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Barr KR, Nguyen TA, Pickup W, Cibralic S, Mendoza Diaz A, Barnett B, Eapen V. Perinatal continuity of care for mothers with depressive symptoms: perspectives of mothers and clinicians. Front Psychiatry 2024; 15:1385120. [PMID: 39364379 PMCID: PMC11447617 DOI: 10.3389/fpsyt.2024.1385120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/26/2024] [Indexed: 10/05/2024] Open
Abstract
Background Mothers with mild to moderate depression in pregnancy are at risk of developing postpartum depression. Midwife-led continuity of care may support maternal mental health throughout the perinatal period. Research is needed to better understand how continuity of care may support mothers experiencing depression in pregnancy. This study aimed to investigate the perspectives of mothers with mild to moderate depression and clinicians regarding continuity of care in the perinatal period. Method Fourteen mothers and clinicians participated in individual interviews or a focus group. Analysis was conducted using inductive reflexive thematic analysis with a constructivist orientation. Results From the perspectives of mothers and clinicians, continuity of care during the antenatal period benefitted mothers' mental health by providing connection and rapport, information about pregnancy and referral options, and reassurance about whether pregnancy symptoms were normal. The experience of seeing multiple clinicians was noted by mothers to increase distress while participants discussed the value of extending continuity of care into the postpartum period, including having someone familiar checking in on them. The importance of having a second opinion and not always relying on a single provider during pregnancy was highlighted by some mothers and clinicians. Mothers also described how multiple modes of communication with a midwife can be helpful, including the ease and accessibility of text or email. Conclusion Mothers and clinicians perceived benefits of continuity of care for maternal mental health. Offering midwife-led continuity of care to mothers with mild to moderate depression during the perinatal period is recommended.
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Affiliation(s)
- Karlen R. Barr
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Trisha A. Nguyen
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Wendy Pickup
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Sara Cibralic
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Antonio Mendoza Diaz
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Tasmanian Centre for Mental Health Service Innovation, Tasmanian Health Service, Hobart, TAS, Australia
| | - Bryanne Barnett
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Cummins A, Booth C, Lennon K, McLaughlin K, Prussing E, Newnham L. "A safe space"; A statewide evaluation of Midwifery Antenatal and Postnatal Service (MAPS) using the quality maternal newborn care, evidence informed framework. Women Birth 2024; 37:101642. [PMID: 38964229 DOI: 10.1016/j.wombi.2024.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The World Health Organization recommends Midwifery Continuity of Care (MCoC) due to the consistent improvements in outcomes for mothers and babies. Surveys from the United Kingdom and Australia reported large numbers of midwives are unable to commit to the on call component required to provide MCoC across the continuum. To address this challenge a modified MCoC model called Midwifery Antenatal and Postnatal Services (MAPS) has been introduced. The aim of this study was to evaluate MAPS services in six sites across one State in Australia. METHODS A multi-site qualitative descriptive study was undertaken framed by the Quality Maternal Newborn Care (QMNC) Framework. The QMNC framework was used to develop focus group questions for data collection, and as a lens for analysing data. Data were collected via focus groups from midwives and women at six sites ranging from metropolitan to regional and rural settings and thematically analysed. FINDINGS Participants (n=80) included women (n=28), midwives (n=44) and MAPS managers (n=8). This paper reports the findings from the women and midwives, presented under three themes: Getting onto the program, Knowing the story and Building confidence by sharing information. Each theme had subthemes and the findings were aligned either positively or negatively with the QMNC framework. CONCLUSION This study found the MAPS model aligns in positive ways with the QMNC quality care framework with some recommendations to improve quality care. Midwives want to provide continuity of care and MAPS is a useful model for providing continuity through the antenatal and postnatal periods.
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Affiliation(s)
- Allison Cummins
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia.
