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McNeil D, Elliott SA, Wong A, Kromm S, Bialy L, Montesanti S, Purificati-Fuñe A, Juul S, Roach P, Bromely J, Tailfeathers E, Amyotte M, Oster RT. Indigenous maternal and infant outcomes and women's experiences of midwifery care: A mixed-methods systematic review. Birth 2024. [PMID: 38898696 DOI: 10.1111/birt.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/16/2024] [Accepted: 05/02/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The impact of midwifery, and especially Indigenous midwifery, care for Indigenous women and communities has not been comprehensively reviewed. To address this knowledge gap, we conducted a mixed-methods systematic review to understand Indigenous maternal and infant outcomes and women's' experiences with midwifery care. METHODS We searched nine databases to identify primary studies reporting on midwifery and Indigenous maternal and infant birth outcomes and experiences, published in English since 2000. We synthesized quantitative and qualitative outcome data using a convergent segregated mixed-methods approach and used a mixed-methods appraisal tool (MMAT) to assess the methodological quality of included studies. The Aboriginal and Torres Strait Islander Quality Appraisal Tool (ATSI QAT) was used to appraise the inclusion of Indigenous perspectives in the evidence. RESULTS Out of 3044 records, we included 35 individual studies with 55% (19 studies) reporting on maternal and infant health outcomes. Comparative studies (n = 13) showed no significant differences in mortality rates but identified reduced preterm births, earlier prenatal care, and an increased number of prenatal visits for Indigenous women receiving midwifery care. Quality of care studies indicated a preference for midwifery care among Indigenous women. Sixteen qualitative studies highlighted three key findings - culturally safe care, holistic care, and improved access to care. The majority of studies were of high methodological quality (91% met ≥80% criteria), while only 14% of studies were considered to have appropriately included Indigenous perspectives. CONCLUSION This review demonstrates the value of midwifery care for Indigenous women, providing evidence to support policy recommendations promoting midwifery care as a physically and culturally safe model for Indigenous women and families.
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Affiliation(s)
- Deborah McNeil
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child & Youth Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Sarah A Elliott
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Angie Wong
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Indigenous Wellness Core, Alberta Health Services, Edmonton, Alberta, Canada
| | - Seija Kromm
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child & Youth Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada
| | - Liza Bialy
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie Montesanti
- School of Public Health, College of Health Sciences, Edmonton, Alberta, Canada
- Centre for Healthy Communities, School of Public Health, College of Health Sciences, Edmonton, Alberta, Canada
| | - Adam Purificati-Fuñe
- Department of Agricultural, Food & Nutritional Sciences, Faculty of Agricultural, Life & Environmental Sciences, College of Natural & Applied Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sonje Juul
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pamela Roach
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jackie Bromely
- Awo Taan Healing Lodge Society, Calgary, Alberta, Canada
| | | | - Maddie Amyotte
- ihkapaskwa Indigenous Wellness Collective, Fort McMurray, Alberta, Canada
| | - Richard T Oster
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Indigenous Wellness Core, Alberta Health Services, Edmonton, Alberta, Canada
- School of Public Health, College of Health Sciences, Edmonton, Alberta, Canada
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Hertle D, Wende D, zu Sayn-Wittgenstein F. [Postpartum Care by Midwives: Socioeconomic Status has a Strong Influence on the Amount of Care Received An Analysis with Routine Data from BARMER Health Insurance]. DAS GESUNDHEITSWESEN 2024; 86:354-361. [PMID: 38134914 PMCID: PMC11077544 DOI: 10.1055/a-2144-5180] [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] [Indexed: 12/24/2023]
Abstract
