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Wang X, Wang X, Tian Z, Li W, He N, Zhang G. Effect of humanised care on the surgical site wound infection after caesarean: A meta-analysis. Int Wound J 2024; 21:e14547. [PMID: 38098219 PMCID: PMC10961047 DOI: 10.1111/iwj.14547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 03/25/2024] Open
Abstract
Herein, a meta-analysis was conducted to systematically evaluate the effect of humanised care on maternal postoperative wound infections in patients who underwent caesarean section. A computerised search of Embase, Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang database was performed, supplemented by a manual search from database inception to September 2023, to collate randomised controlled trials (RCTs) regarding the application of humanised care during the perioperative period of caesarean section. Two researchers screened and selected studies identified according to inclusion and exclusion criteria, and the included literature was evaluated for quality, extracted information and required data. Data analysis was performed using RevMan 5.4 software. Twenty RCTs comprising 2408 patients were included. The results revealed the humanised care group had a lower incidence of postoperative wound infections (0.83% vs. 4.32%, odds ratio [OR]: 0.26, 95% confidence interval [CI]: 0.15-0.46, p < 0.00001) and fewer postoperative complications than the conventional care group (4.32% vs. 16.35%, OR: 0.23, 95% CI: 0.16-0.31, p < 0.00001), with lower anxiety scores (standardised mean difference [SMD]: -3.15, 95% CI: -3.90 to -2.40, p < 0.00001) and depression scores (SMD: -3.68, 95% CI: -4.49 to -2.88, p < 0.00001). The application of humanised care during the perioperative period of caesarean section can prevent postoperative wound infection, reduce postoperative complications and help alleviate maternal anxiety and depression, which is worthy of clinical promotion and application.
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Affiliation(s)
- Xiao‐Yan Wang
- Department of ObstetricsJinan City People's HospitalJinanShandongChina
| | - Xiu‐Qin Wang
- Department of Neurology IJinan City People's HospitalJinanShandongChina
| | - Zhong‐Hua Tian
- Department of ObstetricsJinan City People's HospitalJinanShandongChina
| | - Wei Li
- Department of ObstetricsJinan City People's HospitalJinanShandongChina
| | - Ning He
- Department of ObstetricsJinan City People's HospitalJinanShandongChina
| | - Gui‐Qin Zhang
- Department of Science and EducationJinan City People's HospitalJinanShandongChina
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Park M, Wanigaratne S, D'Souza R, Geoffrion R, Williams S, Muraca GM. Asian-White disparities in obstetric anal sphincter injury: a systematic review and meta-analysis. AJOG GLOBAL REPORTS 2024; 4:100296. [PMID: 38283323 PMCID: PMC10820309 DOI: 10.1016/j.xagr.2023.100296] [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] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE Obstetrical anal sphincter injury describes a severe injury to the perineum and perianal muscles after birth. Obstetrical anal sphincter injury occurs in approximately 4.4% of vaginal births in the United States; however, racial and ethnic inequities in the incidence of obstetrical anal sphincter injury have been shown in several high-income countries. Specifically, an increased risk of obstetrical anal sphincter injury in individuals who identify as Asian vs those who identify as White has been documented among residents of the United States, Australia, Canada, Western Europe, and the Scandinavian countries. The high rates of obstetrical anal sphincter injury among the Asian diaspora in these countries are higher than obstetrical anal sphincter injury rates reported among Asian populations residing in Asia. A systematic review and meta-analysis of studies in high-income, non-Asian countries was conducted to further evaluate this relationship. DATA SOURCES MEDLINE, Ovid, Embase, EmCare, and the Cochrane databases were searched from inception to March 2023 for original research studies. STUDY ELIGIBILITY CRITERIA Observational studies using keywords and controlled vocabulary terms related to race, ethnicity and obstetrical anal sphincter injury. All observational studies, including cross-sectional, case-control, and cohort were included. 2 reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Meta-analysis of Observational Studies in Epidemiology recommendations. METHODS Meta-analysis was performed using RevMan (version 5.4; Cochrane Collaboration, London, United Kingdom) for dichotomous data using the random effects model and the odds ratios as effect measures with 95% confidence intervals. Subgroup analysis was performed among Asian subgroups. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools. Meta-regression was used to determine sources of between-study heterogeneity. Results A total of 27 studies conducted in 7 countries met the inclusion criteria encompassing 2,337,803 individuals. The pooled incidence of obstetrical anal sphincter injury was higher among Asian individuals than White individuals (pooled odds ratio, 1.64; 95% confidence interval, 1.48-1.80). Subgroup analyses showed that obstetrical anal sphincter injury rates were highest among South Asians and among population-based vs hospital-based studies. Meta-regression showed that moderate heterogeneity remained even after accounting for differences in studies by types of Asian subgroups included, study year, mode of delivery included, and study setting. Conclusion Obstetrical anal sphincter injury is more frequent among Asian versus white birthing individuals in multiple high-income, non-Asian countries. Qualitative and quantitative research to elucidate underlying causal mechanisms responsible for this relationship are warranted.