| | - Chelsea Booth
- Nursing and Midwifery Office, New South Wales Ministry of Health, Australia
| | - Kelley Lennon
- Nursing and Midwifery Office, New South Wales Ministry of Health, Australia
| | - Karen McLaughlin
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Elysse Prussing
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Liz Newnham
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
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Anchors ZG, Arnold R, D Burnard S, Bressington CA, Moreton AE, Moore LJ. Effectiveness of interventions on occupational stress, health and well-being, performance, and job satisfaction for midwives: A systematic mixed methods review. Women Birth 2024; 37:101589. [PMID: 38580584 DOI: 10.1016/j.wombi.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Work-related stress is high in midwifery with negative implications for midwives' health and performance. This systematic review therefore examined which stress management interventions (SMIs) are most effective at reducing occupational stress and improving midwives' health and well-being, performance, and job satisfaction. METHODS A systematic review included studies if they were: investigating midwives or student midwives; examining an individual- or organisation-level intervention; reporting the intervention effects on at least one outcome (e.g., job performance); peer-reviewed; and published in English. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was conducted and data were presented by SMI level (i.e., individual vs. organisation) and modality type (e.g., mindfulness, care model). Sum codes were used to compare the effects of individual- and organisation-level SMIs on outcomes. FINDINGS From 2605 studies identified, 30 were eligible (18 individual- and 12 organisation-level SMIs). Eight studies were deemed low quality. While individual- and organisation-level SMIs were equally effective in improving job satisfaction and performance, there was a trend for organisation-level SMIs more effectively reducing work stress and improving health and well-being. Specific individual- (i.e., mindfulness, simulation training) and organisation-level (i.e., reflective groups, midwifery care models) SMIs were most beneficial. CONCLUSION It is recommended that health practitioners and policy makers implement interventions that target both individual- and organisation-levels to optimally support midwives' work stress, health, well-being, and performance. Notwithstanding these findings and implications, some studies had poor methodological quality; thus, future research should better follow intervention reporting guidelines.
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Affiliation(s)
- Zoe G Anchors
- School of Health and Social Wellbeing, University of the West of England, BS16 1DD, England.
| | - Rachel Arnold
- Department for Health, Claverton Down, University of Bath, Bath BA2 7PB, England
| | - Sara D Burnard
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, England
| | | | - Annette E Moreton
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, England
| | - Lee J Moore
- Department for Health, Claverton Down, University of Bath, Bath BA2 7PB, England
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van Wijngaarden M, Blonk H, Simmelink R, van der Lee N, van der Vliet-Torij HH, Nieuwenhuijze M, de Jonge A, Verhoeven C. Working in smaller teams in community midwifery practices to foster continuity of carer: Midwives' experiences - A qualitative study in the Netherlands. Women Birth 2024; 37:101663. [PMID: 39154393 DOI: 10.1016/j.wombi.2024.101663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/09/2024] [Accepted: 07/31/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Midwife-led continuity of carer (MLCC) improves health outcomes and increases pregnant women's satisfaction. Working in smaller teams in community midwifery practices is one of the ways to promote continuity of carer. AIM To gain insight into the experiences of Dutch community midwives regarding working in smaller teams, by identifying motivators and barriers. METHODS A qualitative study was conducted using individual, semi-structured interviews (n=9). The sample was purposively selected. The interviews were analysed using the Abbreviated Grounded Theory. FINDINGS Four themes were identified: 1) Ideal implementation of working in smaller teams, 2) Best care for pregnant women, 3) Conflicts with the current maternity care system, 4) Personal interests of the midwife. The core concept connecting all themes was midwives' experiences of an 'inner conflict' regarding working in smaller teams. CONCLUSION A strong motivation for working in smaller teams is the wish to provide the best care for pregnant women through offering more continuity of carer. The structure of maternity care, financially and organisationally, acts as a barrier in the transition to working in smaller teams. How community midwives manage these motivators and barriers depends on their personal interests, vision, and personal life. The balance between the motivators and barriers can create an inner conflict among the midwives. This inner conflict encompasses an ethical issue: what is the best care and what is it worth? A discussion within the professional group concerning the practical and ethical aspects of working in smaller teams is needed to find ways to reduce the inner conflict of community midwives who wish to work in smaller teams, thereby promoting the implementation of MLCC.