BACKGROUND Socio-economic situation is associated with inequalities in access to health care and health-related resources. This also applies to pregnancy, birth and the postpartum period. Compared to other European countries, Germany has very good care options for the postpartum period. It has an unique system of postpartum care, which comprises home visits by midwives for 12 weeks after birth and beyond in problem cases and thus has structurally good care options. So far, however, there are hardly any studies based on routine data that show which mothers receive homevisits in postpartum care and to what extent. METHOD The study population comprised 199,978 women insured with BARMER who gave birth to at least one child in the years 2017-2020. Some women were pregnant several times in this period of time. The services billed by freelance midwives for outreach midwifery care in the puerperium were considered for 227,088 births, taking into account the socioeconomic situation of the mothers. RESULTS According to the definition of the German Institute for Economic Research, 26% of the mothers belonged to a low income group, 46% to a medium income group and 29% to a high income group. Similar to what was shown for midwifery care during pregnancy, large differences were also found with regard to postpartum care: While 90.5% of the women with a high income received home visits, only 83.5% of women with a medium income did so, and only 67.9% of women with a low income. The groups did not differ with regard to other characteristics such as rate of caesarean section, preterm births, twins, age or concomitant diseases to an extent that could explain the differences in care. Women who had received midwifery services in pregnancy were much more likely to receive home visits by a midwife in the postpartum period. Furthermore, there was a correlation with the density of midwives in the respective region. CONCLUSIONS The results suggest that access to home-based postpartum care by freelance midwives is significantly limited for low-income women. In contrast to antenatal care, women in the postpartum period cannot switch to other service providers, as outreach postpartum care is a reserved activity of midwives. Women with low incomes thus receive less midwifery care, although they have a higher need for support (Eickhorst et al. 2016).
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Affiliation(s)
- Dagmar Hertle
- BARMER Institut für Gesundheitssystemforschung, Wuppertal,
Germany
| | - Danny Wende
- BARMER Institut für Gesundheitssystemforschung, Wuppertal,
Germany
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Modde Epstein C, Houfek JF, Jones LP. Deep health: A qualitative, woman-centered perspective of health during pregnancy. Midwifery 2023; 120:103628. [PMID: 36870255 PMCID: PMC10111285 DOI: 10.1016/j.midw.2023.103628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/09/2022] [Accepted: 02/05/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To explore and define a woman-centered perspective on health during pregnancy. DESIGN Qualitative study using abductive thematic analysis of semi-structured interview data. SETTING & PARTICIPANTS Twenty pregnant participants, primarily single and low-income, were recruited from an urban women's health clinic in the Midwestern United States and interviewed during mid-to-late pregnancy. FINDINGS Women experienced health as "deeper than physical health" to include emotional well-being, financial stability, and support. We defined the central theme of Deep Health to be an embodied sense of happiness, energy, stability, and purpose (Being) supported through positive health practices (Doing) and adequate financial and social resources (Having). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE While the Doing aspects of health are often a focal point for health promotion efforts in prenatal care, a restricted focus on lifestyle behaviors may contribute to a lack of shared understanding about health between women and their healthcare providers. Greater attention to the Being and Having aspects of health may work to bolster shared priorities for health between pregnant women and their providers.
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Affiliation(s)
- Crystal Modde Epstein
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, United States; School of Nursing, University of North Carolina Greensboro, 1007 Walker Avenue, Greensboro, NC 27412, United States.