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Affiliation(s)
- Meejin Park
- Faculty of Health Sciences, Department of Global Health, McMaster University, Hamilton, Ontario, Canada (Ms Park)
| | - Susitha Wanigaratne
- Edwin S.H. Leong Centre for Healthy Children, SickKids Research Institute, Toronto, Ontario, Canada (Dr Wanigaratne)
| | - Rohan D'Souza
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada (Drs D'Souza and Muraca)
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Drs D'Souza and Muraca)
| | - Roxana Geoffrion
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (Dr Geoffrion)
| | - Sarah Williams
- Department of Anthropology, University of Connecticut, Mansfield, CT (Dr Williams)
| | - Giulia M. Muraca
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada (Drs D'Souza and Muraca)
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Drs D'Souza and Muraca)
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden (Dr Muraca)
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DiMeo A, Karlage A, Schoenherr K, Spigel L, Chakraborty S, Bazan M, Molina RL. Cultural brokering in pregnancy care: A critical review. Int J Gynaecol Obstet 2023; 163:357-366. [PMID: 37681939 DOI: 10.1002/ijgo.15063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
People who speak languages other than English face structural barriers in accessing the US healthcare system. With a growing number of people living in countries other than their countries of birth, the impact of language and cultural differences between patients and care teams on quality care is global. Cultural brokering presents a unique opportunity to enhance communication and trust between patients and clinicians from different cultural backgrounds during pregnancy care-a critical window for engaging families in the healthcare system. This critical review aims to synthesize literature describing cultural brokering in pregnancy care. We searched keywords relating to cultural brokering, pregnancy, and language in PubMed, Embase, and CINAHL and traced references of screened articles. Our search identified 33 articles. We found that cultural brokering is not clearly defined in the current literature. Few of the articles provided information about language concordance between cultural brokers and patients or clinicians. No article described the impact of cultural brokering on health outcomes. Facilitators of cultural brokering included: interprofessional collaboration within the care team, feeling a family connection between the cultural broker and patients, and cultivating trust between the cultural broker and clinicians. Barriers to cultural brokering included: misunderstanding the responsibilities, difficulty maintaining personal boundaries, and limited availability and accessibility of cultural brokers. We propose cultural brokering as interactions that cover four key aims: (1) language support; (2) bridging cultural differences; (3) social support and advocacy; and (4) navigation of the healthcare system. Clinicians, researchers, and policymakers should develop consistent language around cultural brokering in pregnancy care and examine the impact of cultural brokers on health outcomes.
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Affiliation(s)
- Amanda DiMeo
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ami Karlage
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Karen Schoenherr
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lauren Spigel
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Saugata Chakraborty
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Maria Bazan
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Rose L Molina
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Wytiaz V, Levin NJ, Tan CY, Stelmak D, Iannarino N, Zhang A, Ellman E, Herrel L, Moravek M, Walling E, Chugh R, Zebrack B. Body image disturbances in adolescent and young adult cancer patients confronting infertility risk and fertility preservation decisions. J Psychosoc Oncol 2023; 42:208-222. [PMID: 37452662 PMCID: PMC10788379 DOI: 10.1080/07347332.2023.2235607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
PURPOSE Body image is a major psychosocial concern for all cancer patients but can affect the adolescent and young adult (AYA) population in distinct ways. Similarly, the prospect of infertility and the fertility preservation process can create additional stress during cancer treatment. Discussions regarding infertility inherently implicate the body and its reproductive function, but downstream effects on self-perception have not been previously described. The aim of this study was to explore the experiences of AYAs as they considered their risk of infertility and options for fertility preservation (FP), specifically the ways in which this impacted body image and FP decision-making. METHODS AYA cancer patients (n = 27) aged 12-25 years whose cancer and treatment conferred risk of infertility were recruited through electronic health record query at an NCI-Designated Comprehensive Cancer Center. Participants completed semi-structured interviews, which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to body image were identified. RESULTS Body image concerns, related to both physical appearance and body functioning emerged. Common concerns included anticipating change as it pertains to the body and its functions, physical discomfort, fear of judgment, and meeting expectations of the body. While these themes are broad in nature, they have been previously explored in relation to body image in general and their emergence in the oncofertility space provides guidance for further optimization of infertility and fertility preservation discussions. CONCLUSIONS AYA cancer patients experience a multitude of body image related disturbances when faced with the possibility of infertility and fertility preservation. In identifying and exploring these themes, future opportunities for improving oncofertility practice and discussions among AYAs with a focus on body image positivity are called upon.
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Affiliation(s)
- Victoria Wytiaz
- Department of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nina Jackson Levin
- Department of Anthropology, University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Chiu Yi Tan
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Daria Stelmak
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Nick Iannarino
- Department of Language, Culture and Communication, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Anao Zhang
- Univsersity of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Erin Ellman
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey Herrel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Walling
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashmi Chugh
- Department of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Brad Zebrack
- Univsersity of Michigan School of Social Work, Ann Arbor, Michigan, USA
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Navarro-Prado S, Sánchez-Ojeda MA, Plaza Del Pino FJ, Vázquez-Sánchez MÁ, Tovar-Gálvez MI, Azirar-Mohamed N. Coping Strategies during Childbirth Related to Cultural Identity: Companionship, Choice of Analgesia and Maternal Satisfaction. Healthcare (Basel) 2023; 11:1714. [PMID: 37372832 DOI: 10.3390/healthcare11121714] [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: 05/10/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Childbirth is a biological process and how it is experienced and managed is influenced by numerous factors, among them, socio-cultural or health care received. OBJECTIVE The objective of this study is to ascertain whether cultural factors influence the way in which women deal with childbirth through the treatment of pain, companionship and maternal satisfaction. METHODS This study is a non-experimental, quantitative, ex post facto, cross-sectional study of women who gave birth in a border town in southern Spain. The sample consisted of 249 women. RESULTS No relationship was found between cultural factors and the choice of epidural analgesia, alternative methods to alleviate pain, being accompanied nor maternal satisfaction. There was a significant relationship between the type of companionship and with maternal satisfaction. CONCLUSIONS Cultural factors did not influence how women dealt with dilation and childbirth. Results found that the person accompanying the mother was important for increasing maternal satisfaction. The intercultural training of healthcare professionals is necessary.
