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Murray-Davis B, Grenier LN, Li J, Malott AM, Mattison CA, Cameron C, Hutton EK, Darling EK. Comparing birth experiences and satisfaction with midwifery care before and after the implementation of Canada's first Alongside Midwifery Unit (AMU). PLoS One 2024; 19:e0306916. [PMID: 39167592 PMCID: PMC11338437 DOI: 10.1371/journal.pone.0306916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/25/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Globally, midwifery-led birthing units are associated with favourable clinical outcomes and positive birth experiences. As part of our evaluation of Canada's first Alongside Midwifery Unit (AMU) at Markham Stouffville Hospital, we sought to explore and compare birth experiences and satisfaction among midwifery clients who gave birth on the AMU with midwifery clients who gave birth on the traditional obstetric unit prior to AMU implementation. METHODS We conducted a structured, online, cross-sectional survey of midwifery clients in the six months before, and up to 18 months after, opening of the AMU at Markham Stouffville Hospital, Ontario Canada. The survey contained validated measures of satisfaction including personal capacity and participation; perceived safety, control, and security; professional support; and satisfaction. Descriptive statistics and tests of significance were completed in SPSS. RESULTS A total of 193 responses were included in our analyses (pre-AMU n = 47, post-AMU n = 146). All participants had positive experiences in the four domains assessed. Compared to those who gave birth with midwives on the Labour unit, those who gave birth on the AMU indicated more positive experiences for some measures. Perceptions pertaining to being an active participant in care, to security and sense of control were more positive among those who gave birth on the AMU. CONCLUSION The AMU in Ontario is associated with high levels of satisfaction during birth, particularly the perception of being actively engaged in decision making, having a sense of control and safety, and having confidence in the care provider team. Care received on the AMU does not compromise birth experiences or satisfaction and may be associated with greater autonomy and agency for the person giving birth.
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Affiliation(s)
- Beth Murray-Davis
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay N. Grenier
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Jenifer Li
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Anne M. Malott
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Cristina A. Mattison
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Carol Cameron
- Markham Stouffville Hospital Alongside Midwifery Unit, Markham, Ontario, Canada
| | - Eileen K. Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth K. Darling
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
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Murray-Davis B, Grenier LN, Mattison C, Malott AM, Cameron C, Li J, Darling E, Hutton EK. Mediating expectations and experiences that influence birth experiences in Canada's first Alongside Midwifery Unit. Birth 2023; 50:968-977. [PMID: 37485759 DOI: 10.1111/birt.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 10/28/2022] [Accepted: 06/24/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Globally, midwifery-led birthing units are associated with excellent maternal and neonatal outcomes, and positive childbirth experiences. However, little is known about what aspects of midwife-led units contribute to favorable experiences and overall satisfaction. Our aim was to explore and describe midwifery service user experiences at Canada's first Alongside Midwifery Unit (AMU). METHODS We used a qualitative, grounded theory approach using semi-structured interviews with recipients of midwifery care at the AMU. FINDINGS Data were collected from twenty-eight participants between September 2018 and March 2020. Our generated theory explains how birth experiences and satisfaction were influenced by how well the AMU aligned with expectations or desired experiences related to the following four themes: (1) maintaining the midwifery model of care, (2) emphasizing control and choice, (3) facilitating interprofessional relationships, and (4) appreciating the unique AMU birthing environment. CONCLUSION Canada's first AMU met or exceeded service-user expectations, resulting in high levels of satisfaction with their birth experience. Maintaining core elements of the midwifery model of care, promoting high levels of autonomy, and facilitating positive interprofessional interactions are crucial elements contributing to childbirth satisfaction in the AMU environment.
