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Ku Carbonell SE, Ogba P, Vanstone M, Gombay C, Darling EK. Midwives' adaptation of their practice, role, and scope to ensure access to sexual and reproductive services during humanitarian crises: A scoping review. Midwifery 2024; 136:104065. [PMID: 38963995 DOI: 10.1016/j.midw.2024.104065] [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: 12/22/2023] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024]
Abstract
PROBLEM Limited research has examined and synthesized the adaptation of midwives and midwife-led interventions during crises. BACKGROUND Evidence suggests that midwives are essential to respond to sexual and reproductive health care needs during disruptive times, and that they adapt to continue to provide their services during those circumstances. AIM To map the adaptations of midwives when providing care during crises globally. Secondary objectives include identifying which midwives adapted, what services were adapted and how, and the demographic receiving care. STUDY METHODS Scoping review using Levac's modifications of Arksey and O'Malley's methods. Publications and grey literature, in English and Spanish, with no limitations based on study design or date were included. Data was extracted and mapped using Wheaton and Maciver's Adaptation framework. FINDINGS We identified 3329 records, of which forty-two were included. Midwives' prior training impacted adaptation. Midwives adapted to the COVID-19 pandemic, epidemics, natural disasters, and World War II. They adapted in hospital and community settings around the provision of antenatal, labor and birth, postpartum, and contraceptive care. However, no specific data identified population demographics. Midwifery adaptations related to their practice, role, and scope of practice. CONCLUSION The limited available evidence identified the challenges, creativity, and mutual aid activities midwives have undertaken to ensure the provision of their services. Evidence is highly concentrated around maternal health services. Further high-quality research is needed to provide a deeper understanding of how midwifery-led care can adapt to guide sustainable responses to ensure access to sexual and reproductive health services during crises.
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Affiliation(s)
- Susana E Ku Carbonell
- McMaster Midwifery Research Center, McMaster University, 1280 Main St W, HSC 4H24, Hamilton, ON L8S 4K1, Canada; Global Health Graduate Programs, McMaster University, 1280 Main Street W, MDCL 3500, Hamilton, ON L8S 4K1, Canada
| | - Patricia Ogba
- Global Health Graduate Programs, McMaster University, 1280 Main Street W, MDCL 3500, Hamilton, ON L8S 4K1, Canada
| | - Meredith Vanstone
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON L8P 1H6, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, HSC 2C, Hamilton, ON L8S 4K1, Canada
| | - Christy Gombay
- Global Health Graduate Programs, McMaster University, 1280 Main Street W, MDCL 3500, Hamilton, ON L8S 4K1, Canada
| | - Elizabeth K Darling
- McMaster Midwifery Research Center, McMaster University, 1280 Main St W, HSC 4H24, Hamilton, ON L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, HSC 2C, Hamilton, ON L8S 4K1, Canada; Department of Obstetrics and Gynaecology, McMaster University, 1280 Main St W, HSC 2F, Hamilton, ON L8S 4K1, Canada.
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Moghasemi S, Adib Moghaddam E, Arab S. Explaining Iranian midwives' experiences of providing healthcare services during the COVID-19 pandemic: a qualitative study. BMC Health Serv Res 2023; 23:1363. [PMID: 38057880 DOI: 10.1186/s12913-023-10265-5] [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: 04/27/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND COVID-19 has changed and challenged the way health and maternity care is provided. Midwives are among the first and most influential maternity care providers during the COVID-19 pandemic; however, there is inadequate information about their experiences in providing healthcare services, particularly in Iran. The present study was conducted to explain the midwives' experiences of providing healthcare services during the COVID-19 pandemic in Gorgan. METHODS The present study was conducted qualitatively through the inductive content analysis method in 2022. Data were collected through semi-structured interviews. A total of 21 individuals were selected as participants using a purposeful method and the maximum diversity strategy. RESULTS Data analysis led to the emergence of 377 codes, 12 subcategories, and 3 main categories, including, the laborious occupational challenges for midwives during the pandemic, identifying and creating new opportunities for the development of the midwifery profession, and the lack of perceived organizational and social support. CONCLUSIONS During the COVID-19 pandemic, midwives experienced various challenges in providing healthcare services, yet sacrificed themselves to perform their duties and provide quality care incessantly. The COVID-19 pandemic was a combination of laborious occupational challenges and individual and professional growth opportunities for midwives in Iran. Strong and managed organizational support is essential to overcome the crisis, maintain the workforce, and empower them to deal with future crises.
