce which has been exacerbated by the COVID 19 pandemic. Midwives have high levels of burnout and many, often early career midwives, are planning to leave the profession. There are reports of a poor workplace culture in maternity units, including bullying. Support is essential for the welfare of the workforce to be able to cope with the demands of their jobs. Supportive strategies, such as Clinical Supervision, a recognised approach in healthcare, enable reflection in a facilitated, structured way, and can enhance professional standards. The purpose of this research is to study burnout levels in midwives, those exiting their workplace and perceptions of workplace culture in relation to access to, and attendance of, monthly Clinical Supervision. Methods This study will be a cluster randomised controlled trial of maternity sites within Sydney and the surrounding districts. Twelve sites will be recruited and half will receive monthly Clinical Supervision for up to two years. Midwives from all sites will be requested to complete 6-monthly surveys comprising validated measurement tools: the Copenhagen Burnout Inventory (CBI), the Australian Midwifery Workplace Culture (AMWoC) tool and the Clinical Supervision Evaluation Questionnaire (CSEQ) (the latter for intervention sites only). Primary outcomes are the levels of burnout in midwives (using the CBI). Secondary outcomes will be the quality of the intervention (using the CSEQ), perceptions of workplace culture (using the AMWoC tool) and midwives’ intention to stay in their role/profession, as well as sick leave rates and numbers of exiting staff. We will also determine the dose effect – ie the impact in relation to how many Clinical Supervision sessions the midwives have attended, as well as other supportive workplace strategies such as mentoring/coaching on outcomes. Discussion Through attending monthly Clinical Supervision we hypothesise that midwives will report less burnout and more positive perceptions of workplace culture than those in the control sites. The potential implications of which are a productive workforce giving high quality care with the flow-on effect of having physically and psychologically well women and their babies. Trial registration The ACTRN Registration number is ACTRN12621000545864p, dated 10/05/2021,
Collapse
Affiliation(s)
- Christine Catling
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia.
| | - Helen Donovan
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Hala Phipps
- Sydney Institute for Women, Children & their Families, Sydney Local Health District, Camperdown, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Sungwon Chang
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, Australia
| |
Collapse
|
6
|
Tannous KW, George A, Ahmed MU, Blinkhorn A, Dahlen HG, Skinner J, Ajwani S, Bhole S, Yaacoub A, Srinivas R, Johnson M. Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia. BMJ Open 2021; 11:e047072. [PMID: 34341045 PMCID: PMC8330572 DOI: 10.1136/bmjopen-2020-047072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures. DESIGN AND SETTING The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years. PARTICIPANTS Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up. COST MEASURES Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach. OUTCOME MEASURES Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios. RESULTS Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only 'cost-effective' in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was 'cost-effective' in all scenarios except at 3 months scenario. CONCLUSIONS The midwives' only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives' and dentists' combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide. TRIAL REGISTRATION NUMBER ACTRN12612001271897; Post-results.
Collapse
Affiliation(s)
- Kathy W Tannous
- Translational Health Research Institute, Digital Health Cooperative Research Centre, Economics, Finance and Property, School of Business, Western Sydney University, Penrith, New South Wales, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Moin Uddin Ahmed
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Anthony Blinkhorn
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shilpi Ajwani
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Oral Health Services and Sydney Dental Hospital, Sydney Local Health District, Surry Hills, New South Wales, Australia
| | - Sameer Bhole
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Oral Health Services and Sydney Dental Hospital, Sydney Local Health District, Surry Hills, New South Wales, Australia
| | - Albert Yaacoub
- Oral Health Services, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Ravi Srinivas
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Oral Health Services, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Maree Johnson
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Australian Catholic University, North Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Pace CA, Crowther S, Lau A. Midwife experiences of providing continuity of carer: A qualitative systematic review. Women Birth 2021; 35:e221-e232. [PMID: 34253467 DOI: 10.1016/j.wombi.2021.06.005] [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: 04/08/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Continuity of carer models present positives and challenges for midwives working in them, and are difficult to sustain. BACKGROUND Research shows midwifery continuity of carer improves perinatal outcomes and experiences, and is considered the optimal model of care. AIM To synthesise existing research on midwives' experiences of providing continuity of carer and generate further understanding of what sustains them in practice. METHODS Protocol for the review was developed using PRISMA guidelines and registered with PROSPERO. 22 studies were included with original themes and findings extracted using JBI tools and synthesised using meta-ethnographic techniques. GRADE CERQual assessment of review findings showed high confidence. FINDINGS Midwives identified working in continuity of carer models as both fulfilling and challenging. Professional autonomy and ability to develop meaningful relationships were the most commonly cited positives, while lack of work life balance and conflict with the wider maternity team were the main challenges. 15 studies identified strategies employed by midwives which sustained them in practice. DISCUSSION Midwife experiences of providing continuity are impacted by personal and professional factors. Of paramount importance to sustainability of the model is the support of the wider organisation, and their alignment with principles of person-centred, relational care. CONCLUSION Relational models of care are desired by midwives, service users and are recommended in policy. Relational models of care must be responsive to midwives needs as well as birthing people, and therefore need to be designed and managed by those working in them and supported by the whole organisation to be sustainable.
Collapse
Affiliation(s)
- Charlotte Ashley Pace
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK.
| | - Susan Crowther
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK; AUT University, Auckland, New Zealand.
| | - Annie Lau
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
| |
Collapse
|
8
|
Chen T, Laplante DP, Elgbeili G, Brunet A, Simcock G, Kildea S, King S. Coping During Pregnancy Following Exposure to a Natural Disaster: The QF2011 Queensland Flood Study. J Affect Disord 2020; 273:341-349. [PMID: 32560927 DOI: 10.1016/j.jad.2020.03.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/23/2020] [Accepted: 03/29/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study investigated how coping strategies moderated the impact of disaster-related objective hardship on subjective distress in pregnant women. METHODS The objective hardship (exposure severity), subjective distress (Peritraumatic Distress Inventory, Peritraumatic Dissociative Experiences Questionnaire and Impact of Event Scale-Revised) and coping styles (Brief COPE) of pregnant women (N = 226) exposed to the 2011 Queensland, Australia flood were assessed. Moderation analyses were used to assess how coping strategies moderated the relationship between objective hardship and subjective distress levels. RESULTS We found that the more severe the objective flood exposure, the greater the women's subjective distress. The moderation analyses were significant for the Brief COPE's three coping styles (i.e., problem-focused coping, emotion-focused coping, and dysfunctional coping). For women experiencing high levels of objective hardship, problem-focused (∆R2 = 1.7%) and dysfunctional coping (∆R2 = 1.5%) elevated subjective distress levels. For women experiencing low or moderate levels of objective hardship, emotion-focused coping reduced levels of subjective distress (∆R2 = 1.3%). A three-way interaction between objective hardship, emotion-focused coping, and dysfunctional coping approached significance (∆R2 = 1.0%), indicating a protective role of emotion-focused coping under high levels of objective hardship, for women who frequently use maladaptive coping strategies. LIMITATIONS Sample was generally high SES and no measure of social support was available. CONCLUSION Results suggest that both problem-focused and dysfunctional coping strategies were maladaptive for women with relatively high exposure levels. Overall, emotion-focused coping strategies were more likely than problem-focused or dysfunctional strategies to reduce pregnant women's subjective distress following the flood.