| | - Julia F Houfek
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, United States
| | - Lawrency P Jones
- School of Nursing, University of North Carolina Greensboro, 1007 Walker Avenue, Greensboro, NC 27412, United States
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Hertle D, Lange U, Wende D. [Healthcare in Pregnancy and Access to Midwives according to Socio-Economic Situation: An Analysis with Routine Data from BARMER Health Insurance]. DAS GESUNDHEITSWESEN 2023; 85:364-370. [PMID: 34942665 PMCID: PMC11248034 DOI: 10.1055/a-1690-7079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Socio-economic status is an important cause of inequality in health status and access to healthcare. This also applies to pregnancy, birth and the postpartum period. Healthcare during pregnancy plays a crucial role in the success of the life phase around birth. On the basis of routine data from BARMER health insurance, the study investigated which services pregnant women received during pregnancy depending on their socio-economic situation. METHODS The study population comprised 237,251 women insured with BARMER with 278,237 births in 2015-2019. The services billed by gynaecologists and midwives during pregnancy were considered in relation to the socio-economic situation of the women involved. RESULTS Physicians dominated the provision of preventive healthcare. For almost 98% of the pregnant women, a medical preventive healthcare flat rate was billed in at least three quarters. A regular participation of the midwife in preventive healthcare from the fourth month of pregnancy with more than four preventive services was the case in only 1.2% of women. Women from low-income backgrounds received fewer antenatal healthcare services from both gynaecologists and midwives, with 31% of women with low income having no antenatal midwife contact at all, compared to only 11% of high-income women. High-income earning women were also more likely to have had early contact with a midwife (47 vs. 37% in the first trimester). The timing of the first contact seemed to be relevant for the subsequent cooperative antenatal healthcare by both professional groups. CONCLUSION The potentials of midwifery healthcare are not being leveraged. Midwives should be significantly more involved in prenatal healthcare overall, and access to midwives must be improved, especially for socially disadvantaged women. These women could benefit in particular from midwifery healthcare, as it takes greater account of social aspects in healthcare and also provides outreach services.
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Affiliation(s)
- Dagmar Hertle
- BARMER Institut für Gesundheitssystemforschung, Wuppertal,
Deutschland
| | - Ute Lange
- Studienbereich Hebammenwissenschaft, Hochschule für Gesundheit
Bochum, Deutschland
| | - Danny Wende
- BARMER Institut für Gesundheitssystemforschung, Wuppertal,
Deutschland
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Gerzen L, Tietjen SL, Heep A, Puth MT, Schmid M, Gembruch U, Merz WM. Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany. J Perinat Med 2022; 50:1124-1134. [PMID: 35611852 DOI: 10.1515/jpm-2022-0041] [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: 01/27/2022] [Accepted: 04/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES For healthy women entering labor after an uneventful pregnancy, advantages of birth in midwife-led models of care have been demonstrated. We aimed to study the level of awareness regarding care in alongside midwifery units (AMU), factors involved in the decision for birth in obstetrician-led units (OLU), and wishes for care and concerns about birth in women registering for birth in OLU who would have been eligible for care in AMU. METHODS Healthy women with a term singleton cephalic fetus after an uneventful pregnancy course booking for birth in OLU were prospectively recruited. Data were collected by questionnaire. RESULTS In total, 324 questionnaires were analyzed. One quarter (23.1%) of participants never had heard of care in AMU. Two thirds (64.2%) of women had made their choice regarding model of care before entering late pregnancy; only 16.4% indicated that health professionals had the biggest impact on their decision. One-to-one care and the availability of a pediatrician were most commonly quoted wishes (30.8 and 34.0%, respectively), and the occurrence of an adverse maternal or perinatal event the greatest concern (69.5%). CONCLUSIONS Although the majority of respondents had some knowledge about care in AMU, expressed wishes for birth matching core features of AMU and concerns matching those of OLU, a decision for birth in OLU was taken. This finding may be a result of lack of knowledge about details of care in AMU; additionally, wishes and concerns may be put aside in favor of other criteria.
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Affiliation(s)
| | | | - Andrea Heep
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Marie-Therese Puth
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Schneider M, Müller CP, Knies AK. Low income and schizophrenia risk: a narrative review. Behav Brain Res 2022; 435:114047. [PMID: 35933046 DOI: 10.1016/j.bbr.2022.114047] [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: 02/25/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/02/2022]
Abstract
Despite decades of research, the precise etiology of schizophrenia is not fully understood. Ample evidence indicates that the disorder derives from a complex interplay of genetic and environmental factors during vulnerable stages of brain maturation. Among the plethora of risk factors investigated, stress, pre- and perinatal insults, and cannabis use have been repeatedly highlighted as crucial environmental risk factors for schizophrenia. Compelling findings from population-based longitudinal studies suggest low income as an additional risk factor for future schizophrenia diagnosis, but underlying mechanisms remain unclear. In this narrative review, we 1) summarize the literature in support of a relationship between low (parental) income and schizophrenia risk, and 2) explore the mediating role of chronic stress, pre- and perinatal factors, and cannabis use as established risk factors for schizophrenia. Our review describes how low income facilitates the occurrence and severity of these established risk factors and thus contributes to schizophrenia liability. The broadest influence of low income was identified for stress, as low income was found to be associated with exposure to a multitude of severe psychological and physiological stressors. This narrative review adds to the growing literature reporting a close relationship between income and mental health.