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Affiliation(s)
| | - Hinke Blonk
- Midwifery Academy Amsterdam, the Netherlands
| | - Renate Simmelink
- Midwifery Academy Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Department of Midwifery Science, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, the Netherlands
| | | | | | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Ank de Jonge
- Midwifery Academy Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Department of Midwifery Science, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, the Netherlands
| | - Corine Verhoeven
- Midwifery Academy Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Department of Midwifery Science, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
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Fisher L, Davey A, Wong G, Morgan-Trimmer S, Howard LM, Sharp H, Atmore KH, Brook J, Collins G, Domoney J, Makinde E, McCree C, O'Mahen HA. Women's engagement with community perinatal mental health services: a realist evaluation. BMC Psychiatry 2024; 24:492. [PMID: 38977965 PMCID: PMC11232178 DOI: 10.1186/s12888-024-05804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/30/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND In recognition of the burden of Perinatal Mental Health problems, NHS England invested £365 million to transform women's access to mental health care, including investment in Community Perinatal Mental Health Services. This study examined how elements of provider care affected women's engagement with these services. METHODS Semi-structured interviews were conducted with 139 women and explored their experiences of care from 10 different Community Perinatal Mental Health Teams; including which service components participants believed made a difference to their initial and continued engagement. Realist analysis was used to create context-mechanism-outcome configurations (CMOCs) across interviews, since not all parts of the configurations were always articulated within singular interviews. RESULTS Four key pillars for engagement were identified: perinatal competence, relationship building, accurate reassurance, and reliability. The way perinatal competencies were relayed to women mattered; compassion, understanding and consistency were critical interactional styles. The extent to which these factors affected women's engagement varied by their context and personal characteristics. CONCLUSIONS As mental health problems increase, disproportionately affecting vulnerable populations, it is critical to continue to ensure support is not only available, but appropriately meets the needs of those individuals. Our findings suggest that key staff behaviours applied at the right time can support women's engagement and potentially contribute to better treatment outcomes.
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Affiliation(s)
- L Fisher
- Department of Primary Care and Mental Health, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - A Davey
- Mood Disorders Centre, Psychology Department, Faculty of Health and Life Sciences, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter, EX4 4QG, UK
| | - G Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S Morgan-Trimmer
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - L M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - H Sharp
- Department of Primary Care and Mental Health, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - K H Atmore
- Department of Global Health and Social Medicine, School of Global Affairs, King's College London, London, UK
| | - J Brook
- The Tavistock and Portman NHS Foundation Trust, London, UK
| | - G Collins
- Mood Disorders Centre, Psychology Department, Faculty of Health and Life Sciences, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter, EX4 4QG, UK
| | - J Domoney
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Makinde
- Mood Disorders Centre, Psychology Department, Faculty of Health and Life Sciences, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter, EX4 4QG, UK
| | - C McCree
- Centre for Parent and Child Support and Community Perinatal services, South London and Maudsley NHS Foundation Trust, London, UK
| | - Heather A O'Mahen
- Mood Disorders Centre, Psychology Department, Faculty of Health and Life Sciences, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter, EX4 4QG, UK.
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Lognos B, Oude Engberink A, Gonzalez L, Leandri J, Charlot Pisoni C, Rachedi N, Clary B, Bourrel G, Bayen S, Million E. Meeting the needs of pregnant women in socially vulnerable situations: A phenomenological qualitative study. Heliyon 2024; 10:e24881. [PMID: 38318039 PMCID: PMC10840009 DOI: 10.1016/j.heliyon.2024.e24881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Objective Vulnerability relates to fragile physical, psychological, and socio-environmental circumstances. Pregnant women's social vulnerability can lead to disruptions in their medical follow-ups, prematurity, and increased infant mortality rates, such that their special needs must be considered. Yet, despite different governments' 'perinatality' plans, international literature suggests their care can be improved. Although quantitative studies regularly evaluate these plans, few studies have assessed vulnerable pregnant women's views. This study explores the needs and expectations of vulnerable women regarding their follow-ups during pregnancy and identified strategies to improve their circumstances. Methods The study was a phenomenological qualitative study involving semi-structured interviews with women who gave birth in the past six months (December 2017 to June 2018) and who fulfilled at least one vulnerability criterion. The women were recruited by French midwives and general practitioners (GPs). Findings Concerning these vulnerable pregnant women, three phenomenological categories emerged: 1) they need to be monitored by a single trusted contact; 2) they seek medical and social support adapted to their situations that addresses their needs; and 3) they expect kind and person-centred communication skills from professionals who provide them appropriate information. Conclusion We identified various international recommendations to screen and care for vulnerable pregnant women, but still these women often experience numerous challenges. Finally, the implementation of recommendations for healthcare professionals based on women's real-life experiences could help optimise the identification of vulnerable pregnant women as well as their follow-up care.