Collapse
Affiliation(s)
- T Chen
- Department of Psychology, Tsinghua University, Beijing, People's Republic of China; Douglas Institute Research Center, Montreal, Canada
| | - D P Laplante
- Douglas Institute Research Center, Montreal, Canada
| | - G Elgbeili
- Douglas Institute Research Center, Montreal, Canada
| | - A Brunet
- Douglas Institute Research Center, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - G Simcock
- Mater Research, The University of Queensland, South Brisbane, Australia; School of Psychology, The University of Queensland, St Lucia, Australia
| | - S Kildea
- Mater Research, The University of Queensland, South Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Australia
| | - S King
- Douglas Institute Research Center, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
| |
Collapse
|
9
|
Rigg EC, Schmied V, Peters K, Dahlen HG. A survey of women in Australia who choose the care of unregulated birthworkers for a birth at home. Women Birth 2020; 33:86-96. [DOI: 10.1016/j.wombi.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 01/06/2023]
|
10
|
Soufizadeh N, Farhadifar F, Tamri S, Behafarid S, Sharifi K, Aslani S, Naqshbandi M. Diagnostic Value of Rapid Biophysical Profile in Comparison to Biophysical Profile in Pregnant Women with Insulin-Dependent Diabetes. J Family Reprod Health 2019; 13:209-213. [PMID: 32518571 PMCID: PMC7264862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: Having a rapid and low cost diagnostic approach in assessment of fetal wellbeing is an important goal for prenatal care process. The aim of this study was to determine the diagnostic value of rapid biophysical profile (rBPP) in comparison to biophysical profile (BPP). Materials and methods: In this study 142 pregnant women with insulin-dependent diabetes referred to Besat Hospital (Sanandaj, Iran) were evaluated in terms of fetal health. Age, gestational age and non-stress test (NST) data of patients were collected. The fetuses were evaluated using the standard BPP and selected rBPP methods. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated. The receiver operating characteristic (ROC) curve was plotted. The data were analyzed in Stata 14 software, using appropriate statistical analyses. Results: The mean ± standard deviation (SD) of maternal age and gestational age of the studied subjects were 30.6 ± 6.3 and 35.6 ± 1.5 weeks, respectively. The frequency of normal cases were 126 (88.7%) in the BPP method and 121 (85.2%) in the rBPP method. The results showed that sensitivity, specificity, PPV and NPV of rBPP in this study were 56.2%, 90.5%, 42.8% and 94.2%, respectively. The area under the ROC curve was 73.3%. Pearson Test showed a significant correlation between scores obtained through BPP and rBPP methods (p < 0.001). Conclusion: Considering the high profile of the sensitivity and PPV of the RBPP method compared to BPP, rBPP method has a better capacity to discriminate non-distressed fetuses from distress-exposed fetuses. It can also be used as a quick and easy method in crowded centers with limited evaluation tests, where not much skill is needed.
Collapse
Affiliation(s)
- Nasrin Soufizadeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fariba Farhadifar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Saghar Tamri
- Department of Radiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sara Behafarid
- Department of Radiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Karim Sharifi
- Department of Radiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sima Aslani
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mobin Naqshbandi
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Allen J, Kildea S, Tracy MB, Hartz DL, Welsh AW, Tracy SK. The impact of caseload midwifery, compared with standard care, on women's perceptions of antenatal care quality: Survey results from the M@NGO randomized controlled trial for women of any risk. Birth 2019; 46:439-449. [PMID: 31231863 DOI: 10.1111/birt.12436] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The measurement and interpretation of patient experience is a distinct dimension of health care quality. The Midwives @ New Group practice Options (M@NGO) randomized control trial of caseload midwifery compared with standard care among women regardless of risk reported both clinical and cost benefits. This study reports participants' perceptions of the quality of antenatal care within caseload midwifery, compared with standard care for women of any risk within that trial. METHODS A trial conducted at two Australian tertiary hospitals randomly assigned participants (1:1) to caseload midwifery or standard care regardless of risk. Women were sent an 89-question survey at 6 weeks postpartum that included 12 questions relating to pregnancy care. Ten survey questions (including 7-point Likert scales) were analyzed by intention to treat and illustrated by participant quotes from two free-text open-response items. RESULTS From the 1748 women recruited to the trial, 58% (n = 1017) completed the 6-week survey. Of those allocated to caseload midwifery, 66% (n = 573) responded, compared with 51% (n = 444) of those allocated to standard care. The survey found women allocated to caseload midwifery perceived a higher level of quality care across every antenatal measure. Notably, those women with identified risk factors reported higher levels of emotional support (aOR 2.52 [95% CI 1.87-3.39]), quality care (2.94 [2.28-3.79]), and feeling actively involved in decision-making (3.21 [2.35-4.37]). CONCLUSIONS Results from the study show that in addition to the benefits to clinical care and cost demonstrated in the M@NGO trial, caseload midwifery outperforms standard care in perceived quality of pregnancy care regardless of risk.
Collapse
Affiliation(s)
- Jyai Allen
- Midwifery Research Unit, Mater Research Institute - University of Queensland, South Brisbane, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
| | - Sue Kildea
- Midwifery Research Unit, Mater Research Institute - University of Queensland, South Brisbane, QLD, Australia.,Molly Wardaguga Research Centre, Asia Pacific College of Nursing & Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Mark B Tracy
- Department of Paediatrics and Child Health, The University of Sydney, Camperdown, NSW, Australia
| | - Donna L Hartz
- Asia Pacific College of Nursing & Midwifery, Charles Darwin University, Sydney, NSW, Australia.,Midwifery and Women's Health Research Unit, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
| | - Alec W Welsh
- Faculty of Medicine, Level 0, Royal Hospital for Women, University of NSW, Randwick, NSW, Australia
| | - Sally K Tracy
- Midwifery and Women's Health Research Unit, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
12
|
Simcock G, Cobham VE, Laplante DP, Elgbeili G, Gruber R, Kildea S, King S. A cross-lagged panel analysis of children's sleep, attention, and mood in a prenatally stressed cohort: The QF2011 Queensland flood study. J Affect Disord 2019; 255:96-104. [PMID: 31150945 DOI: 10.1016/j.jad.2019.05.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/24/2019] [Accepted: 05/22/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND It is well recognized that childhood sleep, attention and mood problems increase risk for multiple adverse outcomes across the life-span; therefore, understanding factors, such as prenatal maternal stress, that underlie these types of childhood problems is critical for developing interventions that may optimize longer-term functioning. Our goal was to determine the association between disaster-related stress in pregnancy and young children's sleep, attention, and anxious/depressed symptoms. METHODS Soon after a major flood in Australia in 2011, we assessed various aspects of disaster-related prenatal maternal stress (PNMS) in women who had been pregnant at the time. Mothers rated several domains of their children's development with the Child Behavior Checklist (CBCL) at ages 2½ (n = 134) and 4 years (n = 118). RESULTS The primary finding was that more severe objective flood-related hardship in pregnancy predicted higher sleep problem scores at 2½ years, and that a negative maternal cognitive appraisal of the flood predicted lower attention problem scores at 2½ years. A cross-lagged panel analysis examined the association between children's sleep, attention, and anxious/depressed symptoms within and across ages. Results showed that these problems were likely to co-occur at each age, and that they were stable from 2½ to 4 years. Additionally, anxious/depressed scores at age 2½ predicted sleep problem scores at 4 years, all else being equal. LIMITATIONS Limitations of the study include a relatively small sample size and the children's outcome data relied on maternal report using the CBCL, rather than independent observation of the children's functioning, which may have introduced reporter bias. CONCLUSIONS These findings highlight the importance of early intervention for these childhood problems to optimize long-term mental health, particularly under conditions of prenatal stress.