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Affiliation(s)
- Beth Murray-Davis
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay N Grenier
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Cristina Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Anne M Malott
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
- Markham Stouffville Alongside Midwifery Unit, Markham, Ontario, Canada
| | - Carol Cameron
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
- Markham Stouffville Alongside Midwifery Unit, Markham, Ontario, Canada
| | - Jenifer Li
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Darling
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
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Nori W, Kassim MAK, Helmi ZR, Pantazi AC, Brezeanu D, Brezeanu AM, Penciu RC, Serbanescu L. Non-Pharmacological Pain Management in Labor: A Systematic Review. J Clin Med 2023; 12:7203. [PMID: 38068274 PMCID: PMC10707619 DOI: 10.3390/jcm12237203] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 04/22/2024] Open
Abstract
Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating, physically and emotionally demanding experience that women endure. Labor pain management poses a significant challenge for obstetricians and expectant mothers. Although pharmacological pain management is the gold standard, it still imposes risks on the mother and baby. Recently, non-pharmacological pain management (NPPM) has emerged as a safe, effective option. Six databases were searched for articles published up to 2023 using specific related keywords and defined inclusion and exclusion criteria. The extraction and gathering of data was made so as to be categorized into physical, psychological, and complementary NPPM techniques. In light of the enormous development and diversity of NPPM techniques, the present review aims to examine contemporary NPPM knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects, with a specific focus on women's individual requirements, to strengthen obstetricians' knowledge in guiding decision-making for women in childbirth.
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Affiliation(s)
- Wassan Nori
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Mustafa Ali Kassim Kassim
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Zeena Raad Helmi
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Alexandru Cosmin Pantazi
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Dragos Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Ana Maria Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Roxana Cleopatra Penciu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Lucian Serbanescu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
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Wójcik-Brylska K, Pawlicka P, Tataj-Puzyna U, Szlendak B, Węgrzynowska M, Pięta B, Baranowska B. Cooperation between midwives and doulas in the context of perinatal care - a integrative review of qualitative and quantitative studies. Midwifery 2023; 124:103731. [PMID: 37321158 DOI: 10.1016/j.midw.2023.103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/06/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND A doula is a person who provides support to women in the perinatal period without providing medical services. During childbirth, the doula becomes a member of the interdisciplinary team. This integrative review aims to analyse the nature of the cooperation between doulas and midwives, its efficiency and challenges and ways of strengthening this cooperation. METHODS A structured integrative review of empirical and theoretical studies written in English was conducted. The literature search included MEDLINE, Cochrane, Scopus, ProQuest, Science Direct, Web of Science, and Embase Health Source: Nursing/Academic Edition databases. The analysis included papers published in 1995-2020. Dedicated documents were searched for different combinations of terms and standard logical operators. A manual search of the studies was included for additional references. RESULTS Twenty-three articles from 75 full-text records were analysed. Three main themes emerged. (1) doulas are needed to prop up the system (2) barriers in collaboration between midwives and doulas; and (3) how cooperation between midwives and doulas can be strengthened. None of the articles referred directly to the impact of collaboration between midwives and doulas on the quality of perinatal care. CONCLUSION This is the first review to analyse the impact of collaboration between midwives and doulas on the quality of perinatal care. Ensuring adequate collaboration between doulas and midwives requires effort from both of these professional groups and the health care system. However, such collaboration is supportive for birthing women and the perinatal care system. Further research in terms of the impact of this collaboration on the quality of perinatal care is needed.
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Affiliation(s)
| | - Paulina Pawlicka
- Faculty of Social Sciences, Institute of Psychology, Division of Cross-Cultural and Gender Psychology, University of Gdansk, Gdansk 80-309, Poland.