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Affiliation(s)
- Silvia Navarro-Prado
- Department of Nursing, Faculty of Health Sciences of Melilla, University of Granada, 52017 Melilla, Spain
| | | | | | | | - María Isabel Tovar-Gálvez
- Department of Nursing, Faculty of Health Sciences of Ceuta, University of Granada, 51001 Ceuta, Spain
| | - Nurimán Azirar-Mohamed
- Centre for the Temporary Stay of Immigrants of the Autonomous City of Melilla, 52004 Melilla, Spain
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Agunwamba AA, Finney Rutten LJ, St Sauver JL, Agunwamba AO, Jacobson DJ, McGree ME, Njeru JW. Higher Rates of Cesarean Sections Found in Somali Immigrant Women in Minnesota. J Racial Ethn Health Disparities 2022; 9:1765-1774. [PMID: 34309817 PMCID: PMC9550004 DOI: 10.1007/s40615-021-01113-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare prenatal characteristics and postpartum outcomes among Somali and non-Somali women residing in Olmsted County. METHODS We reviewed the medical records for a cohort of Somali women (≥18 years old; N= 298) who had singleton births between January 2009 and December 2014 and for an age-matched non-Somali cohort (N= 298) of women residing in Olmsted County, Minnesota. Logistic regression models which accounted for repeated measures were used to assess differences in prenatal and postpartum outcomes between Somali and non-Somali women. RESULTS Somali women had a significantly higher odds of cesarean section (adjusted OR=1.81; 95% CI=1.15, 2.84). Additionally, Somali women had a significantly lower odds of postpartum depression (adjusted OR=0.27; 95% CI=0.12, 0.63). CONCLUSION The reported adverse postpartum outcomes have implications for interventions aimed at addressing perinatal care disparity gaps for Somali women immigrant and refugee populations.
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Affiliation(s)
- Amenah A Agunwamba
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA
| | | | | | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Miani C, Batram-Zantvoort S, Wandschneider L, Spallek J, Razum O. Potential of Standard Perinatal Data for Measuring Violation of Birth Integrity. Front Glob Womens Health 2021; 1:581244. [PMID: 34816160 PMCID: PMC8594012 DOI: 10.3389/fgwh.2020.581244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/10/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Measuring the phenomenon of violation of birth integrity (vBI) (e.g., obstetric violence) relies in part on the availability and content of maternity care providers' data. The population coverage and linkage possibilities that these data provide make for a yet untapped potential. Although vBI is a complex phenomenon best measured with dedicated instruments, we argue that maternity care providers' data could contribute to enhance our knowledge of the manifestations and frequency of vBI, and allow for analyses across different sub-groups of the population. Looking into the German standardized perinatal data, we investigate which variables are relevant to vBI-related research, and how complete their reporting is. Methods: First, we analyse state-of-the-art frameworks and recommendations, and, for each vBI-related domain, we search for and list corresponding variables in the perinatal data which could contribute to a better understanding of vBI issues. Second, we use an example and analyse the content of perinatal data obtained between 2013 and 2016 in the context of the BaBi birth cohort study set in Bielefeld, Germany. We use descriptive statistics to assess the completeness of the data. Results: The vBI-related variables can be classified in three main categories: discrimination based on specific patient socio-demographic attributes (e.g., height and weight to calculate BMI before pregnancy, foreign origin), indication for medical interventions (i.e., medicalization-related variables: indication for cesarean sections and induction), and supportive care, in particular the mobilization dimension (e.g., continuous fetal heartbeat monitoring). The data analyses included 876 births, of which 601 were vaginal birth. We found poor reporting on demographic variables in terms of completeness. Medicalization and mobilization variables are better documented, although limited in scope. Conclusions: Putting more emphasis on the completeness of standardized data could increase their potential for vBI-related research. Perinatal data alone are insufficient to assess vBI, but a broader, theory-informed discussion of indicators to be included in standardized datasets would contribute to capturing the different aspects of integrity violation in a more systematic way and expand the evidence-base on different types of vBI.
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Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Rodríguez-Garrido P, Goberna-Tricas J. Birth cultures: A qualitative approach to home birthing in Chile. PLoS One 2021; 16:e0249224. [PMID: 33886560 PMCID: PMC8062023 DOI: 10.1371/journal.pone.0249224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/14/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Birth cultures have been transforming in recent years mainly affecting birth care and its socio-political contexts. This situation has affected the feeling of well-being in women at the time of giving birth. AIM For this reason, our objective was to analyse the social meaning that women ascribe to home births in the Chilean context. METHOD We conducted thirty semi-structured interviews with women living in diverse regions ranging from northern to southern Chile, which we carried out from a theoretical-methodological perspective of phenomenology and situated knowledge. Qualitative thematic analysis was used to analyse the information collected in the field work. FINDINGS A qualitative thematic analysis produced the following main theme: 1) Home birth journeys. Two sub-categories: 1.1) Making the decision to give birth at home, 1.2) Giving birth: (re)birth. And four sub-categories also emerged: 1.1.1) Why do I need to give birth at home? 1.1.2) The people around me don't support me; 1.2.1) Shifting emotions during home birth, 1.2.2) I (don't) want to be alone. CONCLUSION We concluded that home births involve an intense and diverse range of satisfactions and tensions, the latter basically owing to the sociocultural resistance surrounding women. For this reason, they experienced home birth as an act of protest and highly valued the presence of midwives and their partners.
