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Adinew YM, Kelly J, Smith M, Marshall A. Women's perspectives on disrespect and abuse during facility-based childbirth in Ethiopia: a qualitative study. BMC Pregnancy Childbirth 2023; 23:444. [PMID: 37316792 DOI: 10.1186/s12884-023-05762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Disrespect and abuse violates women's basic human rights and autonomy and can traumatize women who are already in a vulnerable position during childbirth and deter them from utilizing skilled care for future childbirth. This study explored women's perspectives on the acceptability of disrespect and abuse during facility-based childbirth in Ethiopia. METHODS A qualitative descriptive design using five focus group discussions and fifteen in-depth, semi-structured, interviews was conducted with women between October 2019 to January 2020 in north Showa zone of Oromia region, central Ethiopia. Using purposive sampling, women who had given birth at public health facilities of North Showa zone during the twelve months preceding data collection were recruited, regardless of birth outcome. Inductive thematic analysis using Open Code software was used to explore the perspectives of participants. RESULTS While women reject disrespectful and abusive acts during childbirth generally, they may consider some disrespectful acts as acceptable and or necessary under certain circumstances. Four emerging themes were identified. (1) Disrespect and abuse is not acceptable, (2) Disrespectful and abusive actions are acceptable only if intended to save lives, (3) Disrespectful and abusive actions are an accepted part of everyday practice to prevent complications and adverse outcomes, (4) Disrespectful and abusive actions are necessary to discipline disobedient women. CONCLUSION Women's perceptions of disrespectful and abusive acts of care providers is deeply rooted within the context of violence in Ethiopia and the societal hierarchies that have systematically disempowered women. Given the pervasiveness of disrespect and abusive actions during childbirth, policymakers, clinical managers and care providers must take these essential contextual and societal norms into account and devise comprehensive clinical interventions that addresses the root causes.
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Affiliation(s)
- Yohannes Mehretie Adinew
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.
- College of Health sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia.
| | - Janet Kelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Morgan Smith
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Amy Marshall
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Cummins A, Symon A. Transforming the Quality Maternal Newborn Care Framework into an index to measure the quality of maternity care. Birth 2023; 50:192-204. [PMID: 36468251 DOI: 10.1111/birt.12694] [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: 07/19/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Quality Maternal and Newborn Care (QMNC) Framework describes the care that childbearing women and newborn infants need in all settings. It comprises five components and was designed for use in planning, workforce development, and resource allocation, aimed at improving the quality and cost effectiveness of maternal and newborn care globally. The purpose of this paper is to describe the first phase of a project designed to transform the Framework into a quantitative tool for service user assessment of the quality of maternity care. METHODS Each component of the original Framework content was developed into a draft service user questionnaire and distributed to an expert panel, drawn from a range of low-, middle-, and high-resource countries. The panel consisted of five Framework authors, nine midwife researchers, six midwives, and five service user (consumer) advocates. Two rounds of discussion and revision were undertaken with the expert panel who commented on the importance, relevance and clarity of questions, and then on their necessity, wording, and order. A third round involved two experts in survey design. RESULTS Following 24 responses in the first round, the questions were refined and returned to the panel. After incorporating the second-round comments from 16 experts, the survey was then sent to two experts in questionnaire design and construction. Face validity was affirmed through this consultative process. CONCLUSIONS Despite Covid-19 pandemic-related restrictions, this robust iterative consultative process with an international expert panel has resulted in the prototype QMNC Framework index (QMNCFi)-a questionnaire designed for use in diverse settings to assess the quality of maternity care. The QMNCFi's psychometric properties are now being tested in an international online survey.