Collapse
Affiliation(s)
- Gabrielle Simcock
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia; Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, QLD, Australia
| | - Vanessa E Cobham
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia; School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - David P Laplante
- Schizophrenia and Neurodevelopmental Disorders Research Program, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Guillaume Elgbeili
- Schizophrenia and Neurodevelopmental Disorders Research Program, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Reut Gruber
- Attention, Behavior and Sleep Laboratory, Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Sue Kildea
- School of Nursing, Midwifery, and Social Work, The University of Queensland, QLD, Australia
| | - Suzanne King
- Schizophrenia and Neurodevelopmental Disorders Research Program, Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada.
| |
Collapse
|
13
|
Simcock G, Kildea S, Kruske S, Laplante DP, Elgbeili G, King S. Disaster in pregnancy: midwifery continuity positively impacts infant neurodevelopment, QF2011 study. BMC Pregnancy Childbirth 2018; 18:309. [PMID: 30053853 PMCID: PMC6062998 DOI: 10.1186/s12884-018-1944-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research shows that continuity of midwifery carer in pregnancy improves maternal and neonatal outcomes. This study examines whether midwifery group practice (MGP) care during pregnancy affects infant neurodevelopment at 6-months of age compared to women receiving standard hospital maternity care (SC) in the context of a natural disaster. METHODS This prospective cohort study included 115 women who were affected by a sudden-onset flood during pregnancy. They received one of two models of maternity care: MGP or SC. The women's flood-related objective stress, subjective reactions, and cognitive appraisal of the disaster were assessed at recruitment into the study. At 6-months postpartum they completed the Ages and Stages Questionnaire (ASQ-3) on their infants' communication, fine and gross motor, problem solving, and personal-social skills. RESULTS Greater maternal objective and subjective stress predicted worse infant outcomes. Even when controlling for maternal stress from the flood, infants of mothers who were in the MGP model of maternity care performed better than infants of mothers in SC on two of the five ASQ-3 domains (fine motor and problem solving) at 6-months of age. Furthermore, infants in the SC model were more likely to be identified as at risk for delayed development on these domains than infants in the MGP model of care. CONCLUSIONS Continuity of midwifery care has positive effects on infant neurodevelopment when mothers experience disaster-related stress in pregnancy, with significantly better outcomes on two developmental domains at 6 months compared to infants whose mothers received standard hospital care.
Collapse
Affiliation(s)
- Gabrielle Simcock
- Mater Research Institute-University of Queensland, Brisbane, QLD Australia
- School of Psychology, The University of Queensland, Brisbane, QLD Australia
| | - Sue Kildea
- Mater Research Institute-University of Queensland, Brisbane, QLD Australia
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, QLD Australia
| | - Sue Kruske
- Institute of Urban Indigenous Health, Brisbane, QLD Australia
| | - David P. Laplante
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health Institute, 6875 LaSalle Boulevard, Verdun, Quebec, H4H 1R3 Canada
| | - Guillaume Elgbeili
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health Institute, 6875 LaSalle Boulevard, Verdun, Quebec, H4H 1R3 Canada
| | - Suzanne King
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health Institute, 6875 LaSalle Boulevard, Verdun, Quebec, H4H 1R3 Canada
- Department of Psychiatry, McGill University, Montreal, QC Canada
| |
Collapse
|
14
|
Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018; 8:e021161. [PMID: 29959146 PMCID: PMC6042583 DOI: 10.1136/bmjopen-2017-021161] [Citation(s) in RCA: 357] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/15/2018] [Accepted: 04/20/2018] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality. DESIGN Systematic review without meta-analysis. DATA SOURCES MEDLINE, Embase and the Web of Science, from 1996 to 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients. RESULTS Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors. CONCLUSIONS This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important. PROSPERO REGISTRATION NUMBER CRD42016042091.
Collapse
Affiliation(s)
| | | | - Eleanor White
- St Leonard's Practice, Exeter, UK
- Medical School, University of Exeter, Exeter, UK
| | - Angus Thorne
- St Leonard's Practice, Exeter, UK
- Medical School, University of Manchester, Manchester, UK
| | - Philip H Evans
- St Leonard's Practice, Exeter, UK
- Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
15
|
Kildea S, Simcock G, Liu A, Elgbeili G, Laplante DP, Kahler A, Austin MP, Tracy S, Kruske S, Tracy M, O'Hara MW, King S. Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study. Arch Womens Ment Health 2018; 21:203-214. [PMID: 28956168 DOI: 10.1007/s00737-017-0781-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 09/19/2017] [Indexed: 01/05/2023]
Abstract
Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women's depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health.
Collapse
Affiliation(s)
- Sue Kildea
- Mater Research, Brisbane, QLD, Australia.,The University of Queensland, Brisbane, QLD, Australia
| | | | - Aihua Liu
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada
| | - Guillaume Elgbeili
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada
| | - David P Laplante
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada
| | - Adele Kahler
- The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Sue Kruske
- The University of Queensland, Brisbane, QLD, Australia.,Institute of Urban Indigenous Health, Bowen Hills, Queensland, Australia
| | - Mark Tracy
- Sydney University, Sydney, NSW, Australia
| | - Michael W O'Hara
- Institute of Urban Indigenous Health, Bowen Hills, Queensland, Australia.,Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - Suzanne King
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada. .,McGill University, Montreal, QC, Canada.
| |
Collapse
|
16
|
Prenatal maternal stress shapes children's theory of mind: the QF2011 Queensland Flood Study. J Dev Orig Health Dis 2017; 8:483-492. [PMID: 28337952 DOI: 10.1017/s2040174417000186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Research shows that stress in pregnancy has powerful and enduring effects on many facets of child development, including increases in behavior problems and neurodevelopmental disorders. Theory of mind is an important aspect of child development that is predictive of successful social functioning and is impaired in children with autism. A number of factors related to individual differences in theory of mind have been identified, but whether theory of mind development is shaped by prenatal events has not yet been examined. In this study we utilized a sudden onset flood that occurred in Queensland, Australia in 2011 to examine whether disaster-related prenatal maternal stress predicts child theory of mind and whether sex of the child or timing of the stressor in pregnancy moderates these effects. Higher levels of flood-related maternal subjective stress, but not objective hardship, predicted worse theory of mind at 30 months (n=130). Further, maternal cognitive appraisal of the flood moderated the effects of stress in pregnancy on girls' theory of mind performance but not boys'. These results illuminate how stress in pregnancy can shape child development and the findings are discussed in relation to biological mechanisms in pregnancy and stress theory.
Collapse
|
17
|
Simcock G, Stapleton H, Kildea S, Shoo L, Laplante DP, King S. Failure of Saliva Sampling in the QF2011 Queensland Flood Study Examining the Effects of Prenatal Maternal Stress on Neonatal Stress Reactivity. INTERNATIONAL JOURNAL OF CHILDBIRTH 2017. [DOI: 10.1891/2156-5287.7.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The study was designed to investigate the impact of disaster-related prenatal maternal stress on neonates’ reactivity to the routinely administered, painful, newborn screen procedure (heelstick or heel prick). We hypothesized that pregnancy exposure to a flood stressor would affect fetal developmental pathways and subsequently neonatal responses to other stressful events, including the newborn screen. The pregnant women we recruited were affected by sudden onset floods in Queensland, Australia in 2011. Using methods similar to those described in the literature, we collected neonatal saliva immediately prior to the newborn screen and +20 and +40 min afterwards. Saliva sampling was halted after failed saliva collection attempts by trained research staff on 17 newborns. This article discusses reasons for our failure, including the influence of bioethical concerns and the requirement that research activities are compliant with hospital policies as well as the necessity of publishing studies that fail to replicate prior research.