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Affiliation(s)
- Pía Rodríguez-Garrido
- Department of Public Health, Mental Health and Perinatal Nursing, Faculty of Medicine and Health Sciences, ADHUC Research Centre: Theory, Gender and Sexuality, University of Barcelona, Barcelona, Spain
- Department of Health, University of O’Higgins, O’Higgins, Chile
| | - Josefina Goberna-Tricas
- Department of Public Health, Mental Health and Perinatal Nursing, Faculty of Medicine and Health Sciences, ADHUC Research Centre: Theory, Gender and Sexuality, University of Barcelona, Barcelona, Spain
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Malmquist A, Wikström J, Jonsson L, Nieminen K. How norms concerning maternity, femininity and cisgender increase stress among lesbians, bisexual women and transgender people with a fear of childbirth. Midwifery 2020; 93:102888. [PMID: 33260003 DOI: 10.1016/j.midw.2020.102888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore and describe norms concerning maternity, femininity and cisgender in lesbian and bisexual women and transgender people (LBT) assigned female at birth, with an expressed fear of childbirth (FOC). DESIGN Semi-structured interviews were conducted with self-identified LBT people with an expressed FOC. PARTICIPANTS 17 self-identified LBT people participated. 15 had an expressed FOC, and two were non-afraid partners. FINDINGS Participants described how their FOC was related to ideals of "the primal woman", including ideals of a natural birth. They also described stress in relation to expectations of gaining a feminine-coded body during pregnancy and of being related to as feminine women. KEY CONCLUSIONS Maternity ideals, and the ideal of the "natural" birth, can be particularly stressful on those who fear childbirth. Norms concerning femininity and cisgender can contribute to FOC among those who do not comfortably conform with feminine body ideals or feminine gender expressions. IMPLICATION FOR PRACTICE Treatments of FOC must be designed to acknowledge whether and how norms concerning maternity, femininity and cisgender affect the individual's FOC.
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Affiliation(s)
- Anna Malmquist
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83, Linköping, Sweden.
| | - Johanna Wikström
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83, Linköping, Sweden
| | - Louise Jonsson
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83, Linköping, Sweden
| | - Katri Nieminen
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
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Martín-Arribas A, Vila-Candel R, O’Connell R, Dillon M, Vila-Bellido I, Beneyto MÁ, De Molina-Fernández I, Rodríguez-Conesa N, González-Blázquez C, Escuriet R. Transfers of Care between Healthcare Professionals in Obstetric Units of Different Sizes across Spain and in a Hospital in Ireland: The MidconBirth Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228394. [PMID: 33202745 PMCID: PMC7696735 DOI: 10.3390/ijerph17228394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022]
Abstract
Background: In Europe, the majority of healthy women give birth at conventional obstetric units with the assistance of registered midwives. This study examines the relationships between the intrapartum transfer of care (TOC) from midwife to obstetrician-led maternity care, obstetric unit size (OUS) with different degrees of midwifery autonomy, intrapartum interventions and birth outcomes. Methods: A prospective, multicentre, cross-sectional study promoted by the COST Action IS1405 was carried out at eight public hospitals in Spain and Ireland between 2016–2019. The primary outcome was TOC. The secondary outcomes included type of onset of labour, oxytocin stimulation, epidural analgesia, type of birth, episiotomy/perineal injury, postpartum haemorrhage, early initiation of breastfeeding and early skin-to-skin contact. A logistic regression was performed to ascertain the effects of studied co-variables on the likelihood that participants had a TOC; Results: Out of a total of 2,126 low-risk women, those whose intrapartum care was initiated by a midwife (1772) were selected. There were statistically significant differences between TOC and OUS (S1 = 29.0%, S2 = 44.0%, S3 = 52.9%, S4 = 30.2%, p < 0.001). Statistically differences between OUS and onset of labour, oxytocin stimulation, type of birth and episiotomy or perineal injury were observed (p = 0.009, p < 0.001, p < 0.001, p < 0.001 respectively); Conclusions: Findings suggest that the model of care and OUS have a significant effect on the prevalence of intrapartum TOC and the birth outcomes. Future research should examine how models of care differ as a function of the OUS in a hospital, as well as the cost-effectiveness for the health care system.
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Affiliation(s)
- Anna Martín-Arribas
- GHenderS Research Group, School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (A.M.-A.); (R.E.)
- Faculty of Medicine, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain;
| | - Rafael Vila-Candel
- La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
- Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain
- Correspondence:
| | - Rhona O’Connell
- School of Nursing and Midwifery, University College Cork, T12 YN60 Cork, Ireland;
| | - Martina Dillon
- Cork University Maternity Hospital, Wilton, T12 YE02 Cork, Ireland;
| | - Inmaculada Vila-Bellido
- Verge dels Lliris Hospital, Poligon de Caramanxel s/n, 03804 Alcoi, Spain; (I.V.-B.); (M.Á.B.)
| | - M. Ángeles Beneyto
- Verge dels Lliris Hospital, Poligon de Caramanxel s/n, 03804 Alcoi, Spain; (I.V.-B.); (M.Á.B.)
| | | | | | | | - Ramón Escuriet
- GHenderS Research Group, School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (A.M.-A.); (R.E.)
- Catalan Health Service, Government of Barcelona, 08028 Catalonia, Spain
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Dahlen HG, Downe S, Jackson M, Priddis H, de Jonge A, Schmied V. An ethnographic study of the interaction between philosophy of childbirth and place of birth. Women Birth 2020; 34:e557-e566. [PMID: 33176996 DOI: 10.1016/j.wombi.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Organisational culture and place of birth have an impact on the variation in birth outcomes seen in different settings. AIM To explore how childbirth is constructed and influenced by context in three birth settings in Australia. METHOD This ethnographic study included observations of 25 healthy women giving birth in three settings: home (9), two birth centres (10), two obstetric units (9). Individual interviews were undertaken with these women at 6-8 weeks after birth and focus groups were conducted with 37 midwives working in the three settings: homebirth (11), birth centres (10) and obstetric units (16). RESULTS All home birth participants adopted a forward leaning position for birth and no vaginal examinations occurred. In contrast, all women in the obstetric unit gave birth on a bed with at least one vaginal examination. One summary concept emerged, Philosophy of childbirth and place of birth as synergistic mechanisms of effect. This was enacted in practice through 'running the gauntlet', based on the following synthesis: For women and midwives, depending on their childbirth philosophy, place of birth is a stimulus for, or a protection from, running the gauntlet of the technocratic approach to birth. The birth centres provided an intermediate space where the complex interplay of factors influencing acceptance of, or resistance to the gauntlet were most evident. CONCLUSIONS A complex interaction exists between prevailing childbirth philosophies of women and midwives and the birth environment. Behaviours that optimise physiological birth were associated with increasing philosophical, and physical, distance from technocratic childbirth norms.
