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Shorey S, Ng ED. Midwives' perceptions of and experiences with normal physiologic birth: A qualitative systematic review. Birth 2023; 50:749-763. [PMID: 37712184 DOI: 10.1111/birt.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 03/06/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Normal physiologic birth has been shown to result in optimal maternal-infant outcomes, but the concept of physiologic birth is continually evolving. Midwives play an important role in advocating for normal physiologic birth; however, their perceptions of what this approach entails have not been systematically appraised. OBJECTIVE In this qualitative review, we aimed to examine midwives' perceived meanings of "normal physiologic birth" and to describe their experiences facilitating such births. METHODS Five electronic databases were searched, and 26 qualitative papers were included, representing a total of 433 midwives from different backgrounds (i.e., independent, home-based, community-based, and hospital-based). Eligible papers were assessed for quality, and then data were coded and synthesized thematically. RESULTS Four highly connected themes were generated: (1) the midwife: fundamental beliefs; (2) the woman: empowerment and advocacy; (3) the environment: ambience and culture; and (4) the team: need for institutional support and recognition. The fundamental beliefs of midwives, such as their perceived role and definition of normal physiologic birth and their self-confidence, influence practice styles and contribute to personal and professional development. Midwives often advocate for a person-centered approach that encouraged women's and other birthing person's autonomy and involvement in shared decision-making. The midwife-client relationship is also central. Most importantly, a conducive birthing environment and an inclusive workplace culture that encourages interprofessional support, collaboration, and recognizes midwifery practices were identified as crucial in providing optimal conditions for the facilitation of physiologic birth. CONCLUSIONS This review provides healthcare policymakers and institutions fresh impetus to evaluate and revise as needed current workplace policies to be more inclusive and supportive of midwifery practices and physiologic birth.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Esperanza Debby Ng
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Mlambo S, Amukugo HJ. Childbirth-choice facilitation experiences among women in selected public healthcare facilities in Namibia. Midwifery 2023; 126:103835. [PMID: 37804668 DOI: 10.1016/j.midw.2023.103835] [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: 07/21/2022] [Revised: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
AIM AND OBJECTIVE To describe childbirth-choice facilitation through the experiences of women, and explore women's views on their experiences of childbirth-choice facilitation. DESIGN This qualitative exploratory study included 12 women who gave birth in selected public hospitals in different parts of Namibia during the study period. Purposive sampling was adopted to ensure that participants had sufficient knowledge of the subject under study. The research employed individual semi-structured in-depth interviews to understand women's experiences during childbirth facilitation. Data analysis followed the six steps as proposed by Creswell: preparation and organisation of data, exploration and coding of data, coding and building descriptions of the themes, presenting and reporting findings, interpreting the findings and validation of the accuracy of findings. FINDINGS Women's choices on type of childbirth were assumed as they did not receive full information pertaining to different modes. The research findings were grouped into two main themes and five sub-themes, as follows: childbirth-choice experience (lack of choice, lack of shared decision-making) and information-giving (information sources, preferred information, timing of information-giving). Women expressed that they had limited knowledge and/or information pertaining to types of childbirth as midwives provided little information about how they would give birth. The women also indicated that healthcare professionals made decisions for them without any clear explanation, and that they received information when it was too late and they were unable to process it. KEY CONCLUSIONS Women who gave birth in public hospitals reported a lack of choice regarding type of childbirth and a lack of shared decision-making. They would have preferred to receive balanced information about types of childbirth in advance in order to make informed decisions. IMPLICATIONS FOR PRACTICE Health professionals need to provide information on types of childbirth to women early in antenatal care so that they understand the choices and can give informed consent regarding their chosen mode when the time comes. Previous experiences of women need to be solicited to guide the facilitation of current or subsequent pregnancies as a way of ensuring women-centred care.
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Affiliation(s)
- Sarah Mlambo
- Welwitchia Health Training Centre, School of Nursing, Windhoek, Namibia.