Collapse
|
18
|
Simcock G, Laplante DP, Elgbeili G, Kildea S, Cobham V, Stapleton H, King S. Infant Neurodevelopment is Affected by Prenatal Maternal Stress: The QF2011 Queensland Flood Study. INFANCY 2016; 22:282-302. [DOI: 10.1111/infa.12166] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 08/25/2016] [Accepted: 08/30/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Gabrielle Simcock
- Mater Research Institute-University of Queensland
- School of Psychology; The University of Queensland
| | - David P. Laplante
- Schizophrenia and Neurodevelopmental Disorders Research Program; Douglas Mental Health University Institute
| | - Guillaume Elgbeili
- Schizophrenia and Neurodevelopmental Disorders Research Program; Douglas Mental Health University Institute
| | - Sue Kildea
- Mater Research Institute-University of Queensland
- School of Nursing, Midwifery, and Social Work; The University of Queensland
| | - Vanessa Cobham
- Mater Research Institute-University of Queensland
- School of Psychology; The University of Queensland
| | - Helen Stapleton
- Mater Research Institute-University of Queensland
- School of Nursing, Midwifery, and Social Work; The University of Queensland
| | - Suzanne King
- Schizophrenia and Neurodevelopmental Disorders Research Program; Douglas Mental Health University Institute
- Department of Psychiatry; McGill University
| |
Collapse
|
19
|
A qualitative study of how caseload midwifery is constituted and experienced by Danish midwives. Midwifery 2016; 36:61-9. [DOI: 10.1016/j.midw.2016.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 11/22/2022]
|
20
|
Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016; 4:CD004667. [PMID: 27121907 PMCID: PMC8663203 DOI: 10.1002/14651858.cd004667.pub5] [Citation(s) in RCA: 463] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. OBJECTIVES To compare midwife-led continuity models of care with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2016) and reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e. regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and all fetal loss before and after 24 weeks plus neonatal death using the GRADE methodology: all primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss before and after 24 weeks plus neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants = 17,561; studies = 13; high quality evidence). Women who had midwife-led continuity models of care were more likely to experience spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.07; participants = 16,687; studies = 12; high quality). There were no differences between groups for caesarean births or intact perineum.For the secondary outcomes, women who had midwife-led continuity models of care were less likely to experience amniotomy (average RR 0.80, 95% CI 0.66 to 0.98; participants = 3253; studies = four), episiotomy (average RR 0.84, 95% CI 0.77 to 0.92; participants = 17,674; studies = 14) and fetal loss less than 24 weeks and neonatal death (average RR 0.81, 95% CI 0.67 to 0.98; participants = 15,645; studies = 11). Women who had midwife-led continuity models of care were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.21, 95% CI 1.06 to 1.37; participants = 10,499; studies = seven), have a longer mean length of labour (hours) (mean difference (MD) 0.50, 95% CI 0.27 to 0.74; participants = 3328; studies = three) and more likely to be attended at birth by a known midwife (average RR 7.04, 95% CI 4.48 to 11.08; participants = 6917; studies = seven). There were no differences between groups for fetal loss equal to/after 24 weeks and neonatal death, induction of labour, antenatal hospitalisation, antepartum haemorrhage, augmentation/artificial oxytocin during labour, opiate analgesia, perineal laceration requiring suturing, postpartum haemorrhage, breastfeeding initiation, low birthweight infant, five-minute Apgar score less than or equal to seven, neonatal convulsions, admission of infant to special care or neonatal intensive care unit(s) or in mean length of neonatal hospital stay (days).Due to a lack of consistency in measuring women's satisfaction and assessing the cost of various maternity models, these outcomes were reported narratively. The majority of included studies reported a higher rate of maternal satisfaction in midwife-led continuity models of care. Similarly, there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models. AUTHORS' CONCLUSIONS This review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care.Further research is needed to explore findings of fewer preterm births and fewer fetal deaths less than 24 weeks, and all fetal loss/neonatal death associated with midwife-led continuity models of care.
Collapse
Affiliation(s)
- Jane Sandall
- Women's Health Academic Centre, King's Health PartnersDivision of Women's Health, King's College, London10th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge RoadLondonUKSE1 7EH
| | - Hora Soltani
- Sheffield Hallam UniversityCentre for Health and Social Care Research32 Collegiate CrescentSheffieldUKS10 2BP
| | - Simon Gates
- Division of Health Sciences, Warwick Medical School, The University of WarwickWarwick Clinical Trials UnitGibbet Hill RoadCoventryUKCV4 7AL
| | - Andrew Shennan
- King's College LondonWomen's Health Academic Centre10th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge RoadLondonUKSE1 7EH
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyUniversity RoadGalwayIreland
| | | |
Collapse
|
21
|
Kornelsen J, McCartney K. Letter to the Editor. Can J Surg 2016; 59:E5-6. [PMID: 27007098 DOI: 10.1503/cjs.001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jude Kornelsen
- From the Applied Policy Research Unit, Department of Family Practice, University of British Columbia, Vancouver, British Columbia
| | - Kevin McCartney
- From the Applied Policy Research Unit, Department of Family Practice, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
22
|
Fernandez Turienzo C, Sandall J, Peacock JL. Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta-analysis. BMJ Open 2016; 6:e009044. [PMID: 26758257 PMCID: PMC4716175 DOI: 10.1136/bmjopen-2015-009044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of models of antenatal care designed to prevent and reduce preterm birth (PTB) in pregnant women. METHODS We conducted a search of seven electronic databases and reference lists of retrieved studies to identify trials from inception up to July 2014 where pregnant women, regardless of risk factors for pregnancy complications, were randomly allocated to receive an alternative model of antenatal care or routine care. We pooled risks of PTB to determine the effect of alternative care models in all pregnant women. We also assessed secondary maternal and infant outcomes, women's satisfaction and economic outcomes. RESULTS 15 trials involving 22,437 women were included. Pregnant women in alternative care models were less likely to experience PTB (risk ratio 0.84, 95% CI 0.74 to 0.96). The subgroup of women randomised to midwife-led continuity models of antenatal care were less likely to experience PTB (0.78, 0.66 to 0.91) but there was no significant difference between this group and women allocated to specialised care (0.92, 0.76 to 1.12) (interaction test for subgroup differences p=0.20). Overall low-risk women in alternative care models were less likely to have PTB (0.74, 0.59 to 0.93), but this effect was not significantly different from that in mixed-risk populations (0.91, 0.79 to 1.05) (subgroup p=0.13). CONCLUSIONS Alternative models of antenatal care for all pregnant women are effective in reducing PTB compared with routine care, but no firm conclusions could be drawn regarding the relative benefits of the two models. Future research should evaluate the impact of antenatal care models which include more recent interventions and predictive tests, and which also offer continuity of care by midwives throughout pregnancy. PROSPERO REGISTRATION NUMBER CRD42014007116.