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw 01-004, Poland
| | - Beata Szlendak
- Foundation for Supporting Midwives, Warsaw 00-112, Poland
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw 01-004, Poland
| | - Beata Pięta
- Practical Midwifery Science Faculty, Poznan University of Medical Sciences, Poznań 60-512, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw 01-004, Poland
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Floris L, Michoud-Bertinotti B, Martinez de Tejada B, de Oliveira S, Pfister R, Parguey S, Thorn-Cole HE, de Labrusse C. Exploring health care professionals' experiences and knowledge of woman-centred care in a university hospital. PLoS One 2023; 18:e0286852. [PMID: 37405995 DOI: 10.1371/journal.pone.0286852] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
Inspired by the six quality-of-care goals developed by the Institute of Medicine, woman-centred care (WCC) as model of care is used in maternity services as it gives an emphasis on the woman as an individual and not her status as a patient. Bringing stronger attention to women's needs and values, is proven to have clear benefits for perinatal outcomes, but fails to be known or recognised by healthcare professionals' (HCPs) and implemented. Using a mixed-methods approach, this study aimed to explore HCPs definitions of WCC and identify the degree of agreement and knowledge regarding perinatal indicators when a WCC model of care is implemented. The quantitative part was carried using a self-administered questionnaire with perinatal indicators identified from the literature. Semi-structured interviews were realized using a purposive sample of 15 HCPs and an interview grid inspired by Leap's WCC model. The study was conducted in the maternity of a university hospital in French-speaking part of Switzerland. Out of 318 HCPs working with mothers and their newborns, 51% had already heard of WCC without being familiar with Leap's model. The HCPs were aware of the positive perinatal care outcomes when WCC was implemented: women's satisfaction (99.2%), health promotion (97.6%), HCP's job satisfaction (93.2%) and positive feelings about their work (85.6%), which were strongly emphasised in the interviews. The respondents reported institutional difficulties in implementing the model such as administrative overload and lack of time. The positive outcomes of WCC on spontaneous deliveries and improved neonatal adaptation were known by most HCPs (63.4% and 59.9%, respectively). However, fewer than half of the HCPs highlighted the model's positive effects on analgesia and episiotomies or its financial benefits. Knowledge of quality-of-care outcomes (i.e women's satisfaction, positive impact on practice…) was prevalent among most of HCPs. Without adhering to a common definition and without a specific model for consensus, most providers have integrated some aspects of WCC into their practice. However, specific perinatal indicators remain largely unknown, which may hinder the implementation of WCC.
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Affiliation(s)
- Lucia Floris
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland
| | - Benedicte Michoud-Bertinotti
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland
| | - Begoña Martinez de Tejada
- Geneva University Hospitals and University of Geneva Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, Geneva, Switzerland
| | - Sara de Oliveira
- Geneva University Hospitals and University of Geneva Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, Geneva, Switzerland
| | - Riccardo Pfister
- Geneva University Hospitals and University of Geneva Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, Geneva, Switzerland
| | - Stéphanie Parguey
- Geneva University Hospitals and University of Geneva Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, Geneva, Switzerland
| | - Harriet E Thorn-Cole
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland
| | - Claire de Labrusse
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland
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Mose A, Fikadu Y, Zewdie A, Haile K, Shitu S, Wasie Kasahun A, Nuriye K. Pregnant women's perception of midwifery-led continuity care model in Ethiopia: a qualitative study. BMC Womens Health 2023; 23:304. [PMID: 37291592 DOI: 10.1186/s12905-023-02456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND A Midwifery-led continuity care (MLCC) model is the provision of care by a known midwife (caseload model) or a team of midwives (team midwifery model) for women throughout the antenatal, intrapartum, and postnatal period. Evidence shows that a MLCC model becomes the first choice for women and improves maternal and neonatal health outcomes. Despite this, little is known about pregnant women's perception of the MLCC model in Ethiopia. Therefore, this study aimed to explore pregnant women's perception and experience of a MLCC model in Ethiopia. METHODS A qualitative study was conducted in Gurage zone public hospital, Southwest Ethiopia, from May 1st to 15th, 2022. Three focused group discussions and eight in-depth interviews were conducted among pregnant women who were selected using a purposive sampling method. Data were first transcribed and then translated from Amharic (local language) to English. Finally, the thematic analysis technique using open code software was used for analysis. RESULTS Thematic analysis revealed that women want a continuity of care model. Four themes emerged. Three were specific to women's improved care. That is, (1) improved continuum of care, (2) improved woman-centred care, and (3) improved satisfaction of care. Theme four (4), barrier to implementation, was concerned with possible barriers to implementation of the model. CONCLUSION The finding of this study shows that pregnant women had positive experiences and showed a willingness to receive midwifery-led continuity care. Woman-centred care, improved satisfaction of care, and continuum of care were identified as the main themes. Therefore, it is reasonable to adopt and implement midwifery-led continuity care for low-risk pregnant women in Ethiopia.