| | - Hans J Amukugo
- University of Namibia, School of Nursing, Oshakati, Namibia
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Haque M, Umar B. Growing concern over rising caesarean section rates: Is it a problem for low- and middle-income countries only? ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_148_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Martin-Arribas A, Escuriet R, Borràs-Santos A, Vila-Candel R, González-Blázquez C. A comparison between midwifery and obstetric care at birth in Spain: Across-sectional study of perinatal outcomes. Int J Nurs Stud 2021; 126:104129. [PMID: 34890836 DOI: 10.1016/j.ijnurstu.2021.104129] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The organizational structure of maternity services determines the choice of which professionals provide care during pregnancy, birth, and the postnatal period, and it influences the kind of care they deliver and the level of continuity of care offered. There is considerable evidence that demonstrates a relationship between how care is provided and the maternal and neonatal health outcomes. Registered midwives and obstetricians provide maternity care across Spain. To date, no studies have assessed whether maternity outcomes differ between these two groups. OBJECTIVE The aim of this study was to examine the association between the care received (midwifery care versus obstetric care) and the maternal and neonatal outcomes in women with normal, low- and medium-risk pregnancies in Spain from 2016 to 2019. DESIGN A prospective, multicentre, cross-sectional study was carried out as part of COST Action IS1405 at 44 public hospitals in Spain in the years 2016-2019. The protocol can be accessed through the registry ISRCTN14062994. The sample size of this study was 11,537 women. The primary outcome was mode of birth. The secondary outcomes included augmentation with oxytocin, use of epidural analgesia, women's position at birth, perineal integrity, third stage of labour management, maternal and neonatal admission to intensive care, Apgar score, neonatal resuscitation, and early initiation of breastfeeding. Chi-square tests for categorical variables and independent sample t-test for continuous variables to assess differences between the midwifery and obstetric groups were calculated. Odds ratio with intervals of confidence at 95% were calculated for obstetric interventions and perinatal outcomes. A multivariate logistic regression model was applied in order to examine the effect of type of healthcare provider on perinatal outcomes. These models were adjusted for care provider, type of onset of labour, use of anaesthesia, pregnancy risk, maternal age, parity, and gestational age at birth. RESULTS Midwifery care was associated with lower rates of operative births and severe perineal damage and had no higher adverse outcomes. No statistically significant differences were observed in the use of other obstetric interventions between the two groups. CONCLUSIONS The findings of this study should encourage a shift in the current maternity care system towards a greater integration of midwifery-led services in order to achieve optimal birth outcomes for women and newborns. REGISTRY NUMBER ISRCTN14062994.
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Affiliation(s)
- Anna Martin-Arribas
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain; Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.
| | - Ramon Escuriet
- Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain.
| | - Alicia Borràs-Santos
- Gimbernat School of Nursing, Universitat Autònoma de Barcelona (UAB), Sant Cugat del Vallès, Spain.
| | - Rafael Vila-Candel
- La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Alzira, Valencia, Spain; Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain; Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.
| | - Cristina González-Blázquez
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.
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Anna MA, Olga CV, Rocío CS, Isabel SP, Xavier ET, Pablo RC, Montserrat PA, Cristina GB, Ramon E. Midwives' experiences of the factors that facilitate normal birth among low risk women in public hospitals in Catalonia (Spain). Midwifery 2020; 88:102752. [PMID: 32521407 DOI: 10.1016/j.midw.2020.102752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal birth has major benefits for women and infants. Nevertheless, during the last few decades, the advancement in technology and an increasing domination of obstetrician-led childbirths have resulted in the medicalization of childbirth. Midwives are interested in amending this trend and aim to support women to achieve the best possible birth experience for them. OBJECTIVE This study aimed to explore midwives' experiences on the facilitators and barriers of normal birth in conventional obstetric units. DESIGN A descriptive qualitative study. Three focus groups were audio recorded and transcribed verbatim. Recurrent themes were identified and formulated. Feedback from data were analysed using thematic analysis. Investigator triangulation was used during the analysis. SETTING Midwives from eleven different public hospitals in Catalonia participated in the study. PARTICIPANTS A purposive sample of 33 midwives participated in the focus groups. FINDINGS Midwives identified several factors that complicated their task of facilitating normal birth. Barriers included: (1) inadequate institutional support; (2) existing obstetrician-led practices, (3) lack of evidence-based practice and (4) midwives' lack of awareness of professional competencies. Factors facilitating normal birth included: (1) midwives' positive perceptions of normal birth, (2) midwives' additional effort and (3) women's awareness of normal birth. KEY CONCLUSIONS Midwives wishing to promote normal birth in obstetric units face a number of challenges and often feel unsupported. Nonetheless, the midwives perceive the increasing women's demand for normal births as an opportunity to implement changes in such a way that women are involved in the decision-making process and midwives act as their advocates. IMPLICATIONS FOR PRACTICE There is a need to increase the midwifery workforce and enhance regulations and funding strategies to support their practice as well as normal birth. Policy makers in settings without well-functioning midwife-led care should consider implementing this model after successfully scaling up of the number of midwives and ensuring an effective midwifery training.