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Affiliation(s)
- Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Soo Downe
- Research in Childbirth and Health (ReaCH) Unit, UCLan THRIVE Centre, University of Central Lancashire, Preston PR1 2HE, UK; Adjunct Western Sydney University, Australia.
| | - Melanie Jackson
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | | | - Ank de Jonge
- Adjunct Western Sydney University, Australia; Amsterdam University Medical Center, VU University Amsterdam, Department of Midwifery Science, AVAG/ Amsterdam Public Health, the Netherlands.
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
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12
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Longworth MK, Furber C, Kirk S. Fathers' roles matter too: An ethnographic study examining fathers' roles and the influences on their roles during labour and birth. Midwifery 2020; 92:102857. [PMID: 33186868 DOI: 10.1016/j.midw.2020.102857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 09/27/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mary K Longworth
- The School of Health Sciences, Bangor University, Friddoedd Road, Bangor LL57 2EF, UK.
| | - Christine Furber
- The School of Nursing, Midwifery and Social Work, The University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester M13 9PL, UK.
| | - Susan Kirk
- The School of Nursing, Midwifery and Social Work, The University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester M13 9PL, UK.
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13
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Olza I, Uvnas-Moberg K, Ekström-Bergström A, Leahy-Warren P, Karlsdottir SI, Nieuwenhuijze M, Villarmea S, Hadjigeorgiou E, Kazmierczak M, Spyridou A, Buckley S. Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth. PLoS One 2020; 15:e0230992. [PMID: 32722725 PMCID: PMC7386571 DOI: 10.1371/journal.pone.0230992] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. METHODOLOGY In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth. FINDINGS The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. CONCLUSION By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.
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Affiliation(s)
- Ibone Olza
- Faculty of Medicine, University of Alcalá, Henares, Spain
| | | | | | | | | | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science Maastricht, Zuyd University, Heerlen, The Netherlands
| | - Stella Villarmea
- Faculty of Philosophy, University of Alcalá, Henares, Spain
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Eleni Hadjigeorgiou
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | - Andria Spyridou
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Sarah Buckley
- School of Public Health, The University of Queensland, Herston, Qld, Australia
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14
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Konje ET, Hatfield J, Kuhn S, Sauve RS, Magoma M, Dewey D. Is it home delivery or health facility? Community perceptions on place of childbirth in rural Northwest Tanzania using a qualitative approach. BMC Pregnancy Childbirth 2020; 20:270. [PMID: 32375691 PMCID: PMC7201655 DOI: 10.1186/s12884-020-02967-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low and middle-income countries, pregnancy and delivery complications may deprive women and their newborns of life or the realization of their full potential. Provision of quality obstetric emergency and childbirth care can reduce maternal and newborn deaths. Underutilization of maternal and childbirth services remains a public health concern in Tanzania. The aim of this study was to explore elements of the local social, cultural, economic, and health systems that influenced the use of health facilities for delivery in a rural setting in Northwest Tanzania. METHODS A qualitative approach was used to explore community perceptions of issues related to low utilization of health facilities for childbirth. Between September and December 2017, 11 focus group discussions were conducted with women (n = 33), men (n = 5) and community health workers (CHWs; n = 28); key informant interviews were conducted with traditional birth attendants (TBAs; n = 2). Coding, identification, indexing, charting, and mapping of these interviews was done using NVIVO 12 after manual familiarization of the data. Data saturation was used to determine when no further interviews or discussions were required. RESULTS Four themes emerge; self-perceived obstetric risk, socio-cultural issues, economic concerns and health facility related factors. Health facility delivery was perceived to be crucial for complicated labor. However, the idea that childbirth was a "normal" process and lack of social and cultural acceptability of facility services, made home delivery appealing to many women and their families. In addition, out of pocket payments for suboptimal quality of health care was reported to hinder facility delivery. CONCLUSION Home delivery persists in rural settings due to economic and social issues, and the cultural meanings attached to childbirth. Accessibility to and affordability of respectful and culturally acceptable childbirth services remain challenging in this setting. Addressing barriers on both the demand and supply side could result in improved maternal and child outcomes during labor and delivery.