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Affiliation(s)
- Sedigheh Moghasemi
- Counseling, and Reproductive Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
| | - Elham Adib Moghaddam
- Counseling, and Reproductive Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Sahar Arab
- Counseling, and Reproductive Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
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O'Brien C, Newport M. Prioritizing women's choices, consent, and bodily autonomy: From a continuum of violence to women-centric reproductive care. Soc Sci Med 2023; 333:116110. [PMID: 37567015 DOI: 10.1016/j.socscimed.2023.116110] [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: 02/03/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023]
Abstract
Obstetric violence is a product of medical institutions' failure to prioritize women-centric reproductive care. Through interviews with local activists and leaders in Oaxaca, Mexico, as well as analysis of primary and secondary sources, we find that women-centric reproductive care is hindered by three barriers that are a part of a continuum of violence. These barriers include the cultural and religious norms surrounding reproductive care, the medical community and medical profiteers' opposition to combatting obstetric violence, and the state's resistance to women's human rights policy changes. Shifting to a women-centric reproductive care model requires: the life of the woman to be prioritized in reproductive care, the criminalization of obstetric violence, improved training for the medical community, reduced monetary incentives for unnecessary cesarean sections, and the respectful inclusion of indigenous and midwife knowledge and practices. Our study's theoretical and empirical contributions add to the scholarly research regarding the systemic causes of obstetric violence and the care ethic required for transformative change. Our recommendations can be applied across contexts with locally developed and culturally inclusive models of women-centric reproductive care.
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Affiliation(s)
- Cheryl O'Brien
- Department of Political Science, San Diego State University, San Diego, 5500 Campanile Dr, San Diego, CA, 92182-4427, USA.
| | - Morgan Newport
- Department of Political Science, San Diego State University, San Diego, 5500 Campanile Dr, San Diego, CA, 92182-4427, USA
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Turkmani S, Nove A, Bazirete O, Hughes K, Pairman S, Callander E, Scarf V, Forrester M, Mandke S, Homer CSE. Exploring networks of care in implementing midwife-led birthing centres in low- and middle-income countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001936. [PMID: 37220124 DOI: 10.1371/journal.pgph.0001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/27/2023] [Indexed: 05/25/2023]
Abstract
The evidence for the benefits of midwifery has grown over the past two decades and midwife-led birthing centres have been established in many countries. Midwife-led care can only make a sustained and large-scale contribution to improved maternal and newborn health outcomes if it is an integral part of the health care system but there are challenges to the establishment and operation of midwife-led birthing centres. A network of care (NOC) is a way of understanding the connections within a catchment area or region to ensure that service provision is effective and efficient. This review aims to evaluate whether a NOC framework-in light of the literature about midwife-led birthing centres-can be used to map the challenges, barriers and enablers with a focus on low-to-middle income countries. We searched nine academic databases and located 40 relevant studies published between January 2012 and February 2022. Information about the enablers and challenges to midwife-led birthing centres was mapped and analysed against a NOC framework. The analysis was based on the four domains of the NOC: 1) agreement and enabling environment, 2) operational standards, 3) quality, efficiency, and responsibility, 4) learning and adaptation, which together are thought to reflect the characteristics of an effective NOC.Of the 40 studies, half (n = 20) were from Brazil and South Africa. The others covered an additional 10 countries. The analysis showed that midwife-led birthing centres can provide high-quality care when the following NOC elements are in place: a positive policy environment, purposeful arrangements which ensure services are responsive to users' needs, an effective referral system to enable collaboration across different levels of health service and a competent workforce committed to a midwifery philosophy of care. Challenges to an effective NOC include lack of supportive policies, leadership, inter-facility and interprofessional collaboration and insufficient financing. The NOC framework can be a useful approach to identify the key areas of collaboration required for effective consultation and referral, to address the specific local needs of women and their families and identify areas for improvement in health services. The NOC framework could be used in the design and implementation of new midwife-led birthing centres.