Collapse
Affiliation(s)
| | - Jane Sandall
- Division of Women's Health, Faculty of Life Sciences & Medicine, King's College London, Women's Health Academic Centre, St Thomas' Hospital,, London, UK
| | - Janet L Peacock
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, London, UK
| |
Collapse
|
23
|
Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2015:CD004667. [PMID: 26370160 DOI: 10.1002/14651858.cd004667.pub4] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. OBJECTIVES To compare midwife-led continuity models of care with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e., regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and overall fetal loss and neonatal death (fetal loss was assessed by gestation using 24 weeks as the cut-off for viability in many countries) using the GRADE methodology: All primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = 8; high quality) and less overall fetal/neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants = 17,561; studies = 13; high quality evidence). Women who had midwife-led continuity models of care were more likely to experience spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.07; participants = 16,687; studies = 12; high quality). There were no differences between groups for caesarean births or intact perineum.For the secondary outcomes, women who had midwife-led continuity models of care were less likely to experience amniotomy (average RR 0.80, 95% CI 0.66 to 0.98; participants = 3253; studies = 4), episiotomy (average RR 0.84, 95% CI 0.77 to 0.92; participants = 17,674; studies = 14) and fetal loss/neonatal death before 24 weeks (average RR 0.81, 95% CI 0.67 to 0.98; participants = 15,645; studies = 11). Women who had midwife-led continuity models of care were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.21, 95% CI 1.06 to 1.37; participants = 10,499; studies = 7), have a longer mean length of labour (hours) (mean difference (MD) 0.50, 95% CI 0.27 to 0.74; participants = 3328; studies = 3) and more likely to be attended at birth by a known midwife (average RR 7.04, 95% CI 4.48 to 11.08; participants = 6917; studies = 7). There were no differences between groups for fetal loss or neonatal death more than or equal to 24 weeks, induction of labour, antenatal hospitalisation, antepartum haemorrhage, augmentation/artificial oxytocin during labour, opiate analgesia, perineal laceration requiring suturing, postpartum haemorrhage, breastfeeding initiation, low birthweight infant, five-minute Apgar score less than or equal to seven, neonatal convulsions, admission of infant to special care or neonatal intensive care unit(s) or in mean length of neonatal hospital stay (days).Due to a lack of consistency in measuring women's satisfaction and assessing the cost of various maternity models, these outcomes were reported narratively. The majority of included studies reported a higher rate of maternal satisfaction in midwife-led continuity models of care. Similarly, there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models. AUTHORS' CONCLUSIONS This review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care.Further research is needed to explore findings of fewer preterm births and fewer fetal deaths less than 24 weeks, and overall fetal loss/neonatal death associated with midwife-led continuity models of care.
Collapse
Affiliation(s)
- Jane Sandall
- Division of Women's Health, King's College, London, Women's Health Academic Centre, King's Health Partners, 10th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, UK, SE1 7EH
| | | | | | | | | |
Collapse
|
24
|
Women's reasons for, and experiences of, choosing a homebirth following a caesarean section. BMC Pregnancy Childbirth 2015; 15:206. [PMID: 26337330 PMCID: PMC4560080 DOI: 10.1186/s12884-015-0639-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 08/26/2015] [Indexed: 11/29/2022] Open
Abstract
Background Caesarean section is rising in the developed world and vaginal birth after caesarean (VBAC) is declining. There are increased reports of women seeking a homebirth following a caesarean section (HBAC) in Australia but little is known about the reasons for this study aimed to explore women's reasons for and experiences of choosing a HBAC. Methods Twelve women participated in a semi-structured one-to-one interview. The interviews were digitally recorded, then transcribed verbatim. These data were analysed using thematic analysis. Results The overarching theme that emerged was ‘It’s never happening again’. Women clearly articulated why it [caesarean section] was never happening again under the following sub themes: ‘treated like a piece of meat’, ‘I was traumatised by it for years’, ‘you can smell the fear in the room’, ‘re-traumatised by the system’. They also described how it [caesarean section] was never happening again under the sub themes: ‘getting informed and gaining confidence’, ‘avoiding judgment through selective telling’, ‘preparing for birth’, ‘gathering support’ and ‘all about safety but I came first’. The women then identified the impact of their HBAC under the subthemes ‘I felt like superwoman’ and ‘there is just no comparison’. Conclusions Birth intervention may cause physical and emotional trauma that can have a significant impact on some women. Inflexible hospital systems and inflexible attitudes around policy and care led some women to seek other options. Women report that achieving a HBAC has benefits for the relationship with their baby. VBAC policies and practices in hospitals need to be flexible to enable women to negotiate the care that they wish to have.
Collapse
|
25
|
King S, Kildea S, Austin MP, Brunet A, Cobham VE, Dawson PA, Harris M, Hurrion EM, Laplante DP, McDermott BM, McIntyre HD, O'Hara MW, Schmitz N, Stapleton H, Tracy SK, Vaillancourt C, Dancause KN, Kruske S, Reilly N, Shoo L, Simcock G, Turcotte-Tremblay AM, Yong Ping E. QF2011: a protocol to study the effects of the Queensland flood on pregnant women, their pregnancies, and their children's early development. BMC Pregnancy Childbirth 2015; 15:109. [PMID: 25943435 PMCID: PMC4518637 DOI: 10.1186/s12884-015-0539-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/22/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increases the fetus' risk for a variety of disorders in adulthood. Animal studies testing the fetal programming hypothesis find that maternal glucocorticoids pass through the placenta and alter fetal brain development, particularly the hypothalamic-pituitary-adrenal axis. However, there are no prospective studies of pregnant women exposed to a sudden-onset independent stressor that elucidate the biopsychosocial mechanisms responsible for the wide variety of consequences of prenatal stress seen in human offspring. The aim of the QF2011 Queensland Flood Study is to fill this gap, and to test the buffering effects of Midwifery Group Practice, a form of continuity of maternity care. METHODS/DESIGN In January 2011 Queensland, Australia had its worst flooding in 30 years. Simultaneously, researchers in Brisbane were collecting psychosocial data on pregnant women for a randomized control trial (the M@NGO Trial) comparing Midwifery Group Practice to standard care. We invited these and other pregnant women to participate in a prospective, longitudinal study of the effects of prenatal maternal stress from the floods on maternal, perinatal and early childhood outcomes. Data collection included assessment of objective hardship and subjective distress from the floods at recruitment and again 12 months post-flood. Biological samples included maternal bloods at 36 weeks pregnancy, umbilical cord, cord blood, and placental tissues at birth. Questionnaires assessing maternal and child outcomes were sent to women at 6 weeks and 6 months postpartum. The protocol includes assessments at 16 months, 2½ and 4 years. Outcomes include maternal psychopathology, and the child's cognitive, behavioral, motor and physical development. Additional biological samples include maternal and child DNA, as well as child testosterone, diurnal and reactive cortisol. DISCUSSION This prenatal stress study is the first of its kind, and will fill important gaps in the literature. Analyses will determine the extent to which flood exposure influences the maternal biological stress response which may then affect the maternal-placental-fetal axis at the biological, biochemical, and molecular levels, altering fetal development and influencing outcomes in the offspring. The role of Midwifery Group Practice in moderating effects of maternal stress will be tested.
Collapse
Affiliation(s)
- Suzanne King
- Douglas Mental Health University Institute, Montreal, Canada.
- McGill University, Montreal, Canada.
| | - Sue Kildea
- Mater Research Institute, Brisbane, Australia.
- The University of Queensland, Brisbane, Australia.
| | - Marie-Paule Austin
- University of New South Wales, Sydney, Australia.
- St. John of God Health Care, Brisbane, Australia.
| | - Alain Brunet
- Douglas Mental Health University Institute, Montreal, Canada.
- McGill University, Montreal, Canada.
| | - Vanessa E Cobham
- Mater Research Institute, Brisbane, Australia.
- The University of Queensland, Brisbane, Australia.
| | - Paul A Dawson
- Mater Research Institute, Brisbane, Australia.
- The University of Queensland, Brisbane, Australia.
| | | | - Elizabeth M Hurrion
- Mater Research Institute, Brisbane, Australia.
- The University of Queensland, Brisbane, Australia.
- Mater Health Services, Brisbane, Australia.
| | | | | | - H David McIntyre
- Mater Research Institute, Brisbane, Australia.
- The University of Queensland, Brisbane, Australia.
| | | | - Norbert Schmitz
- Douglas Mental Health University Institute, Montreal, Canada.
- McGill University, Montreal, Canada.
| | - Helen Stapleton
- Mater Research Institute, Brisbane, Australia.