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Affiliation(s)
- Béatrice Lognos
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Agnès Oude Engberink
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluri professionnelle universitaire Avicenne, 2 rue IBN Sinaï dit Avicenne 66 330 Cabestany, France
| | - Lorène Gonzalez
- Centre médical, Rue de la Brèche, 34630 Saint-Thibéry, France
| | - Julia Leandri
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Carla Charlot Pisoni
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Nadia Rachedi
- Département de L’Hérault, Hôtel du Département mas d’Alco, 1977 avenue du mas de Moulin 34087 Montpellier, France
| | - Bernard Clary
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de Santé Professionnelle 20 route Minervois, 11800 Trèbes, France
| | - Gérard Bourrel
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
| | - Sabine Bayen
- Department of General Practice, Pôle formation Faculté médecine H. Warembourg 59045 Lille CEDEX 1, University of Lille, 1, place de Verdun, 59045, France
| | - Elodie Million
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
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Willan K, Moss RH, Santorelli G, Ahern S, Bryant M, Bywater T, Blower SL, Richardson G, Hinde S, Huo D, Wright J, Dickerson J, Innovation Hub BSB. Effectiveness of a midwife-led continuity of care model on birth outcomes and maternal mental health in vulnerable women: study protocol for a randomised controlled trial with an internal pilot, process evaluation and economic analysis. BMJ Open 2023; 13:e072415. [PMID: 37996235 PMCID: PMC10668235 DOI: 10.1136/bmjopen-2023-072415] [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: 02/07/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Women from social disadvantage are at greater risk of poor birth outcomes. The midwife-led continuity of care (MCC) model, which offers flexible and relational care from a small team of midwives, has demonstrated improved birth outcomes. In the general population, the impact of MCC on socially disadvantaged women and on birth outcomes is still unclear. This protocol describes a pragmatic evaluation of the MCC model in a socially disadvantaged population. METHODS AND ANALYSIS An open-labelled individual prospective randomised controlled trial with an internal pilot, process evaluation and economic analysis, from 1 April 2022 to 31 March 2024.Women will be randomly allocated to MCC or standard care as part of usual midwifery practice. Participants and midwives will not be blinded, but researchers will be. An internal pilot will test the feasibility of this process.Participants are those randomised into MCC or standard care, who consent to participate in one of two Born in Bradford (BiB) birth cohort studies. Outcomes are taken from routinely linked health data, supplemented by additional data capture. The sample size is fixed by the capacity of MCC teams, commissioning duration and numbers recruited into the cohort. The estimated maximum fixed sample size is 1,410 pregnancies (minimum 734).Intention to treat (ITT) analysis will be undertaken to assess the impact of MCC on two independent primary outcomes. An economic evaluation will explore the impact on health resource use and a process evaluation will explore fidelity to the MCC model, and barriers/facilitators to implementation from midwives' and women's perspectives. ETHICS AND DISSEMINATION Ethical approval has been obtained for the randomisation in midwifery practice, use of the cohort data for evaluation and for the process evaluation. Findings will be published in peer-reviewed journals, presented at conferences and translated into policy briefings. TRIAL REGISTRATION NUMBER IsRCTNhttps://doi.org/10.1186/ISRCTN31836167.
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Affiliation(s)
- Kathryn Willan
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Bradford, UK
| | - Rachael H Moss
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Bradford, UK
| | - Gillian Santorelli
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Bradford, UK
| | - Sara Ahern
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Bradford, UK
| | - Maria Bryant
- Health Sciences, University of York, York, North Yorkshire, UK
| | - Tracey Bywater
- Health Sciences, University of York, York, North Yorkshire, UK
| | | | - Gerry Richardson
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Dacheng Huo
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - John Wright
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Bradford, UK
| | - Josie Dickerson
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Bradford, UK
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8
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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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Depla AL, Pluut B, Lamain-de Ruiter M, Kersten AW, Evers IM, Franx A, Bekker MN. PROMs and PREMs in routine perinatal care: mixed methods evaluation of their implementation into integrated obstetric care networks. J Patient Rep Outcomes 2023; 7:26. [PMID: 36894797 PMCID: PMC9998006 DOI: 10.1186/s41687-023-00568-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND In the transition towards value-based healthcare, patient-reported outcome and experience measures (PROM and PREM) are recommended by international collaborations and government programs to guide clinical practice and quality improvement. For many conditions, using PROM/PREM over the complete continuum of care requires implementation across care organizations and disciplines. Along PROM/PREM implementation in obstetric care networks (OCN), we aimed to evaluate implementation outcomes and the processes influencing these outcomes in the complex context of care networks across the continuum of perinatal care. METHODS Three OCN in the Netherlands implemented PROM/PREM in routine practice, using an internationally developed outcomes set with care professionals and patient advocates. Their aim was to use PROM/PREM results individually to guide patient-specific care decisions and at group-level to improve quality of care. The implementation process was designed following the principles of action research: iteratively planning implementation, action, data generation and reflection to refine subsequent