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Affiliation(s)
- Ayenew Mose
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Yohannes Fikadu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Kassahun Haile
- Department of Medical Laboratory Science, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Solomon Shitu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Abebaw Wasie Kasahun
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Keyredin Nuriye
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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Ingram MA, Brady S, Peacock AS. The barriers to offering non-pharmacological pain management as an initial option for laboring women: A review of the literature. Eur J Midwifery 2022; 6:37. [PMID: 35794877 PMCID: PMC9186088 DOI: 10.18332/ejm/149244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Many women use pharmacological or non-pharmacological pain management (NPPM) during childbirth, however, evidence shows the usage rates of pharmacological pain management are increasing. The shift towards a biomedical approach to birth care opposes the enduring midwifery philosophy of trusting the woman and her body. Identifying midwives’ beliefs and attitudes towards perceived and actual barriers to offering NPPM as an initial option will provide insight into the factors that affect this. METHODS This review of the literature sought to understand midwives’ beliefs and attitudes towards the barriers to offering NPPM as an initial option for laboring women. Peer-reviewed journals were searched for primary research that met the inclusion criteria and explored midwives’ beliefs and attitudes towards the barriers to offering NPPM as an initial option for laboring women. Included studies were evaluated for quality according to the Critical Appraisal Skills Programme (CASP) checklists. RESULTS Thirteen qualitative studies met the inclusion criteria and four main themes of barriers to midwives offering NPPM emerged: health system-related, health facility-related, health practitioner-related, and health consumer-related barriers. CONCLUSIONS The review of the literature highlighted there are barriers that prevent or delay the initial utilization of non-pharmacological methods of pain management in labor by midwives. These findings can be used as a platform to inform further research into this topic.
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Affiliation(s)
- Matilda A. Ingram
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Susannah Brady
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Ann S. Peacock
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
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Kuipers Y, Degraeve J, Bosmans V, Thaels E, Mestdagh E. Midwifery-led care: A single mixed-methods synthesis. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2070824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yvonne Kuipers
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Antwerp University, Wilrijk, Belgium
| | - Julie Degraeve
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Antwerp University, Wilrijk, Belgium
| | - Valerie Bosmans
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
| | - Ellen Thaels
- Faculty of Health & Wellbeing, School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | - Eveline Mestdagh
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Antwerp University, Wilrijk, Belgium
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Cai D, Villanueva P, Stuijfzand S, Lu H, Zimmermann B, Horsch A. The pregnancy experiences and antenatal care services of Chinese migrants in Switzerland: a qualitative study. BMC Pregnancy Childbirth 2022; 22:148. [PMID: 35193501 PMCID: PMC8863093 DOI: 10.1186/s12884-022-04444-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Differences in reproductive health outcomes according to the mothers' origins have been reported in Switzerland, for example, women from European countries and non-European countries. The Swiss Federal Office of Public Health has therefore called for specific Swiss-wide studies on migrant populations. This study explores the pregnancy and antenatal care experiences of Chinese migrants in Switzerland, intending to clarify their maternity care needs. METHODS In-depth interviews of 14 Chinese mothers and 13 family members were conducted in Chinese or English and audio recorded. All audio-recordings were transcribed verbatim. All Chinese transcripts were translated into English. Thematic analysis was performed with the assistance of the qualitative data analysis software, MAXQDA Analytics Pro 2020. RESULTS Five themes were extracted from the transcripts: (1) Motivations and concerns about having children, (2) The merits of the Swiss maternity care system, (3) The inconveniences and barriers of accessing Swiss maternity care services, (4) Strategies to deal with the inconveniences of the Swiss maternity care system, and (5) The need for culturally sensitive care. CONCLUSIONS The results of our study provide new knowledge and understanding of pregnancy experiences and antenatal care services of Chinese mothers and their families in Switzerland. Their unique positive experiences included: family planning, the continuity of maternity services, humane care with the privacy respected, personalized sensitive care needs, preferences for female obstetricians and obstetricians of Asian origin. Several barriers were highlighted, such as information seeking difficulties, communication difficulties, and a rigid appointment system. Reducing barriers enabling access to maternity care services within the Swiss healthcare system is necessary to provide equal quality maternity care for individuals, irrespective of their origins.