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Affiliation(s)
- Allison Cummins
- College of Health, Medicine and Wellbeing, School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Symon
- Maternal Infant Health Research Unit, University of Dundee, Dundee, UK
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Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia: Women's experiences and birth outcomes. Women Birth 2023; 36:80-88. [PMID: 35339411 DOI: 10.1016/j.wombi.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The ongoing closure of regional maternity services in Australia has significant consequences for women and communities. In South Australia, a regional midwifery model of care servicing five birthing sites was piloted with the aim of bringing sustainable birthing services to the area. An independent evaluation was undertaken. This paper reports on women's experiences and birth outcomes. AIM To evaluate the effectiveness, acceptability, continuity of care and birth outcomes of women utilising the new midwifery model of care. METHOD An anonymous questionnaire incorporating validated surveys and key questions from the Quality Maternal and Newborn Care (QMNC) Framework was used to assess care across the antenatal, intrapartum and postnatal period. Selected key labour and birth outcome indicators as reported by the sites to government perinatal data collections were included. FINDINGS The response rate was 52.6% (205/390). Women were overwhelmingly positive about the care they received during pregnancy, birth and the postnatal period. About half of women had caseload midwives as their main antenatal care provider; the other half experienced shared care with local general practitioners and caseload midwives. Most women (81.4%) had a known midwife at their birth. Women averaged 4 post-natal home visits with their midwife and 77.5% were breastfeeding at 6-8 weeks. Ninety-five percent of women would seek this model again and recommend it to a friend. Maternity indicators demonstrated a lower induction rate compared to state averages, a high primiparous normal birth rate (73.8%) and good clinical outcomes. CONCLUSION This innovative model of care was embraced by women in regional SA and labour and birth outcomes were good as compared with state-wide indicators.
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Hall H, Fooladi E, Kloester J, Ulnang A, Sinni S, White C, McLaren M, Yeganeh L. Factors that Promote a Positive Childbearing Experience: A Qualitative Study. J Midwifery Womens Health 2023; 68:44-51. [PMID: 36083856 PMCID: PMC10087184 DOI: 10.1111/jmwh.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Experiences of pregnancy and birth are important and have long-term impacts on the well-being of women and their families. Perinatal services should aim for care that promotes a positive childbearing experience, as well as optimizing health outcomes for the woman and newborn. This study aimed to understand the health system factors that promote a positive childbearing experience. METHODS Women who had a positive experience and had given birth in Australia in the previous 12 months were recruited for individual semistructured interviews. The interview guide focused on health system factors that participants credited with contributing to their positive experience of perinatal care. Interviews were conducted until data saturation was reached. Qualitative data were transcribed verbatim and analyzed using inductive thematic analysis. RESULTS Data from 36 interviews were thematically analyzed, and 4 major themes were generated: health care provider attributes, health system attributes, communication and decision-making, and experience of care. The salient factors that promoted positive experiences included care that was respectful and individualized with effective communication, access to midwifery continuity of care models, and good integration between services. Competent and professional health care providers who facilitated shared decision-making were also essential. DISCUSSION Although women often sought out care that promoted physiologic birth, they emphasized that the way they were cared for was more important than fulfilling specific birth aspirations. Quality maternity care has the capacity to support a woman's confidence in her own abilities and promote a positive, and sometimes transformative, childbearing experience.
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Affiliation(s)
- Helen Hall
- School of Health, Federation University, Australia
| | - Ensieh Fooladi
- School of Nursing and Midwifery, Monash University, Australia
| | - Joy Kloester
- School of Nursing and Midwifery, Monash University, Australia
| | | | | | | | | | - Ladan Yeganeh
- School of Nursing and Midwifery, Monash University, Australia
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Shipton EV, Callaway L, Foxcroft K, Lee N, de Jersey SJ. Midwife-Led Continuity of Antenatal Care and Breastfeeding Duration Beyond Postpartum Hospital Discharge: A Systematic Review. J Hum Lact 2022:8903344221126644. [PMID: 36197006 DOI: 10.1177/08903344221126644] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life and that breastfeeding should continue for 2 years and beyond. Most women initiate breastfeeding, but many do not continue for the recommended duration. While midwife-led continuity of antenatal care is linked to improved mother and infant outcomes, the influence on breastfeeding duration has not been previously reviewed. RESEARCH AIM To critically analyze the literature that compared midwife-led continuity of antenatal care with other models of care where researchers have measured breastfeeding duration beyond postpartum hospital discharge. METHODS A systematic literature review with critical analysis was used to answer the research aim. We systematically searched and screened five databases for quantitative studies where researchers had reported breastfeeding duration beyond postpartum hospital discharge after midwife-led continuity of antenatal care, compared with another model of antenatal care. Methodological quality was assessed using tools from the Cochrane Collaboration (RoB2 and ROBINS-I). In total, nine studies met the inclusion criteria. RESULTS Clear conclusions about the association between midwife-led continuity of antenatal care and breastfeeding duration were not found. The risk of bias within non-randomized studies ranged from serious to critical, and a judgement of "some concerns" of risk of bias in the one randomized study. CONCLUSION To date, the question of whether midwife-led continuity of antenatal care improves breastfeeding duration has not been established. There has been a lack of consistency in definitions of breastfeeding and descriptions of models of care, which has weakened the evidence-based of literature reviewed.Our review protocol was registered with PROSPERO; although due to COVID-19, this registration was not checked for eligibility by the PROSPERO team (CRD42020151276). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151276.