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Affiliation(s)
- Eveline T. Konje
- Department of Biostatistics & Epidemiology, School of Public Health, Catholic University of Health and Allied Sciences, P.O. BOX 1464 BUGANDO AREA, Mwanza, Tanzania
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, NW, Calgary, AB Canada
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, NW, Calgary, AB Canada
| | - Susan Kuhn
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 OKE Dr. NW, Calgary, AB Canada
| | - Reginald S. Sauve
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, NW, Calgary, AB Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 OKE Dr. NW, Calgary, AB Canada
| | - Moke Magoma
- Engender Health Tanzania, Dar es Salaam, Tanzania
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, NW, Calgary, AB Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 OKE Dr. NW, Calgary, AB Canada
- Owerko Centre at the Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB Canada
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15
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Shabot SC. Why ‘normal’ feels so bad: violence and vaginal examinations during labour – a (feminist) phenomenology. FEMINIST THEORY 2020. [DOI: 10.1177/1464700120920764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, I argue that many women lack the epistemic resources that would allow them to recognise the practice of vaginal examinations during childbirth as violent or as unnecessary and potentially declinable. I address vaginal examinations during childbirth as a special case of obstetric violence, in which women frequently lack the epistemic resources necessary to recognise the practice as violent not only because of the inherent difficulty of recognising violence that happens in an ‘essentially benevolent’ setting such as the medical one, but also, and mainly, due to the pervasive sexual reification of women under patriarchy and the pervasive shame to which women are subjected. My argument is that the practice of vaginal examinations is indeed experienced – bodily apprehended – as violent by many women, but that full epistemic recognition of this violence is frequently obstructed because the experience perfectly coincides with the normal phenomenological situation of women within patriarchy and thus cannot really be framed as violent. A phenomenological analysis presenting the embodied experience of women under patriarchy as always already essentially tied to sexual availability and commodification, and to shame, will explain this epistemological impairment. A phenomenological take on Judith Butler’s distinction between ‘recognition’ and ‘apprehension’ informs my analysis: I deploy it to provide a richer, more nuanced response to the question of why vaginal examinations are not fully recognised and expressed as violent – even when they are, frequently, apprehended as such. Furthermore, Butler’s ideas about the epistemic ‘framings’ through which we make sense of different kinds of lives (grievable versus ungrievable) will help me to explain how the patriarchal sexual reification of women in fact already frames sexual violence as not-violence – which ultimately also prevents labouring women (and obstetrics staff) from recognising vaginal examinations during labour as violence.
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Dugle G, Akanbang BAA, Abiiro GA. Exploring factors influencing adverse birth outcomes in a regional hospital setting in Ghana: A configuration theoretical perspective. Women Birth 2020; 34:187-195. [PMID: 32098721 DOI: 10.1016/j.wombi.2020.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Understanding the complexity of factors that influence adverse childbirth outcomes at health facilities can be enhanced by the theoretical articulation of the interplay between external socio-structural and internal technical dynamics of the birthplace in context. Guided by configuration theory, this study explored the factors that influence adverse birth outcomes at a regional hospital setting in Ghana. METHODS Qualitative data were collected from the Upper West regional hospital in Ghana. In-depth interviews were administered to 30 purposively selected respondents comprising 20 postpartum mothers and 10 midwives. The data was electronically audio-recorded, transcribed and analysed using thematic analysis. FINDINGS The study revealed three key dimensions of socio-technical configurations shaping adverse birth outcomes within the hospital setting. These are mother-midwife personality and behavioral dynamics including personality clashes and poor communication; birth process dynamics consisting of diverse paradigms of safe birthing process and socio-technical conflicts on caesarean section; and birthplace context, comprising nature of the birthing environment, confidence in the safety of the birthplace and national health policy implementation challenges. These socio-technical interactions result in late reporting at facilities by mothers and delay in care delivery by midwives, contributing to adverse birth outcomes. CONCLUSION In line with configuration theory, our study positions the influences of adverse birth outcomes in hospital settings in alignment with a subtle and iterative interplay of socio-technical factors. To comprehensively address adverse birth outcomes in hospital settings, health policymakers and practitioners need to understand and contextualise the socio-technical interactions that shape notable outcomes at specific hospital settings.
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Affiliation(s)
- Gordon Dugle
- Department of Management Studies, School of Business and Law, University for Development Studies, Wa Campus, Ghana; Nottingham University Business School, Jubilee Campus, Nottingham, NG8 1BB, UK.
| | | | - Gilbert Abotisem Abiiro
- Department of Planning, Faculty of Planning and Land Management, University for Development Studies, Wa Campus, Ghana
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Prosen M, Krajnc MT. Perspectives and experiences of healthcare professionals regarding the medicalisation of pregnancy and childbirth. Women Birth 2019; 32:e173-e181. [DOI: 10.1016/j.wombi.2018.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 06/06/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
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Ngoma-Hazemba A, Hamomba L, Silumbwe A, Munakampe MN, Soud F. Community Perspectives of a 3-Delays Model Intervention: A Qualitative Evaluation of Saving Mothers, Giving Life in Zambia. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:S139-S150. [PMID: 30867214 PMCID: PMC6519671 DOI: 10.9745/ghsp-d-18-00287] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 10/25/2018] [Indexed: 11/16/2022]
Abstract
While the Saving Mothers, Giving Life's health systems strengthening approach reduced maternal mortality, respondents still reported significant barriers accessing maternal health services. More research is needed to understand the necessary intervention package to affect system-wide change. Background: Saving Mothers, Giving Life (SMGL), a health systems strengthening approach based on the 3-delays model, aimed to reduce maternal and perinatal mortality in 6 districts in Zambia between 2012 and 2017. By 2016, the maternal mortality ratio in SMGL-supported districts declined by 41% compared to its level at the beginning of SMGL—from 480 to 284 deaths per 100,000 live births. The 10.5% annual reduction between the baseline and 2016 was about 4.5 times higher than the annual reduction rate for sub-Saharan Africa and about 2.6 times higher than the annual reduction estimated for Zambia as a whole. Objectives: While outcome measures demonstrate reductions in maternal and perinatal mortality, this qualitative endline evaluation assessed community perceptions of the SMGL intervention package, including (1) messaging about use of maternal health services, (2) access to maternal health services, and (3) quality improvement of maternal health services. Methods: We used purposive sampling to conduct semistructured in-depth interviews with women who delivered at home (n=20), women who delivered in health facilities (n=20), community leaders (n=8), clinicians (n=15), and public health stakeholders (n=15). We also conducted 12 focus group discussions with a total of 93 men and women from the community and Safe Motherhood Action Group members. Data were coded and analyzed using NVivo version 10. Results: Delay 1: Participants were receptive to SMGL's messages related to early antenatal care, health facility-based deliveries, and involving male partners in pregnancy and childbirth. However, top-down pressure to increase health facility deliveries led to unintended consequences, such as community-imposed penalty fees for home deliveries. Delay 2: Community members perceived some improvements, such as refurbished maternity waiting homes and dedicated maternity ambulances, but many still had difficulty reaching the health facilities in time to deliver. Delay 3: SMGL's clinician trainings were considered a strength, but the increased demand for health facility deliveries led to human resource challenges, which affected perceived quality of care. Conclusion and Lessons Learned: While SMGL's health systems strengthening approach aimed to reduce challenges related to the 3 delays, participants still reported significant barriers accessing maternal and newborn health care. More research is needed to understand the necessary intervention package to affect system-wide change.