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Affiliation(s)
- Sabera Turkmani
- Burnet Institute, Melbourne, Victoria, Australia
- University of Technology Sydney, Sydney, Australia
| | | | - Oliva Bazirete
- Novametrics Ltd, Duffield, United Kingdom
- University of Rwanda, Kigali, Rwanda
| | | | - Sally Pairman
- International Confederation of Midwives, The Hague, Netherlands
| | | | | | - Mandy Forrester
- International Confederation of Midwives, The Hague, Netherlands
| | - Shree Mandke
- International Confederation of Midwives, The Hague, Netherlands
| | - Caroline S E Homer
- Burnet Institute, Melbourne, Victoria, Australia
- University of Technology Sydney, Sydney, Australia
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Nove A, Bazirete O, Hughes K, Turkmani S, Callander E, Scarf V, Forrester M, Mandke S, Pairman S, Homer CS. Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey. Midwifery 2023; 123:103717. [PMID: 37182478 PMCID: PMC10281083 DOI: 10.1016/j.midw.2023.103717] [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: 01/26/2023] [Revised: 04/22/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
Evidence about the safety and benefits of midwife-led care during childbirth has led to midwife-led settings being recommended for women with uncomplicated pregnancies. However, most of the research on this topic comes from high-income countries. Relatively little is known about the availability and characteristics of midwife-led birthing centres in low- and middle-income countries (LMICs). This study aimed to identify which LMICs have midwife-led birthing centres, and their main characteristics. The study was conducted in two parts: a scoping review of peer-reviewed and grey literature, and a scoping survey of professional midwives' associations and United Nations Population Fund country offices. We used nine academic databases and the Google search engine, to locate literature describing birthing centres in LMICs in which midwives or nurse-midwives were the lead care providers. The review included 101 items published between January 2012 and February 2022. The survey consisted of a structured online questionnaire, and responses were received from 77 of the world's 137 low- and middle-income countries. We found at least one piece of evidence indicating that midwife-led birthing centres existed in 57 low- and middle-income countries. The evidence was relatively strong for 24 of these countries, i.e. there was evidence from at least two of the three types of source (peer-reviewed literature, grey literature, and survey). Only 14 of them featured in the peer-reviewed literature. Low- and lower-middle-income countries were more likely than upper-middle-income countries to have midwife-led birthing centres. The most common type of midwife-led birthing centre was freestanding. Public-sector midwife-led birthing centres were more common in middle-income than in low-income countries. Some were staffed entirely by midwives and some by a multidisciplinary team. We identified challenges to the midwifery philosophy of care and to effective referral systems. The peer-reviewed literature does not provide a comprehensive picture of the locations and characteristics of midwife-led birthing centres in low- and middle-income countries. Many of our findings echo those from high-income countries, but some appear to be specific to some or all low- and middle-income countries. The study highlights knowledge gaps, including a lack of evidence about the impact and costs of midwife-led birthing centres in low- and middle-income countries.
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Affiliation(s)
| | - Oliva Bazirete
- Novametrics Ltd, Duffield, Derbyshire, UK; University of Rwanda School of Nursing and Midwifery, Kigali, Rwanda
| | | | - Sabera Turkmani
- Burnet Institute Global Women's and Newborn Health Group, Melbourne, Vic, Australia
| | - Emily Callander
- Monash University Health Systems Services & Policy Unit, Melbourne, Vic, Australia
| | - Vanessa Scarf
- University of Technology Sydney School of Nursing and Midwifery, Sydney, NSW, Australia
| | - Mandy Forrester
- International Confederation of Midwives, The Hague, The Netherlands
| | - Shree Mandke
- International Confederation of Midwives, The Hague, The Netherlands
| | - Sally Pairman
- International Confederation of Midwives, The Hague, The Netherlands
| | - Caroline Se Homer
- Burnet Institute Global Women's and Newborn Health Group, Melbourne, Vic, Australia; University of Technology Sydney School of Nursing and Midwifery, Sydney, NSW, Australia
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