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Affiliation(s)
- Dingcui Cai
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de la Corniche 10, Lausanne, 1011, Switzerland
| | - Paulina Villanueva
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de la Corniche 10, Lausanne, 1011, Switzerland
| | - Susannah Stuijfzand
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de la Corniche 10, Lausanne, 1011, Switzerland
| | - Hong Lu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Basile Zimmermann
- Confucius Institute, University of Geneva, Rue de Candolle, Geneva, 1211, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de la Corniche 10, Lausanne, 1011, Switzerland. .,Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, 1011, Switzerland.
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Grylka-Baeschlin S, Aeberli R, Guenthard-Uhl B, Meier-Kaeppeli B, Leu-tenegger V, Volken T, Pehlke-Milde J. Job satisfaction of midwives working in a labor ward: A repeat measure mixed-methods study. Eur J Midwifery 2022; 6:8. [PMID: 35233515 PMCID: PMC8842085 DOI: 10.18332/ejm/145494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/26/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Job satisfaction of midwives is important to prevent skill shortage. Those working in midwife-led models of care work more independently and have more responsibility. No previous study investigated if a self-initiated and self-responsible project could enhance job satisfaction of midwives working in a medicalled maternity unit. The aim of this study was therefore to assess job satisfaction before and after the implementation of such a project. METHODS This is longitudinal observational study at three time points using quantitative and qualitative methods. A total of 43 midwives working in a Swiss labor ward participated in the online surveys and in the focus group discussions. The surveys comprised questions from validated instruments to assess job satisfaction. Descriptive and multivariable time series analysis were used for quantitative and content analysis for qualitative data. RESULTS Adjusted predicted scores decreased between t0 and t1, and subsequently increased at t2 without reaching baseline values (e.g. ‘professional support subscales’ between t0 and t1: (0.65; 95% CI: 0.45–0.86 vs 0.26; 95% CI: 0.08–0.45, p=0.005) and between t0 and t2 (0.65; 95% CI: 0.45–0.86 vs 0.29; 95% CI: 0.12–0.47, p=0.004). Focus group discussions revealed four themes: ‘general job satisfaction’, ‘challenges with the implementation’, ‘continuity of care’ and ‘meaning for the mothers’. Midwives perceived the additional tasks as stressors. CONCLUSIONS The implementation of new projects might enhance work-related stress and consequently have negative impacts on job satisfaction in an early phase. Heads of institutions and policy makers should recognize the needs of support and additional resources for staff when implementing new projects.
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Affiliation(s)
- Susanne Grylka-Baeschlin
- Research Institute for Midwifery Science, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Regula Aeberli
- Division of Women’s Health and Newborn Care, Department of Obstetrics, University Hospital of Zurich, Zürich, Switzerland
| | - Barbara Guenthard-Uhl
- Division of Women’s Health and Newborn Care, Department of Obstetrics, University Hospital of Zurich, Zürich, Switzerland
| | - Barbara Meier-Kaeppeli
- Division of Women’s Health and Newborn Care, Department of Obstetrics, University Hospital of Zurich, Zürich, Switzerland
| | - Vanessa Leu-tenegger
- Research Institute for Midwifery Science, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Thomas Volken
- Research Institute for Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Jessica Pehlke-Milde
- Research Institute for Midwifery Science, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
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Morr AK, Malah N, Messer AM, Etter A, Mueller M, Raio L, Surbek D. Obstetrician involvement in planned midwife-led births: a cohort study in an obstetric department of a University Hospital in Switzerland. BMC Pregnancy Childbirth 2021; 21:728. [PMID: 34706693 PMCID: PMC8549258 DOI: 10.1186/s12884-021-04209-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Healthy women with low risk singleton pregnancies are offered a midwife-led birth model at our department. Exclusion criteria for midwife-led births include a range of abnormalities in medical history and during the course of pregnancy. In case of complications before, during or after labor and birth, an obstetrician is involved. The purpose of this study was 1) to evaluate the frequency of and reasons for secondary obstetrician involvement in planned midwife-led births and 2) to assess the maternal and neonatal outcome. Methods We analyzed a cohort of planned midwife-led births during a 14 years period (2006-2019). Evaluation included a comparison between midwife-led births with or without secondary obstetrician involvement, regarding maternal characteristics, birth mode, and maternal and neonatal outcome. Statistical analysis was