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Affiliation(s)
- Alice Ngoma-Hazemba
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
| | - Leoda Hamomba
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Adam Silumbwe
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Margarate Nzala Munakampe
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Fatma Soud
- Centers for Disease Control and Prevention, Lusaka, Zambia. Now an independent consultant, Gainesville, FL, USA
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Clesse C, Lighezzolo-Alnot J, de Lavergne S, Hamlin S, Scheffler M. The evolution of birth medicalisation: A systematic review. Midwifery 2018; 66:161-167. [PMID: 30176390 DOI: 10.1016/j.midw.2018.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/01/2018] [Accepted: 08/12/2018] [Indexed: 02/04/2023]
Abstract
First described at the beginning of the 1970s, the concept of birth medicalisation has experienced a theoretical and ideological evolution influenced by the lines of research that have been associated with it. This evolution has given rise to different schools of thought concerning medicalisation, but also various methodologies used in different scientific fields. It seems relevant to propose a global synthesis of the various lines of thought related to birth medicalisation. To do this, the authors conducted a systematic literature review based on the PRISMA method. With a total of 38 occurrences in French and English, the authors scrutinised 17 databases with a publication period between 1995 and 2018. A total of 112 documents (107 articles, 3 book chapters, 2 books) has been identified, grouped and categorised into five main themes in the results section (1) the theoretical evolution of the concept of medicalisation, (2) factors related to the birth medicalisation, (3) the impact of the birth medicalisation, (4) the humanisation of birth and (5) experiences related to childbirth. A reasoned synthesis of the literature is therefore carried out in each part and then discussed according to the selected lines of research that require development in order to guarantee the best possible accompaniment to women who give birth.
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Affiliation(s)
- Christophe Clesse
- Interpsy Laboratory (EA4432) Université de Lorraine - Nancy 2. 3 Place Godeffroy de Bouillon, 54000 Nancy, France; Hospital Centre of Jury-les-Metz - Route d'Ars Laquenexy BP75088, 57073, JURY-LESMETZ Cedex 03, France; Polyclinic Majorelle. 1240 avenue Raymond Pinchard 54100 Nancy, France.
| | - Joëlle Lighezzolo-Alnot
- Interpsy Laboratory (EA4432) Université de Lorraine - Nancy 2. 3 Place Godeffroy de Bouillon, 54000 Nancy, France.
| | | | - Sandrine Hamlin
- Polyclinic Majorelle. 1240 avenue Raymond Pinchard 54100 Nancy, France.
| | - Michèle Scheffler
- Polyclinic Majorelle. 1240 avenue Raymond Pinchard 54100 Nancy, France; Cabinet de Gynécologie Médicale et Obstétrique. 21 avenue Foch 54000 Nancy, France.
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Teixeirense MMDS, Santos SLSD. From expectation to experience: humanizing childbirth in the Brazilian National Health System. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2018. [DOI: 10.1590/1807-57622016.0926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
During the past 15 years Brazil has increased efforts to humanize maternal care within the Brazilian National Health System (SUS). Humanization efforts come along with de-medicalization of birth even if quality care and reduction of inequalities are still pressing matters in the country. For this qualitative study we interviewed ten women regarding their experiences of pregnancy and childbirth. The study took place in Brasília (DF) and women narrated their birth experiences at local hospitals or a birth center. Women were mostly satisfied with their attention during childbirth, specifically those giving birth at the birth center, in contrast to women giving birth at local hospitals. However, the humanization movement, essentializing women's bodies can also reproduce normative discourses that shape a sense of self-blame and disappointment if the ‘ideal birth is not achieved.
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21
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Lokugamage AU, Pathberiya SDC. Human rights in childbirth, narratives and restorative justice: a review. Reprod Health 2017; 14:17. [PMID: 28148304 PMCID: PMC5289003 DOI: 10.1186/s12978-016-0264-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
This review describes the emerging global debate on the role of human rights childbirth. It is also tailored to a UK perspective in view of the Montgomery v. Lanarkshire [2015] legal ruling and it implications to practice. We can never underestimate the power of humane care on health. The compassion and evidence based medicine agenda in healthcare is interconnected with human rights in healthcare, feeding into the principles of decision making and patient centred care. When this has not happened and there is been healthcare conflict, the power of storytelling serves to connect disparate parties to their common humanity. Narratives are an important aspect of restorative justice processes and we suggest that this could be beneficial in the field of human rights in childbirth.
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Affiliation(s)
- A U Lokugamage
- International MotherBaby Childbirth Organisation (NGO), London, UK.
- Advisory Board of Human Rights in Childbirth (NGO), London, UK.
- Whittington Hospital, Department of Women's Health, University College London, Jenner Building, Magdala Avenue, London, N19 5NF, UK.