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Affiliation(s)
- Emma V Shipton
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Leonie Callaway
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Katie Foxcroft
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nigel Lee
- School of Nursing, Midwifery and Social Work, The University of Queensland, South Brisbane, QLD, Australia
| | - Susan J de Jersey
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Cummins A, Griew K, Devonport C, Ebbett W, Catling C, Baird K. Exploring the value and acceptability of an antenatal and postnatal midwifery continuity of care model to women and midwives, using the Quality Maternal Newborn Care Framework. Women Birth 2021; 35:59-69. [PMID: 33741311 DOI: 10.1016/j.wombi.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/25/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Having a known midwife throughout pregnancy, birth and the early parenting period improves outcomes for mothers and babies. In Australia, midwifery continuity of care has been recommended in all states, territories and nationally although uptake has been slow. Several barriers exist to implementing midwifery continuity of care models and some maternity services have responded by introducing modified models of continuity of care. An antenatal and postnatal continuity of care model without intrapartum care is one example of a modified model of care that has been introduced by health services. OBJECTIVES The aim of this study was to explore the value and acceptability of an antenatal and postnatal midwifery program to women, midwives and obstetricians prior to implementation of the model at one hospital in Metropolitan Sydney, Australia. METHODS A qualitative descriptive methodology was undertaken to discover the value and acceptability to the implementation of the model. Data was collected via focus groups and one to one interviews from the service users (pregnant women and two partners) and service providers (midwives and obstetricians). We also collected demographic data to demonstrate the diversity of the setting. The Quality Maternal Newborn Care (QMNC) Framework was used to guide the focus groups and analyse the data. FINDINGS Four themes emerged from the data that were named feeling safe and connected, having more quality time and being confident, having a sense of community and respecting cultural diversity. The findings were analysed through the lens of the quality components of the QMNC framework. The final findings demonstrate the value and acceptability of implementing this model of care from women's, midwives and obstetrician's perspective. CONCLUSIONS/IMPLICATIONS Providing midwifery continuity of care through the antenatal and postnatal period without intrapartum care, is being implemented in Australia without any research. Using the QMNC framework is a useful way to explore the qualities of a new emerging service and the values and acceptability of this model of care for service providers and service users.
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Affiliation(s)
- Allison Cummins
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia.