performed by unpaired t-tests and Chi-square tests. Results In total, there were 532 intended midwife-led births between 2006 and 2019 (2.6% of all births during this time-period at the department). Among these, 302 (57%) women had spontaneous vaginal births as midwife-led births. In the remaining 230 (43%) births, obstetricians were involved: 62% of women with obstetrician involvement had spontaneous vaginal births, 25% instrumental vaginal births and 13% caesarean sections. Overall, the caesarean section rate was 5.6% in the whole cohort of women with intended midwife-led births. Reasons for obstetrician involvement primarily included necessity for labor induction, abnormal fetal heart rate monitoring, thick meconium-stained amniotic fluid, prolonged first or second stage of labor, desire for epidural analgesia, obstetrical anal sphincter injuries, retention of placenta and postpartum hemorrhage. There was a significantly higher rate of primiparous women in the group with obstetrician involvement. Arterial umbilical cord pH < 7.10 occurred significantly more often in the group with obstetrician involvement, while 5′ Apgar score < 7 did not differ significantly. The overall transfer rate of newborns to neonatal intensive care unit was low (1.3%). Conclusion A midwife-led birth in our setting is a safe alternative to a primarily obstetrician-led birth, provided that selection criteria are being followed and prompt obstetrician involvement is available in case of abnormal course of labor and birth or postpartum complications.
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Affiliation(s)
- Ann-Katrin Morr
- Department of Obstetrics and Gynecology, University Hospital Inselspital Bern, University of Bern, 3010, Bern, Switzerland.
| | - Nicole Malah
- Department of Obstetrics and Gynecology, University Hospital Inselspital Bern, University of Bern, 3010, Bern, Switzerland
| | - Andrea Manuela Messer
- Department of Obstetrics and Gynecology, University Hospital Inselspital Bern, University of Bern, 3010, Bern, Switzerland
| | - Annina Etter
- Department of Obstetrics and Gynecology, University Hospital Inselspital Bern, University of Bern, 3010, Bern, Switzerland
| | - Martin Mueller
- Department of Obstetrics and Gynecology, University Hospital Inselspital Bern, University of Bern, 3010, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University Hospital Inselspital Bern, University of Bern, 3010, Bern, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University Hospital Inselspital Bern, University of Bern, 3010, Bern, Switzerland
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Hailemeskel S, Alemu K, Christensson K, Tesfahun E, Lindgren H. Health care providers' perceptions and experiences related to Midwife-led continuity of care-A qualitative study. PLoS One 2021; 16:e0258248. [PMID: 34648571 PMCID: PMC8516211 DOI: 10.1371/journal.pone.0258248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Though Midwife-led care remains a key to improving the health status of pregnant mothers, in Ethiopia, maternity care has traditionally been based on a model in which responsibility for care is shared by hospital-based midwives, nurses, general practitioners, and obstetricians. This type of care has been seen as representing a fragmented approach. Objective The aim of this study was to explore health care providers’ perceptions and experiences related to Midwife-led continuity of care at primary hospitals in the north Shoa zone Ethiopia Methods A qualitative approach was selected as the methodology for this study. Data were collected from 25 midwives and 8 integrated emergency surgical officers (IESO) and medical doctors working in maternal health care units in four primary hospitals in the north Shoa zone, Amhara Regional State. Four focus group discussions and eight individual interviews were conducted. The facilitator utilized a set of open-ended questions for the focus group discussion. Semi-structured interview questions were used for the interviews and thematic data analysis was done. Finding The main theme extracted was “Midwives welcome consideration of a Midwife-led model that would provide greater continuity of care, but they expressed concerns about organisation and workload”. The midwives said that they would welcome working with the midwife-led care model, as they believed using it could lead to improving the quality of maternal health care, provide greater continuity, and improve coverage, birth outcomes, and maternal satisfaction. The midwives could become more autonomous and be able to take more responsibility for maternity care. The group of 25 midwives and the group of 8 IESO and medical doctors perceived that working procedures and changes in the organization of care in the health facility would have to be studied carefully before any changes can be considered. Conclusion In this study, we found that replacing the existing system of maternal care with a Midwife-led model would require careful analysis of how this model of care might be implemented in Ethiopia. Further investigation will be of great importance in providing insights that will help in developing a final model.