actions, involving both researchers and care professionals. During the one-year implementation period in each OCN, implementation outcomes and processes were evaluated in this mixed-methods study. Data generation (including observation, surveys and focus groups) and analysis were guided by two theoretical implementation frameworks: the Normalization Process Theory and Proctor's taxonomy for implementation outcomes. Qualitative findings were supplemented with survey data to solidify findings in a broader group of care professionals. RESULTS Care professionals in OCN found the use of PROM/PREM acceptable and appropriate, recognized their benefits and felt facilitated in their patient-centered goals and vision. However, feasibility for daily practice was low, mainly due to IT issues and time constraints. Hence PROM/PREM implementation did not sustain, but strategies for future PROM/PREM implementation were formulated in all OCN. Processes contributing positively to implementation outcomes were internalization (understand the value) and initiation (driven by key-participants), whereas challenges in relational integration (maintain confidence) and reconfiguration (refine activities) affected implementation negatively. CONCLUSION Although implementation did not sustain, network-broad PROM/PREM use in clinic and quality improvement matched professionals' motivation. This study provides recommendations to implement PROM/PREM meaningfully in practice in ways that support professionals in their drive towards patient-centered care. In order for PROM/PREM to fulfill their potential for value-based healthcare, our work highlights the need for sustainable IT infrastructures, as well as an iterative approach to refine their complex implementation into local contexts.
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Affiliation(s)
- Anne L Depla
- Department of Obstetrics and Gynecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Bettine Pluut
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marije Lamain-de Ruiter
- Department of Obstetrics and Gynecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Anna W Kersten
- Department of Public Health, Julius Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Inge M Evers
- Department of Obstetrics and Gynecology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Arie Franx
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
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Buultjens M, Gill J, Fielding J, Lambert KA, Vondeling K, Mastwyk SE, Sloane S, Fedele W, Karimi L, Milgrom J, von Treuer K, Erbas B. Maternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health? Women Birth 2022; 36:305-313. [PMID: 36184532 PMCID: PMC9551992 DOI: 10.1016/j.wombi.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/21/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
Background The transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman’s experience – with likely adverse effects on mental health and wellbeing. Aim To explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period. Methods Using a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia. Findings Whilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (−1.17, 95% CI: −1.81, −0.53) and the EPDS (−0.83, 95% CI: −1.5, −0.15). Discussion The analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers. Conclusion This study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support.
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Affiliation(s)
- Melissa Buultjens
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Jessica Gill
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jennifer Fielding
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Katrina A Lambert
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kirsty Vondeling
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Sally E Mastwyk
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Sarita Sloane
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Wendy Fedele
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Applied Health, Psychology Department, RMIT University, Melbourne, Australia.
| | - Jeannette Milgrom
- Parent-Infant Research Institute (PIRI), Australia and Melbourne School of Psychological Science, University of Melbourne, Australia
| | | | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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11
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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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12
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Jolles DR, Montgomery TM, Blankstein Breman R, George E, Craddock J, Sanders S, Niemcyzk N, Stapleton S, Bauer K, Wright J. Place of Birth Preferences and Relationship to Maternal and Newborn Outcomes Within the American Association of Birth Centers Perinatal Data Registry, 2007-2020. J Perinat Neonatal Nurs 2022; 36:150-160. [PMID: 35476769 DOI: 10.1097/jpn.0000000000000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to describe sociodemographic variations in client preference for birthplace and relationships to perinatal health outcomes. METHODS Descriptive data analysis (raw number, percentages, and means) showed that preference for birthplace varied across racial and ethnic categories as well as sociodemographic categories including educational status, body mass index, payer status, marital status, and gravidity. A subsample of medically low-risk childbearing people, qualified for birth center admission in labor, was analyzed to assess variations in maternal and newborn outcomes by site of first admission in labor. RESULTS While overall clinical outcomes exceeded national benchmarks across all places of admission in the sample, disparities were noted including higher cesarean birth rates among Black and Hispanic people. This variation was larger within the population of people who preferred to be admitted to the hospital in labor in the absence of medical indication. CONCLUSION This study supports that the birth center model provides safe delivery care across the intersections of US sociodemographics. Findings from this study highlight the importance of increased access and choice in place of birth for improving health equity, including decreasing cesarean birth and increasing breastfeeding initiation.