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Affiliation(s)
- Martin-Arribas Anna
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.; School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Canet-Velez Olga
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Casañas Sanchez Rocío
- Escola Superior d'Infermeria del Mar (ESIM), Universidad Pompeu Fabra (UPF), Carrer Dr. Aiguader 80, 08003 Barcelona, Spain.; Centre d'Higiene Mental Les Corts, CHM Salut Mental Barcelona, Carrer de Numància 103 Baixos, 08029 Barcelona, Spain..
| | - Salgado Poveda Isabel
- Vall d'Hebron University Hospital, Carrer Vall d'Hebron 119-129, 08035 Barcelona, Spain..
| | - Espada-Trespalacios Xavier
- Obstetric care area. Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Bacelona, Spain..
| | - Rodriguez Coll Pablo
- Maternal and Child Healthcare Department. Fundació Sanitària de Mollet, Ronda Pinetons 8, 08100 Mollet del Vallès, Bacelona, Spain..
| | | | - González-Blázquez Cristina
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain..
| | - Escuriet Ramon
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain..
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Khamehchian M, Adib-Hajbaghery M, HeydariKhayat N, Rezaei M, Sabery M. Primiparous women's experiences of normal vaginal delivery in Iran: a qualitative study. BMC Pregnancy Childbirth 2020; 20:259. [PMID: 32349704 PMCID: PMC7191821 DOI: 10.1186/s12884-020-02954-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 04/16/2020] [Indexed: 01/21/2023] Open
Abstract
Background Childbirth is considered as the most challenging psychological event in a woman’s life. It has a major effect on women’s lives with long-term positive or negative impacts. Cultural, religious, and socioeconomic differences can affect women’s perception about normal vaginal delivery (NVD) experience. Therefore, it is necessary to explore the primiparous women’s perception about it. Methods This qualitative study, with a descriptive content analysis approach, was conducted in Kashan, a city in the center of Iran. Purposive sampling was used to recruit the participants of the current study. Data was gathered by semi-structured interviews during 24 h after normal vaginal birth among primiparous women. The sampling started from June to October in 2016. Interviews continued until data saturation which was achieved in the 14th interview but for assurance, it continued until the 17th one. Results The following three main themes were extracted “immersion in stress”, “pain, the essence of NVD” and “strategies for situation management”. Furthermore, seven subthemes were obtained including ‘loss threat’, ‘stressful context’, temporary impairment in physiologic harmony, paradoxical emotions, self-management, emotional support, and spiritual support. Conclusions This study showed that stress and pain were two highlighted issues in NVD process. Increasing women’s awareness about NVD process, familiarizing the primiparous women with the simulated delivery room, accompanying these women for emotional support, and providing spiritual support can be effective in situation management to make the child delivery a pleasant and satisfying experience.
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Affiliation(s)
- Marzieh Khamehchian
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | | | - Mahboubeh Rezaei
- Autoimmune Disease Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahdieh Sabery
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran.
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Roberts J, Evans K, Spiby H, Evans C, Pallotti P, Eldridge J. Women's information needs, decision-making and experiences of membrane sweeping to promote spontaneous labour. Midwifery 2020; 83:102626. [PMID: 31954296 DOI: 10.1016/j.midw.2019.102626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/11/2019] [Accepted: 12/31/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore and synthesise evidence of women's information needs, decision-making and experiences of membrane sweeping to promote spontaneous labour. DESIGN A systematic review following the Joanna Briggs Institute (JBI) meta-aggregative approach to qualitative evidence synthesis. Relevant databases were searched for literature published in English between 2000-19. Study quality was assessed using the JBI quality assessment tool for qualitative studies. SETTING Qualitative research conducted in OECD countries describing women's information needs, decision-making and/or experiences of membrane sweeping to promote spontaneous labour. FINDINGS One article met the criteria for inclusion. This article describes the experience of a membrane sweep given without consent. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE There is a lack of evidence around women's information needs, decision-making and experiences of membrane sweeping. This is concerning, especially in the context of rising rates of formal induction of labour. Further research is needed to investigate how women are being offered membrane sweeping and what information women need to make informed choices about membrane sweeping to promote spontaneous labour.
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Affiliation(s)
- Julie Roberts
- Division of Midwifery, School of Health Sciences, University of Nottingham, Floor 12, Tower Building, University Park, Nottingham NG7 2RD UK.
| | - Kerry Evans
- Division of Midwifery, School of Health Sciences, University of Nottingham, Floor 12, Tower Building, University Park, Nottingham NG7 2RD UK.
| | - Helen Spiby
- Division of Midwifery, School of Health Sciences, University of Nottingham, Floor 12, Tower Building, University Park, Nottingham NG7 2RD UK.
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, B Floor, Queens Medical Centre, Nottingham NG7 2UH UK.
| | - Phoebe Pallotti
- Division of Midwifery, School of Health Sciences, University of Nottingham, Floor 12, Tower Building, University Park, Nottingham NG7 2RD UK.
| | - Jeanette Eldridge
- School of Health Sciences, University of Nottingham, B Floor, Queens Medical Centre, Nottingham NG7 2UH UK.
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