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Affiliation(s)
- Solomon Hailemeskel
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Midwifery, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
- * E-mail:
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kyllike Christensson
- Division of Reproductive Health, Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
| | - Esubalew Tesfahun
- Department of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Helena Lindgren
- Division of Reproductive Health, Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
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Abderhalden-Zellweger A, Politis Mercier MP, Probst I, Wild P, Danuser B, Krief P. Midwives and protection of pregnant workers in Western Switzerland: Practices, difficulties and contributions. Midwifery 2021; 102:103125. [PMID: 34428629 DOI: 10.1016/j.midw.2021.103125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Switzerland's maternity protection legislation aims to protect the health of pregnant employees and their unborn children by regulating their potential occupational exposure to hazards and strenuous activities. This legislation provides a role for obstetricians, but not for midwives. AIMS Identify the practices of Switzerland's French-speaking midwives that favour the implementation of maternity protection legislation and reflect on the profession's role in supporting pregnant employees. METHODS 356 midwives answered an online questionnaire. The analysis focuses on the 205 midwives who perform pregnancy consultations in their practice. Data were analysed in two stages using STATA software: 1) simple descriptive and correlational statistics and 2) hierarchical cluster analysis to identify typologies of practices by grouping similar responses. FINDINGS Despite having no officially defined role in Switzerland's maternity protection legislation, its midwives actively participate in protecting pregnant employees , especially those with more knowledge of the legislation, those with more years of experience and those practicing independently. The barriers that midwives face when trying to provide greater support for pregnant employees are linked significantly to their lack of knowledge about the legislation, a lack of recognition for their role in the current legislation and a lack of continuing education about the occupational health risks associated with pregnancy at work. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Their profession and specific practices give midwives privileged access to pregnant employees. Midwives' knowledge of the legislation, their awareness of the occupational risks and hazards facing pregnant employees and the conviction that their profession has the potential to make a difference could all be improved. The role of midwives should be-and deserves to be-formally and legally recognised and integrated into Switzerland's maternity protection legislation.
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Affiliation(s)
- Alessia Abderhalden-Zellweger
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011 Lausanne, Switzerland; Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Maria-Pia Politis Mercier
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011 Lausanne, Switzerland
| | - Isabelle Probst
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011 Lausanne, Switzerland
| | - Pascal Wild
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, 1066 Epalinges, Switzerland; INRS Scientific Management Unit, Nancy, France
| | - Brigitta Danuser
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, 1066 Epalinges, Switzerland
| | - Peggy Krief
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, 1066 Epalinges, Switzerland
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Abstract
Background Midwifery-led care is a high-certainty, evidence-based strategy to improve maternity care. Midwife-led units (MLUs) are one example of how the midwifery model of care is being integrated into existing health systems to transform maternal health around the world. Purpose To promote global investment in MLUs by describing the benefits, current advances and future directions of this model of care. Method A viewpoint based on prevalent notions of midwifery, research findings, guidance from professional organizations and authors' professional experience. Conclusion Renewed commitment to research and the implementation of MLUs across a variety of settings is needed to address the practice, education and policy issues associated with this evidence-based strategy. The World Health Organization "Year of the Nurse and Midwife-2020" is an opportune time to invest in midwifery models of care that are fundamental to achieving core global health initiatives such as Universal Healthcare 2030.
