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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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Stan D, Dobre CE, Mazilu DC, Brătilă E. Practices, attitudes and knowledge of midwives and nurses regarding gestational diabetes and pregnancy-induced hypertension. J Med Life 2023; 16:227-234. [PMID: 36937469 PMCID: PMC10015574 DOI: 10.25122/jml-2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/29/2023] [Indexed: 03/21/2023] Open
Abstract
Midwives (M) and obstetric nurses (ON) play a critical role in providing healthcare for pregnant patients at all stages of pregnancy, and ongoing training and education are essential to ensure the best outcomes. This longitudinal quantitative research study aimed to assess the impact of an educational program on the knowledge, attitudes, and practices of 125 midwives and obstetric nurses regarding care for patients with gestational diabetes and pregnancy-induced hypertension. The original questionnaire consisted of 56 items grouped into 3 subscales assessing knowledge (15 items), attitudes (18 items), and practices (23 items). The questionnaire was administered at three distinct intervals during the educational program: pre-test, post-test, and follow-up at three months. The data were analyzed using ANOVA and Pearson correlation coefficients to determine the significance of the differences between the 3 moments of the administration of the questionnaire. There was a significant increase in the level of knowledge, attitudes, and practices of midwives and obstetric nurses following the training module, which was sustained at 3 months after completion compared to pre-training. The comparative analysis of the total scores for every 3 sets of items revealed the positive impact of the educational program on the level of knowledge, attitudes, and practices of midwives and obstetric nurses.
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Affiliation(s)
- Daniela Stan
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- The Order of Nurses, Midwives and Medical Assistants in Romania, Bucharest, Romania
| | - Claudia Elena Dobre
- The Order of Nurses, Midwives and Medical Assistants in Romania, Bucharest, Romania
- Department of General and Specific Nursing, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Corresponding Author: Claudia Elena Dobre, Department of General and Specific Nursing, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. E-mail:
| | - Doina Carmen Mazilu
- The Order of Nurses, Midwives and Medical Assistants in Romania, Bucharest, Romania
- Department of General and Specific Nursing, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elvira Brătilă
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Dippenaar JM, Moeti TL, Chetty N, StaffordCloete A, Monticelli F. Early identification of hypertensive disorders of pregnancy (An mhealth feasibility study for resource limited settings). INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Dartey AF, Dzansi G, Lotse CW, Obuobisa R, Afua Bosu CE, Afaya A. Midwives Experiences of Managing Clients with Eclampsia in a low Resource Setting: A Qualitative Descriptive Study. SAGE Open Nurs 2022; 8:23779608221094542. [PMID: 35600007 PMCID: PMC9118454 DOI: 10.1177/23779608221094542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Eclampsia remains a public health issue, especially in low-resource countries worldwide. Midwives are the backbone of the pregnancy and delivery process. Midwives trained in the necessary knowledge and skills are more likely to notice early warning signals of preeclampsia and immediately help clients in such emergencies. This study explored midwives’ experiences in managing patients with eclampsia in Ghana. Methods This study was conducted among eight registered midwives at maternity units of two district hospitals in the Eastern Region of Ghana, using an exploratory, descriptive qualitative research design. A purposive sampling technique was adopted to select and interview participants. Interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. The right of participation and withdrawal from the study was respected. Findings The three emerged overriding themes are: 1. Midwives have knowledge (warning signs, regimens, and prevention of complications) about the management of eclampsia. 2. Challenges in managing clients included inadequate equipment, staffing, and access to drugs. 3. Strategies for mitigating barriers to care for women with eclampsia (adherence to protocols, teamwork, peer mentoring and supervision, midwives’ attitude, and client education. Conclusion Midwives working in underserved facilities have the knowledge and skill to monitor and manage pregnant women experiencing eclampsia. However, they need to be supported with appropriate resources and advanced equipment to ensure adherence to protocols on managing eclampsia promptly referred. Continuous training and workshops for midwives in the management of hypertension in pregnancy are recommended and the public educated on the dangers of eclampsia.