- The University of Queensland, Brisbane, Australia.
| | - Sally K Tracy
- The University of Sydney, Sydney, Australia.
- The Royal Hospital for Women, Randwick, Australia.
| | - Cathy Vaillancourt
- INRS - Institute Armand-Frappier (Université du Québec) and BioMed Research, Laval, Canada.
| | | | - Sue Kruske
- The University of Queensland, Brisbane, Australia.
| | - Nicole Reilly
- University of New South Wales, Sydney, Australia.
- St. John of God Health Care, Brisbane, Australia.
| | - Laura Shoo
- Mater Research Institute, Brisbane, Australia.
| | - Gabrielle Simcock
- Mater Research Institute, Brisbane, Australia.
- The University of Queensland, Brisbane, Australia.
| | | | - Erin Yong Ping
- Douglas Mental Health University Institute, Montreal, Canada.
| |
Collapse
|
26
|
Kurz E, Davis D. Routine culture-based screening versus risk-based management for the prevention of early-onset group B streptococcus disease in the neonate: a systematic review. ACTA ACUST UNITED AC 2015; 13:206-46. [PMID: 26447057 DOI: 10.11124/jbisrir-2015-1876] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 02/20/2015] [Accepted: 03/02/2015] [Indexed: 10/31/2022]
Abstract
BACKGROUND Early-onset group B streptococcus disease, recognized as the most common cause of early onset neonatal sepsis in developed countries, is transmitted vertically from the group B streptococcus carrier mother to the neonate in the peripartum. Accordingly, early-onset group B streptococcus disease is prevented by halting the transmission of the microorganism from the mother to the infant. Two main methods, routine culture-based screening and risk-based management, may be used in the identification of mothers requiring intrapartum antibiotic prophylaxis in labor. While there are advantages and disadvantages to each, there is limited high level evidence available as to which method is superior. OBJECTIVES To identify the effectiveness of risk-based management versus routine culture-based screening in the prevention of early-onset group B streptococcus disease in the neonate. INCLUSION CRITERIA TYPES OF PARTICIPANTS This review considered studies which treated pregnant women with intrapartum antibiotic prophylaxis following risk- and culture-based protocols for the prevention of early-onset group B streptococcus disease in the neonate. Types of intervention: This review considered studies that evaluated risk-based management against routine culture-based screening for the prevention of early-onset group B streptococcus disease in the neonate. Types of studies: This review looked for highest evidence available which in this case consisted of one quasi experimental study and eight comparative cohort studies with historical or concurrent control groups. Types of outcomes: Incidence of early-onset group B streptococcus disease in neonates as measured by positive group B streptococcus culture from an otherwise sterile site. Secondary outcomes include neonatal death due to group B streptococcus sepsis and percentage of women who received intrapartum antibiotic prophylaxis. SEARCH STRATEGY A multi-step search strategy was used to find studies which were limited to the English language and published between January 2000 and June 2013. METHODOLOGICAL QUALITY The quality of the eligible studies was assessed independently by two reviewers using the Joanna Briggs Institute quality assessment tool for observational studies. DATA COLLECTION Data was extracted using a standardized extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS Quantitative papers were, where possible, pooled for meta-analysis using Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument effect sizes expressed as odds ratio and their 95% confidence intervals were calculated. Heterogeneity was assessed statistically using the standard Chi-square. RESULTS The results of this review come from nine studies published in peer reviewed journals. The treatment group consists of those screened as per the culture-based protocol, the control group the risk-based protocol. For combined term and preterm infants the odds of early-onset group B streptococcus disease for the treatment vs control groups is 0.45 (95% CI 0.37 to 0.53). The odds ratio in term infants is 0.45 (95% CI 0.36 to 0.57). Preterm infants are four times (OR 4.20 [95% CI 3.36 to 5.24]) more likely to develop early-onset group B streptococcus disease than term infants regardless of prevention technique. One study provides information on neonatal mortality in which there is one neonatal death in the risk-based cohort and none in the culture-based. The TRUNCATED AT 500 WORDS.
Collapse
Affiliation(s)
- Ella Kurz
- Faculty of Health, University of Canberra, Australia
| | - Deborah Davis
- 1. Faculty of Health, University of Canberra, Australia.,2. ACT Government Health Directorate, Australia
| |
Collapse
|
27
|
Allen J, Kildea S, Stapleton H. How does group antenatal care function within a caseload midwifery model? A critical ethnographic analysis. Midwifery 2015; 31:489-97. [PMID: 25698640 DOI: 10.1016/j.midw.2015.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/14/2015] [Accepted: 01/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND caseload midwifery and CenteringPregnancy™ (a form of group antenatal care) are two models of maternity care that are separately associated with better clinical outcomes, maternal satisfaction scores and positive experiences compared to standard care. One study reported exclusively on younger women׳s experiences of caseload midwifery; none described younger women׳s experiences of group antenatal care. We retrieved no studies on the experiences of women who received a combination of caseload midwifery and group antenatal care. OBJECTIVE examine younger women׳s experiences of caseload midwifery in a setting that incorporates group antenatal care. DESIGN a critical, focused ethnographic approach. SETTING the study was conducted in an Australian hospital and its associated community venue from 2011 to 2013. PARTICIPANTS purposive sampling of younger (19-22 years) pregnant and postnatal women (n=10) and the caseload midwives (n=4) who provided group antenatal care within one midwifery group practice. METHODS separate focus group interviews with women and caseload midwives, observations of the setting and delivery of group antenatal care, and examination of selected documents. Thematic analyses of the women׳s accounts have been given primary significance. Coded segments of the midwives interview data, field notes and documents were used to compare and contrast within these themes. FINDINGS we report on women׳s first encounters with the group, and their interactions with peers and midwives. The group setting minimised the opportunity for the women and midwives to get to know each other. CONCLUSIONS this study challenges the practice of combining group antenatal care with caseload midwifery and recommends further research.
Collapse
Affiliation(s)
- J Allen
- Midwifery Research Unit, Australian Catholic University and Mater Research Institute - University of Queensland, Australia.
| | - S Kildea
- Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Australia.
| | - H Stapleton
- Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Australia.
| |
Collapse
|
28
|
King S, Laplante DP. Using natural disasters to study prenatal maternal stress in humans. ADVANCES IN NEUROBIOLOGY 2015; 10:285-313. [PMID: 25287546 DOI: 10.1007/978-1-4939-1372-5_14] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Animal studies of prenatal maternal stress permit random assignment of pregnant animals to stress and no-stress groups, and allow total control of the type, severity, and timing of the stressor in utero. Human studies have obvious constraints that make the use of experimental methods nearly impossible. Studying pregnant women who experience natural disasters during pregnancy, however, approximates the random assignment to groups enjoyed by animal studies, and can characterize the timing of the stressor in utero with great precision. In this chapter, we briefly describe our three ongoing prospective longitudinal studies of children exposed to prenatal maternal stress from natural disasters. We present results from Project Ice Storm in detail, showing effects of prenatal maternal stress on cognitive and neurodevelopment. We contrast these results with preliminary findings from the Iowa Flood Study and introduce the QF2011 Queensland Flood Project. In the "Discussion" section, we present conclusions to date and discuss the relative effects of the severity of maternal objective disaster exposure and maternal subjective distress levels, the moderating effects of fetal sex and the timing of the stressor in utero, and the longevity of the effects. Finally, we discuss some possible mechanisms that may mediate the effects of prenatal maternal stress on the neurodevelopment of children.