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Transitioning across professional boundaries in midwifery models of care: A literature review. Women Birth 2019; 32:195-203. [DOI: 10.1016/j.wombi.2018.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/24/2022]
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Bodner-Adler B, Kimberger O, Griebaum J, Husslein P, Bodner K. A ten-year study of midwife-led care at an Austrian tertiary care center: a retrospective analysis with special consideration of perineal trauma. BMC Pregnancy Childbirth 2017; 17:357. [PMID: 29037175 PMCID: PMC5644072 DOI: 10.1186/s12884-017-1544-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 10/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In contrast to other countries, Austria rarely offers alternative models to medical led-care. In an attempt to improve the facilities, a midwife-led care service was incorporated within the Department of Obstetrics and Fetomaternal Medicine. The aim of the present study was to analyze the maternal and neonatal outcomes of this approach. METHODS Over a 10-years period, a total of 2123 low-risk women receiving midwife-led care were studied. Among these women, 148 required obstetric referral. Age- and parity matched low-risk women with spontaneous vaginal birth overseen by an obstetrician-led team were used as controls to ensure comparability of data. RESULTS Midwife-led care management demonstrated a significant decrease in interventions, including oxytocin use (p < 0.001), medical pain relief (p < 0.001), and artificial rupture of membranes (ARM) (p < 0.01) as well as fewer episiotomies (p < 0.001), as compared with obstetrician-led care. Moreover, no negative effects on maternal or neonatal outcomes were observed. The mean length of the second stage of labor, rate of perineal laceration and APGAR scores did not differ significantly between the study groups (p > 0.05). Maternal age (p < 0.01), head diameter (p < 0.001), birth weight (p < 0.001) and the absence of midwife-led care (p < 0.05) were independent risk factors for perineal trauma. The overall referral rate was low (7%) and was most commonly caused by pathologic cardiotocography (CTG) and prolonged first- and second-stage of labor. Most referred mothers nevertheless had spontaneous deliveries (77%), and there were low rates of vaginal operative deliveries and cesarean sections (vacuum extraction, 16%; cesarean section, 7%). CONCLUSIONS The present study confirmed that midwife-led care confers important benefits and causes no adverse outcomes for mother and child. The favorable obstetrical outcome clearly highlights the importance of the selection of obstetric care, on the basis of previous risk assessment. We therefore fully support the recommendation that midwife-led care be offered to all low-risk women and that mothers should be encouraged to use this option. However, to increase the numbers of midwife-led care deliveries in Austria in the future, it will be necessary to expand this care model and to establish new midwife-led care units within hospital facilities.
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Affiliation(s)
- Barbara Bodner-Adler
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Oliver Kimberger
- Department of Anesthesiology, Medical University of Vienna, Wien, Austria
| | - Julia Griebaum
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Peter Husslein
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Klaus Bodner
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
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Brailey S, Luyben A, van Teijlingen E, Frith L. Women, Midwives, and a Medical Model of Maternity Care in Switzerland. INTERNATIONAL JOURNAL OF CHILDBIRTH 2017. [DOI: 10.1891/2156-5287.7.3.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article presents a case study on the organization of maternity health care in Switzerland. Switzerland has a costly health care system with high intervention rates within an obstetric-led maternity care model. Evidence has shown that midwifery care is associated with lower cost, higher satisfaction rates among women, and less intervention. However, in this model, midwives are both marginalized and underused.The article focuses on the distribution of power and knowledge between midwives, women, and the medical profession. The varying power structures that shape the maternity care system in Switzerland are examined, using a case study approach that draws on Foucault’s concepts of the gaze, surveillance, disciplinary power, and the docile body. This article critically analyzes the model of maternity care received by women in Switzerland and how it negatively impacts on both women’s personal and midwives’ professional autonomy while simultaneously driving up costs.A better understanding of the underlying power structures operating within the maternity care system may facilitate the implementation of more midwifery-led care currently being endorsed by the Swiss Midwifery Association and some government agencies. This could result in reduced cost and lower intervention rates with reduced associated morbidity.
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