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Affiliation(s)
- Miriam Schneider
- Department of Scientific Coordination and Management, Danube Private University, 3500 Krems-Stein, Austria.
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany; Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Andrea K Knies
- Department of Scientific Coordination and Management, Danube Private University, 3500 Krems-Stein, Austria
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Ala SH, Husain S, Husain S. Reasons for presenting to antenatal care clinics in a sample of Pakistani women and their knowledge of WHO antenatal care package. Eur J Midwifery 2021; 5:43. [PMID: 34693217 PMCID: PMC8486015 DOI: 10.18332/ejm/140794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION The purpose of antenatal care is to ensure that a woman has a safe pregnancy and that does not mean absence of any disease during this period. Antenatal care allows screening of preeclampsia, fetal abnormalities and other prevention strategies to be incorporated. The purpose of this study was to assess the reason for attending antenatal care clinics and knowledge of antenatal care content package in women. METHODS A cross-sectional study was conducted on 395 pregnant women attending antenatal care clinic at the Ruth K. M. Pfau Civil hospital, Karachi, Pakistan from 1 July 2019 to 31 December 2019. Each eligible woman was asked about the reason for attendance and her knowledge about WHO standardized antenatal care package. RESULTS The commonest reason for utilizing antenatal care in booked attendees was place of birth concern (25.9%) and in not booked was referral from private centers (33.6%) which was statistically significant (p=0.006). Both booked and not booked women (67.9% vs 59.1%, p=0.409) stated avoidance of complication during pregnancy and labor as the commonest reason for attendance. Women with higher parity were more likely to identify weight measurement (p=0.001), iron and folic acid supplementation (p=0.001), and urine detailed report (p=0.002), as content of the standard package. CONCLUSIONS Our study shows that women did not utilize antenatal care clinics for improving their health or the health of their fetus. The knowledge of the antenatal care package was limited to weight measurement and supplements. Moreover, attendance and visits at an antenatal care facility do not equate to good service provision.
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Affiliation(s)
- Syed H Ala
- Department of Obstetrics and Gynecology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Samia Husain
- Department of Obstetrics and Gynecology, Aziz Medical Center, Karachi, Pakistan
| | - Saba Husain
- Department of Obstetrics and Gynecology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Fitzgerald E, Hor K, Drake AJ. Maternal influences on fetal brain development: The role of nutrition, infection and stress, and the potential for intergenerational consequences. Early Hum Dev 2020; 150:105190. [PMID: 32948364 PMCID: PMC7481314 DOI: 10.1016/j.earlhumdev.2020.105190] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An optimal early life environment is crucial for ensuring ideal neurodevelopmental outcomes. Brain development consists of a finely tuned series of spatially and temporally constrained events, which may be affected by exposure to a sub-optimal intra-uterine environment. Evidence suggests brain development may be particularly vulnerable to factors such as maternal nutrition, infection and stress during pregnancy. In this review, we discuss how maternal factors such as these can affect brain development and outcome in offspring, and we also identify evidence which suggests that the outcome can, in many cases, be stratified by socio-economic status (SES), with individuals in lower brackets typically having a worse outcome. We consider the relevant epidemiological evidence and draw parallels to mechanisms suggested by preclinical work where appropriate. We also discuss possible transgenerational effects of these maternal factors and the potential mechanisms involved. We conclude that modifiable factors such as maternal nutrition, infection and stress are important contributors to atypical brain development and that SES also likely has a key role.
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Affiliation(s)
- Eamon Fitzgerald
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Kahyee Hor
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Amanda J Drake
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
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