Collapse
Affiliation(s)
- Suzanne King
- Department of Psychiatry, McGill University, Montreal, QC, Canada,
| | | |
Collapse
|
29
|
Madan A, Tracy S, Reid R, Henry A. Recruitment difficulties in obstetric trials: a case study and review. Aust N Z J Obstet Gynaecol 2014; 54:546-52. [PMID: 25350684 DOI: 10.1111/ajo.12233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/29/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND The CONSORT statement calls for complete data on flow of participants, including all losses and exclusions. Incomplete reporting of flow into trials versus flow through trials is not uncommon. Where complete data exist in obstetric trials, poor recruitment seems a recurring theme. AIMS To explore difficulties in recruitment and differences between assessed-but-not-recruited and included women to improve future trial participation, using a case study of a recently published randomised trial of outpatient Foley catheter versus inpatient PGE2 gel for cervical ripening. MATERIALS & METHODS The assessed-but-not-recruited population of an obstetric trial (ACTRN:12609000420246) was prospectively studied for reasons for noninclusion, demographic data and pregnancy outcome. Women assessed-but-not-recruited due to declined consent or obstetrician declined participation were compared to included women. Main outcome measures included demographic and outcome differences associated with trial participation. RESULTS Of 468 assessed participants, 220 (47%) were not eligible by exclusion criteria (potential 'trial factor' recruitment difficulties), 147 (31%) declined consent (n = 100, 'participant factor') or their obstetrician declined participation (n = 47, 'clinician factor') and 101 (22%) were included. Declining women were more likely than participants to be parous (24 vs 10%, P < 0.05), induced for nonmedical reasons (18 vs 4%, P < 0.001), privately admitted (31 vs 3%, P < 0.001) and have longer inpatient stay (4.9 vs 4.2 days, P < 0.05). CONCLUSION The high assessed-but-not-recruited rate highlights important issues with external validity and feasibility when conducting obstetric trials, including recruitment difficulties related to participant, clinician and trial factors. Assessed: recruited ratios and demographic and outcome differences need consideration in planning and interpretation of randomised trials.
Collapse
Affiliation(s)
- Arushi Madan
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | | | | | | |
Collapse
|
30
|
Grigg C, Tracy SK, Daellenbach R, Kensington M, Schmied V. An exploration of influences on women's birthplace decision-making in New Zealand: a mixed methods prospective cohort within the Evaluating Maternity Units study. BMC Pregnancy Childbirth 2014; 14:210. [PMID: 24951093 PMCID: PMC4076764 DOI: 10.1186/1471-2393-14-210] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/09/2014] [Indexed: 11/23/2022] Open
Abstract
Background There is worldwide debate surrounding the safety and appropriateness of different birthplaces for well women. One of the primary objectives of the Evaluating Maternity Units prospective cohort study was to compare the clinical outcomes for well women, intending to give birth in either an obstetric-led tertiary hospital or a free-standing midwifery-led primary maternity unit. This paper addresses a secondary aim of the study – to describe and explore the influences on women’s birthplace decision-making in New Zealand, which has a publicly funded, midwifery-led continuity of care maternity system. Methods This mixed method study utilised data from the six week postpartum survey and focus groups undertaken in the Christchurch area in New Zealand (2010–2012). Christchurch has a tertiary hospital and four primary maternity units. The survey was completed by 82% of the 702 study participants, who were well, pregnant women booked to give birth in one of these places. All women received midwifery-led continuity of care, regardless of their intended or actual birthplace. Results Almost all the respondents perceived themselves as the main birthplace decision-makers. Accessing a ‘specialist facility’ was the most important factor for the tertiary hospital group. The primary unit group identified several factors, including ‘closeness to home’, ‘ease of access’, the ‘atmosphere’ of the unit and avoidance of ‘unnecessary intervention’ as important. Both groups believed their chosen birthplace was the right and ‘safe’ place for them. The concept of ‘safety’ was integral and based on the participants’ differing perception of safety in childbirth. Conclusions Birthplace is a profoundly important aspect of women’s experience of childbirth. This is the first published study reporting New Zealand women’s perspectives on their birthplace decision-making. The groups’ responses expressed different ideologies about childbirth. The tertiary hospital group identified with the ‘medical model’ of birth, and the primary unit group identified with the ‘midwifery model’ of birth. Research evidence affirming the ‘clinical safety’ of primary units addresses only one aspect of the beliefs influencing women’s birthplace decision-making. In order for more women to give birth at a primary unit other aspects of women’s beliefs need addressing, and much wider socio-political change is required.
Collapse
Affiliation(s)
- Celia Grigg
- Midwifery and Women's Health Research Unit, Faculty of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia.
| | | | | | | | | |
Collapse
|
31
|
Gao Y, Gold L, Josif C, Bar-Zeev S, Steenkamp M, Barclay L, Zhao Y, Tracy S, Kildea S. A cost-consequences analysis of a Midwifery Group Practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia. Midwifery 2014; 30:447-55. [DOI: 10.1016/j.midw.2013.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 04/16/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
|
32
|
Murphy A, Wells J, Chesser-Smyth P, Sheahan L, Foley M. An Exploratory Survey of Low-Risk Pregnant Women’s Perceptions of Antenatal Care and Services in Southern Ireland. INTERNATIONAL JOURNAL OF CHILDBIRTH 2014. [DOI: 10.1891/2156-5287.4.3.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ireland currently has the highest birthrate of the 27 European Union countries which has led to an increase in demand for maternity services. In the Irish Republic, most maternity units have traditionally followed the medical-led model of care, which, as a result, has limited women’s choice for maternity care. Although various different midwifery-led schemes are available, concerns exist regarding the knowledge and accessibility of these schemes.The aim of this descriptive, exploratory survey was to explore and determine the views of “low-risk” pregnant women (n= 394) regarding their antenatal care and services. A purposive homogeneous sample comprised the first phase of a mixed methods study and data were analyzed using Predictive Analytics Software. The findings identified a lack of awareness and understanding of the concept of a low-risk pregnancy. Consequently, women identified an overall lack of information and an inability to access available options for their care.
Collapse
|
33
|
Tracy SK, Hartz DL, Tracy MB, Allen J, Forti A, Hall B, White J, Lainchbury A, Stapleton H, Beckmann M, Bisits A, Homer C, Foureur M, Welsh A, Kildea S. Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. Lancet 2013; 382:1723-32. [PMID: 24050808 DOI: 10.1016/s0140-6736(13)61406-3] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Women at low risk of pregnancy complications benefit from continuity of midwifery care, but no trial evidence exists for women with identified risk factors. We aimed to assess the clinical and cost outcomes of caseload midwifery care for women irrespective of risk factors. METHODS In this unblinded, randomised, controlled, parallel-group trial, pregnant women at two metropolitan teaching hospitals in Australia were randomly assigned to either caseload midwifery care or standard maternity care by a telephone-based computer randomisation service. Women aged 18 years and older were eligible if they were less than 24 weeks pregnant at the first booking visit. Those who booked with another care provider, had a multiple pregnancy, or planned to have an elective caesarean section were excluded. Women allocated to caseload care received antenatal, intrapartum, and postnatal care from a named caseload midwife (or back-up caseload midwife). Controls received standard care with rostered midwives in discrete wards or clinics. The participant and the clinician were not masked to assignment. The main primary outcome was the proportion of women who had a caesarean section. The other primary maternal outcomes were the proportions who had an instrumental or unassisted vaginal birth, and the proportion who had epidural analgesia during labour. Primary neonatal outcomes were Apgar scores, preterm birth, and admission to neonatal intensive care. We analysed all outcomes by intention to treat. The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000349246. FINDINGS Publicly insured women were screened at the participating hospitals between Dec 8, 2008, and May 31, 2011. 1748 pregnant women were randomly assigned, 871 to caseload and 877 to standard care. The proportion of caesarean sections did not differ between the groups (183 [21%] in the caseload group vs 204 [23%] in the standard care group; odds ratio [OR] 0·88, 95% CI 0·70-1·10; p=0·26). The proportion of women who had elective caesarean sections (before onset of labour) differed significantly between caseload and standard care (69 [8%] vs 94 [11%]; OR 0·72, 95% CI 0·52-0·99; p=0·05). Proportions of instrumental birth were similar (172 [20%] vs 171 [19%]; p=0·90), as were the proportions of unassisted vaginal births (487 [56%] vs 454 [52%]; p=0·08) and epidural use (314 [36%] vs 304 [35%]; p=0·54). Neonatal outcomes did not differ between the groups. Total cost of care per woman was AUS$566·74 (95% 106·17-1027·30; p=0·02) less for caseload midwifery than for standard maternity care. INTERPRETATION Our results show that for women of any risk, caseload midwifery is safe and cost effective. FUNDING National Health and Medical Research Council (Australia).