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Newnham EC, McKellar LV, Pincombe JI. Paradox of the institution: findings from a hospital labour ward ethnography. BMC Pregnancy Childbirth 2017; 17:2. [PMID: 28049522 PMCID: PMC5209940 DOI: 10.1186/s12884-016-1193-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/10/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Interest in the influence of culture on birth practices is on the rise, and with it comes a sense of urgency to implement practices that aid the normalisation and humanisation of birth. This groundswell is occurring despite a broader cultural milieu of escalating technology-use and medicalisation of birth across the globe. Against this background, rates of epidural analgesia use by women in labour are increasing, despite the risk of side effects. Socio-cultural norms and beliefs are likely to influence pain relief choices but there is currently scant research on this topic. METHODS This study was undertaken to gain insight into the personal, social, cultural and institutional influences on women in deciding whether or not to use epidural analgesia in labour. The study had an ethnographic approach within a theoretical framework of Critical Medical Anthropology (CMA), Foucauldian and feminist theory. Given the nature of ethnographic research, it was assumed that using the subject of epidural analgesia to gain insight into Western birth practices could illuminate broader cultural ideals and that the epidural itself may not remain the focus of the research. RESULTS Findings from the study showed how institutional surveillance, symbolised by the Journey Board led to an institutional momentum that in its attempt to keep women safe actually introduced new areas of risk, a situation which we named the Paradox of the institution. CONCLUSIONS These findings, showing a risk/safety paradox at the centre of institutionalised birth, add a qualitative dimension to the growing number of quantitative studies asserting that acute medical settings can be detrimental to normal birth practices and outcomes.
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Affiliation(s)
- Elizabeth C Newnham
- School of Nursing and Midwifery, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - Lois V McKellar
- School of Nursing and Midwifery, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Jan I Pincombe
- School of Nursing and Midwifery, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
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Cohen Shabot S. Constructing subjectivity through labour pain: A Beauvoirian analysis. EUROPEAN JOURNAL OF WOMENS STUDIES 2015. [DOI: 10.1177/1350506815617792] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traditional western conceptions of pain have commonly associated pain with the inability to communicate and with the absence of the self. Thus pain, it seems, must be avoided, since it is to blame for alienating the body from subjectivity and the self from others. Recent work on pain, however, has began to challenge these assumptions, mainly by discerning between different kinds of pain and by pointing out how some forms of pain might even constitute a crucial element in the production of subjectivity. This article deals with the specific form of pain that is labour pain. Pain in labour has been investigated in medicine and lately, copiously, within the social sciences. Analyses from a more philosophical perspective are still very much missing, however, and in developing such analyses, de Beauvoir’s ideas on subjectivity as inherently embodied, as situated, and as profoundly ambiguous when authentically lived, appear to be of significant use.
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Asefa A, Bekele D. Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia. Reprod Health 2015; 12:33. [PMID: 25890317 PMCID: PMC4403719 DOI: 10.1186/s12978-015-0024-9] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 04/02/2015] [Indexed: 11/12/2022] Open
Abstract
Background According to the 2011 Ethiopian Demographic and Health Survey, 90.1% of mothers do not deliver in health facilities, with 29.5% citing non-customary service as causative. A low level of skilled attendance at birth is among the leading causes of maternal mortality in low - and middle-income countries. Methods A cross-sectional study was undertaken in four health facilities (one specialized teaching hospital and its three catchment health centers) in Addis Ababa, Ethiopia, to quantitatively determine the level and types of disrespect and abuse faced by women during facility-based childbirth, along with their subjective experiences of disrespect and abuse. A questionnaire was administered to 173 mothers immediately prior to discharge from their respective health facility. Reported disrespect and abuse during childbirth was measured under seven categories using 23 performance indicators. Results Among multigravida mothers (n = 103), 71.8% had a history of a previous institutional birth and 78% (75.3% in health centers and 81.8% in hospital; p = 0.295) of respondents experienced one or more categories of disrespect and abuse. The violation of the right to information, informed consent, and choice/preference of position during childbirth was reported by all women who gave birth in the hospital and 89.4% of respondents in health centers. Mothers were left without attention during labor in 39.3% of cases (14.1% in health centers and 63.6% in hospital; p < 0.001). Although 78.6% (n = 136) of respondents objectively faced disrespect and abuse, only 22 (16.2%) subjectively experienced disrespect and abuse. Conclusions This quantitative study reveals a high level of disrespect and abuse during childbirth that was not perceived as such by the majority of respondents. It is every woman’s right to give birth in woman-centered environment free from disrespect and abuse. Understanding how women define abuse is crucial if Ethiopia is to succeed in increasing the uptake of facility-based births.
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Affiliation(s)
- Anteneh Asefa
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
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Predictors of decision making about childbirth setting in the southeast of Iran: home or hospital. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0661-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Escuriet-Peiró R, Goberna-Tricas J, Pueyo-Sanchez MJ, Garriga-Comas N, Úbeda-Bonet I, Caja-López C, Espiga-López I, Ortún-Rubio V. Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals. BMC Pregnancy Childbirth 2015; 15:23. [PMID: 25881263 PMCID: PMC4337058 DOI: 10.1186/s12884-015-0446-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 01/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. Methods This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (37–42 weeks) singleton births. Results Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. Conclusions Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.
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Affiliation(s)
- Ramón Escuriet-Peiró
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain. .,Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain.
| | - Josefina Goberna-Tricas
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Maria J Pueyo-Sanchez
- Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain.
| | - Neus Garriga-Comas
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. .,Hospital de Manresa, Fundació Althaia, Manresa, Spain.
| | - Immaculada Úbeda-Bonet
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Carmen Caja-López
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Isabel Espiga-López
- Observatory on Women's Health, Subdirectorate for Quality and Cohesion, Ministry of Health, Social Services and Equality, Madrid, Spain.
| | - Vicente Ortún-Rubio
- Faculty of Economic and Business Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
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