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Affiliation(s)
- Diana R Jolles
- Frontier University, Tucson, Arizona (Dr Jolles); American Association of Birth Centers Research Committee, Perkiomenville, Pennsylvania (Drs Jolles, Niemcyzk, and Stapleton and Mss Sanders, Bauer, and Wright); Department of Nursing, Temple University College of Public Health, Philadelphia, Pennsylvania (Dr Montgomery); University of Maryland School of Nursing, Baltimore (Dr Blankstein Breman); Boston College Connell School of Nursing, Boston, Massachusetts (Ms George); University of Maryland College of Social Work, Baltimore (Dr Craddock); and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sanders and Dr Niemcyzk)
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13
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Bradford BF, Wilson AN, Portela A, McConville F, Fernandez Turienzo C, Homer CSE. Midwifery continuity of care: A scoping review of where, how, by whom and for whom? PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000935. [PMID: 36962588 PMCID: PMC10021789 DOI: 10.1371/journal.pgph.0000935] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022]
Abstract
Systems of care that provide midwifery care and services through a continuity of care model have positive health outcomes for women and newborns. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? Using a scoping review framework, we searched electronic and grey literature databases for reports in any language between January 2012 and January 2022, which described current and recent trials, implementation or scaling-up of midwifery continuity of care studies or initiatives in high-, middle- and low-income countries. After screening, 175 reports were included, the majority (157, 90%) from high-income countries (HICs) and fewer (18, 10%) from low- to middle-income countries (LMICs). There were 163 unique studies including eight (4.9%) randomised or quasi-randomised trials, 58 (38.5%) qualitative, 53 (32.7%) quantitative (cohort, cross sectional, descriptive, observational), 31 (19.0%) survey studies, and three (1.9%) health economics analyses. There were 10 practice-based accounts that did not include research. Midwives led almost all continuity of care models. In HICs, the most dominant model was where small groups of midwives provided care for designated women, across the antenatal, childbirth and postnatal care continuum. This was mostly known as caseload midwifery or midwifery group practice. There was more diversity of models in low- to middle-income countries. Of the 175 initiatives described, 31 (18%) were implemented for women, newborns and families from priority or vulnerable communities. With the exception of New Zealand, no countries have managed to scale-up continuity of midwifery care at a national level. Further implementation studies are needed to support countries planning to transition to midwifery continuity of care models in all countries to determine optimal model types and strategies to achieve sustainable scale-up at a national level.
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Affiliation(s)
- Billie F Bradford
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Alyce N Wilson
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Anayda Portela
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Fran McConville
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | | | - Caroline S E Homer
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
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14
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de Wolff MG, Midtgaard J, Johansen M, Rom AL, Rosthøj S, Tabor A, Hegaard HK. Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157875. [PMID: 34360168 PMCID: PMC8345548 DOI: 10.3390/ijerph18157875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/30/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
The proportion of childbearing women with pre-existing chronic medical conditions (CMC) is rising. In a randomized controlled trial, we aimed to evaluate the effects of a midwife-coordinated maternity care intervention (ChroPreg) in pregnant women with CMC. The intervention consisted of three main components: (1) Midwife-coordinated and individualized care, (2) Additional ante-and postpartum consultations, and (3) Specialized known midwives. The primary outcome was the total length of hospital stay (LOS). Secondary outcomes were patient-reported outcomes measuring psychological well-being and satisfaction with maternity care, health utilization, and maternal and infant outcomes. A total of 362 women were randomized to the ChroPreg intervention (n = 131) or Standard Care (n = 131). No differences in LOS were found between groups (median 3.0 days, ChroPreg group 0.1% lower LOS, 95% CI −7.8 to 7%, p = 0.97). Women in the ChroPreg group reported being more satisfied with maternity care measured by the Pregnancy and Childbirth Questionnaire (PCQ) compared with the Standard Care group (mean PCQ 104.5 vs. 98.2, mean difference 6.3, 95% CI 3.0–10.0, p < 0.0001). In conclusion, the ChroPreg intervention did not reduce LOS. However, women in the ChroPreg group were more satisfied with maternity care.
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Affiliation(s)
- Mie G. de Wolff
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- The Research Unit for Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Correspondence: ; Tel.: +45-23306414
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Mental Health Centre Glostrup, University of Copenhagen, 2600 Glostrup, Denmark
| | - Marianne Johansen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- Unit for Pregnancy and Heart Disease, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ane L. Rom
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- The Research Unit for Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Susanne Rosthøj
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
| | - Ann Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Hanne K. Hegaard
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- The Research Unit for Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
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