Collapse
Affiliation(s)
- Sally K Tracy
- Midwifery and Women's Health Research Unit, University of Sydney, Royal Hospital for Women, Randwick, NSW, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2013:CD004667. [PMID: 23963739 DOI: 10.1002/14651858.cd004667.pub3] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. OBJECTIVES To compare midwife-led continuity models of care with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS All review authors evaluated methodological quality. Two review authors checked data extraction. MAIN RESULTS We included 13 trials involving 16,242 women. Women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.83, 95% confidence interval (CI) 0.76 to 0.90), episiotomy (average RR 0.84, 95% CI 0.76 to 0.92), and instrumental birth (average RR 0.88, 95% CI 0.81 to 0.96), and were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.16, 95% CI 1.04 to 1.31), spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.08), attendance at birth by a known midwife (average RR 7.83, 95% CI 4.15 to 14.80), and a longer mean length of labour (hours) (mean difference (hours) 0.50, 95% CI 0.27 to 0.74). There were no differences between groups for caesarean births (average RR 0.93, 95% CI 0.84 to 1.02).Women who were randomised to receive midwife-led continuity models of care were less likely to experience preterm birth (average RR 0.77, 95% CI 0.62 to 0.94) and fetal loss before 24 weeks' gestation (average RR 0.81, 95% CI 0.66 to 0.99), although there were no differences in fetal loss/neonatal death of at least 24 weeks (average RR 1.00, 95% CI 0.67 to 1.51) or in overall fetal/neonatal death (average RR 0.84, 95% CI 0.71 to 1.00).Due to a lack of consistency in measuring women's satisfaction and assessing the cost of various maternity models, these outcomes were reported narratively. The majority of included studies reported a higher rate of maternal satisfaction in the midwifery-led continuity care model. Similarly there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models. AUTHORS' CONCLUSIONS Most women should be offered midwife-led continuity models of care and women should be encouraged to ask for this option although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.
Collapse
Affiliation(s)
- Jane Sandall
- Division of Women's Health, King's College, London, Women's Health Academic Centre, King's Health Partners, 10th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, UK, SE1 7EH
| | | | | | | | | |
Collapse
|
35
|
Beasley S, Ford N, Tracy SK, Welsh AW. Collaboration in maternity care is achievable and practical. Aust N Z J Obstet Gynaecol 2012; 52:576-81. [PMID: 23046083 DOI: 10.1111/ajo.12003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/26/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Enhancing collaboration has been highlighted as a marker for future success in maternity care, although this suggestion comes with little methodological guidance. This study assessed the efficacy of a collaborative partnership between obstetric doctors and midwives providing Midwifery Group Practice (MGP) care. METHODS A retrospective analysis was undertaken with notes from weekly case review meetings held between the obstetricians and midwives over a 12-month period; audio recordings and a prospective analysis of 16 meetings with verbal contributions of the different professions; the number and types of cases discussed and referred, medical records kept at these meetings and a professional satisfaction questionnaire. Consistency of care was measured against the Australian National Midwifery Guidelines for Consultation and Referral. RESULTS Of the 337 women booked with MGP, 50% were discussed at least once. Of these, 35% were referred for consultation with an obstetrician. Women as 'Patients' were most commonly discussed, followed by educational discussions and anecdotes with equal verbal contributions from midwives and doctors. Plans for each case were recorded 97% of the time, and adhered to 90% of the time. A high level of consistency of care between similar cases (75% of the time) and with the consultation and referral guidelines (85% of the time) were achieved. Professional satisfaction with this model of care rated highly for both groups. CONCLUSION Inter-professional collaboration between midwifery and obstetric staff is highly attainable within this model of care. This study reinforces the effectiveness of collaboration in the MGP model of care for women of all risk levels and should encourage other maternity care providers to consider adopting this collaborative model.
Collapse
Affiliation(s)
- Sarah Beasley
- Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | | | | | | |
Collapse
|
36
|
Brown M, Dietsch E. The feasibility of caseload midwifery in rural Australia: a literature review. Women Birth 2012; 26:e1-4. [PMID: 23010666 DOI: 10.1016/j.wombi.2012.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/20/2012] [Accepted: 08/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Caseload midwifery is a continuity of care(r) model being implemented in an increasing number of Australian maternity settings. Question for review: is caseload midwifery a feasible model for introducing into the rural Australian context? METHOD Integrative literature review. FINDINGS Four main categories were identified and these include the evidence for caseload midwifery; applicability to the rural context; experiences of registered and student midwives and implementation of caseload midwifery models. CONCLUSION There is evidence to support caseload midwifery and its implementation in the rural setting. However, literature to date is limited by small participant size and possible selection bias. Further research, including rural midwives' expectations and experience of caseload midwifery may lead to improved sustainability of midwifery care for rural Australian women.
Collapse
Affiliation(s)
- Melanie Brown
- Charles Sturt University, School of Nursing, Midwifery and Indigenous Health, Wagga Wagga Campus, Australia.
| | | |
Collapse
|
37
|
Hartz DL, White J, Lainchbury KA, Gunn H, Jarman H, Welsh AW, Challis D, Tracy SK. Australian maternity reform through clinical redesign. AUST HEALTH REV 2012; 36:169-75. [DOI: 10.1071/ah11012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 08/16/2011] [Indexed: 11/23/2022]
Abstract
The current Australian national maternity reform agenda focuses on improving access to maternity care for women and their families while preserving safety and quality. The caseload midwifery model of care offers the level of access to continuity of care proposed in the reforms however the introduction of these models in Australia continues to meet with strong resistance. In many places access to caseload midwifery care is offered as a token, usually restricted to well women, within limited metropolitan and regional facilities and where available, places for women are very small as a proportion of the total service provided. This case study outlines a major clinical redesign of midwifery care at a metropolitan tertiary referral maternity hospital in Sydney. Caseload midwifery care was introduced under randomised trial conditions to provide midwifery care to 1500 women of all risk resulting in half of the publicly insured women receiving midwifery group practice care. The paper describes the organisational quality and safety tools that were utilised to facilitate the process while discussing the factors that facilitated the process and the barriers that were encountered within the workforce, operational and political context. What is known about the topic? Caseload midwifery models of care have been established in a variety of community based and hospital settings throughout Australia with a reported reduction in clinical intervention rates while maintainning safety of mothers and babies. What does this paper add? This case study illustrates the strategies used to achieve a large sustainable clinical service redesign project based on the introduction of the caseload midwifery model of care. What are the implications for practitioners? Establishing midwifery group practice care within the mainstream maternity services has far reaching implications for the retention and recruitment of midwives and the improvement of clinical outcomes in childbirth.
Collapse
|