| | - Kate Griew
- Canterbury Hospital, Sydney Local Health District, 575 Canterbury Rd, Campsie, NSW 2194, Australia
| | - Claire Devonport
- Canterbury Hospital, Sydney Local Health District, 575 Canterbury Rd, Campsie, NSW 2194, Australia
| | - Wilhelmina Ebbett
- Health Services Management, University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia
| | - Christine Catling
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia
| | - Kathleen Baird
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia
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Symon A, Shinwell S. Qualitative evaluation of an innovative midwifery continuity scheme: Lessons from using a quality care framework. Birth 2020; 47:378-388. [PMID: 33263206 DOI: 10.1111/birt.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Innovative midwifery schemes must be robustly evaluated to establish whether they should be modified or can be replicated. Assessing quality of care can help to ascertain a scheme's acceptability and effectiveness. We used an established quality care framework as a benchmark in our qualitative evaluation of a combined continuity of caregiver and planned home birth scheme in Scotland. METHODS Qualitative evaluation of stakeholder perceptions using the Quality Maternal and Newborn Care Framework was the basis for six focus groups and two one-to-one interviews with stakeholders (new mothers, partners, midwives). A thematic analytical approach was used. RESULTS The qualitative evaluation found universal approval among participants. Flexible working patterns helped to nurture positive relationships, and information and support were highly valued. The principal themes-Organization of Care/Work Culture; Information and Support; Relationships-were strongly inter-related. They shared several subthemes, notably continuity of caregiver, flexible family-centered care, and the benefits of being at home. Flexibility and mutual respect helped women to express autonomy and develop agency. Women related their birth experiences to friends, family, and colleagues, thereby helping to normalize home birth. CONCLUSIONS This qualitative evaluation of an innovative scheme used an established quality framework as a benchmark against which to assess stakeholder experiences. This approach helped to identify the critical codependence of factors involved in care delivery, which in turn helps to identify lessons for others considering similar schemes. Although our evaluation relates to one specific scheme, identifying the scheme's critical quality care aspects may assist others when planning similar schemes.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Shona Shinwell
- Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, UK
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Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework. Women Birth 2020; 33:125-134. [DOI: 10.1016/j.wombi.2019.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 11/23/2022]
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Symon A, McFadden A, White M, Fraser K, Cummins A. Using the Quality Maternal and Newborn Care Framework to evaluate women's experiences of different models of care: A qualitative study. Midwifery 2019; 73:26-34. [DOI: 10.1016/j.midw.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 11/30/2022]
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Symon A, McFadden A, White M, Fraser K, Cummins A. Using a quality care framework to evaluate user and provider experiences of maternity care: A comparative study. Midwifery 2019; 73:17-25. [PMID: 30856527 DOI: 10.1016/j.midw.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The Quality Maternal and Newborn Care Framework describes the components and characteristics of quality care and emphasises relational and continuity elements. Continuity of care is increasingly a focus of maternity care policy in the United Kingdom. While some outcomes have been shown to be improved, there is uncertainty about why certain models of care are more effective. Our overall objective is to develop a maternity care evaluation toolkit which incorporates this Framework along with other outcome evaluations. An initial step in developing this toolkit was to use the adapted Framework to evaluate perceptions and experiences of maternity care. Our specific objective in this study was to test this adapted Framework in a series of focus groups with key stakeholders, and to compare findings between different groups. Findings related to service users (pregnant women and new mothers) are reported in our accompanying paper; this paper presents findings from focus groups with service providers (midwives and obstetricians), and then compares user and provider perspectives. DESIGN A qualitative comparative enquiry involving three focus groups with 26 midwives (eight newly qualified; eight working in a community midwifery unit; and ten senior tertiary-based) and two focus groups with twelve obstetricians of all grades. We used a six-phase thematic analysis to derive then compare the focus groups' principal sub-themes; we then mapped these to the original Quality Maternal and Newborn Care Framework and compared these service providers' responses with those from the pregnant women and new mothers. SETTING Two health boards in Scotland. PARTICIPANTS Midwives and obstetricians who had experience of various models of maternity care. FINDINGS There were significant areas of overlap in their perceptions of providing maternity care. All groups reported 'limited resources and time'; the community midwifery unit and senior midwives and one group of obstetricians provided a critique of the system. Achieving tailored care was acknowledged as a problem by the senior midwives and one group of obstetricians. Only obstetricians discussed strategies for improvement. The newly qualified midwives were most positive in their responses. There was both overlap and contrast when comparing the views of service users and providers. We found most agreement when participants discussed some of the Framework's characteristics of care in negative terms, such as (in) accessible care, (lack of) adequate resources, and (absence of) tailored care. KEY CONCLUSIONS Being able firstly to map the participants' responses to the Quality Maternal and Newborn Care Framework, and then to identify strengths and gaps in the provision of quality maternity care, suggests to us that the Framework, derived as it is from a comprehensive analysis of the global evidence on quality care, can indeed be used to inform an evaluation toolkit. While aware that we cannot generalise from this limited qualitative study, we are currently undertaking similar work in other countries by which we hope to confirm our findings and further develop the toolkit.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, DD1 4HJ United Kingdom.
| | - Alison McFadden
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, DD1 4HJ United Kingdom
| | - Marianne White
- Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Katrina Fraser
- Maternity Unit, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom
| | - Allison Cummins
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia
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