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Affiliation(s)
- Anita Fafa Dartey
- School of Nursing and Midwifery, The University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Gladys Dzansi
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Comfort Worna Lotse
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Racheal Obuobisa
- Department of Women and Children, University of Ghana Medical Centre, Ghana
| | | | - Agani Afaya
- College of Nursing, Yonsei University, Yonsei-ro, Seodaemun-gu, Seoul, South Korea
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Abd El Monem M, Shahin M, Salim H. Safety bundle application on nurses’ knowledge and performance regarding management of hypertension during pregnancy and postpartum period. EGYPTIAN NURSING JOURNAL 2021; 18:98. [DOI: 10.4103/enj.enj_22_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Garti I, Gray M, Tan JY, Bromley A. Midwives' knowledge of pre-eclampsia management: A scoping review. Women Birth 2020; 34:87-104. [PMID: 32928690 DOI: 10.1016/j.wombi.2020.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pre-eclampsia is a multi-organ disease affecting pregnant women from the second trimester onwards resulting in multiple adverse outcomes. Sub-optimal treatment of pre-eclampsia is linked with unfavorable outcomes. It is critical for midwives as primary providers to be competent in the diagnosis and management of pre-eclampsia especially in low-and middle-income countries. AIM To identify what midwives' around the world know about pre-eclampsia management. METHODS A scoping review using the JBI three-step search strategy was used to identify relevant research articles and grey literature on the subject. Database searches in PubMed, CINAHL, Cochrane Databases, Web of Science, and Scopus yielded twenty papers in addition to nine guidelines from Google Scholar. The findings were synthesised using a metasynthesis approach and presented as themes. FINDINGS Four themes were identified from the extracted data: Foundational knowledge of pre-eclampsia; Knowledge and management of a woman with pre-eclampsia according to guidelines; Knowledge of being prepared for emergency procedures and management of emergencies; Factors influencing knowledge. The first three themes addressed diagnosis and management whilst the last theme described how contextual factors led to either increased or decreased knowledge of pre-eclampsia. CONCLUSION Worldwide, practicing midwives lack knowledge on several aspects of pre-eclampsia diagnosis and care. Policies on in-service training should be oriented to include innovative non-traditional methods that have the potential to increase midwives' knowledge.
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Affiliation(s)
- Isabella Garti
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia.
| | - Michelle Gray
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Jing-Yu Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Angela Bromley
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
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Ramavhoya IT, Maputle MS, Lebese RT, Ramathuba DU, Netshikweta LM. Managing hypertensive disorders during pregnancy in low resource settings. Hypertens Pregnancy 2019; 38:230-236. [DOI: 10.1080/10641955.2019.1651333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ireen T. Ramavhoya
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | - Maria S. Maputle
- Department of Advance Nursing Science, University of Venda, Thohoyandou, South Africa
| | - Rachel T. Lebese
- Department of Advance Nursing Science, University of Venda, Thohoyandou, South Africa
| | - Dorah U. Ramathuba
- Department of Advance Nursing Science, University of Venda, Thohoyandou, South Africa
| | - Lizzy M. Netshikweta
- Department of Advance Nursing Science, University of Venda, Thohoyandou, South Africa
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Alves FLC, Castro EM, Souza FKR, Lira MCPDS, Rodrigues FLS, Pereira LDP. Group of high-risk pregnant women as a health education strategy. Rev Gaucha Enferm 2019; 40:e20180023. [PMID: 30785543 DOI: 10.1590/1983-1447.2019.20180023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/28/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand the importance of group strategy in the process of nursing care to high-risk pregnant women. METHODS Qualitative and descriptive study conducted at Assis Chateaubriand Teaching Maternity Hospital in February-March 2017, through focus groups with 24 hospitalized pregnant women. Data was submitted to content analysis and the relevant ideas of the discourses were extracted, forming categories. RESULTS Three thematic categories were constructed: Interactive groups as a space of bond and coexistence, Educational strategy as an approach to good delivery and birthcare practices, Impact of group experience in strengthening the connection between the health team and the pregnant woman. The group of pregnant women is a space of coexistence and bonding that stimulates them to share knowledge and experiences, re-signifying links. The groups promote sharing of experiences, learning and reflection on the possibilities and limitations of the health-disease process, reducing anxiety and contributing to empowerment in decision making. CONCLUSION The considerations and suggestions of the pregnant women guided the nurses in the development of the groups, which became strategic spaces of care, acquisition of knowledge and establishment of trust relationships with the nurses, with a consequent impact on the quality of care.
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Affiliation(s)
| | - Elaine Meireles Castro
- Universidade Federal do Ceará (UFCE). Maternidade Escola Assis Chateaubriand. Fortaleza, Ceará, Brasil
| | - Flávia Keli Rocha Souza
- Universidade Federal do Ceará (UFCE). Maternidade Escola Assis Chateaubriand. Fortaleza, Ceará, Brasil
| | | | | | - Lívia de Paulo Pereira
- Universidade Federal do Ceará (UFCE). Maternidade Escola Assis Chateaubriand. Fortaleza, Ceará, Brasil
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Soobryan N, Murugesan S, Pandiyan A, Moodley J, Mackraj I. Angiogenic Dysregulation in Pregnancy-Related Hypertension-A Role for Metformin. Reprod Sci 2018; 25:1531-1539. [PMID: 29739273 DOI: 10.1177/1933719118773484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the face of escalating maternal and fetal health threats, hypertensive pregnancy disorders (HPDs) is one of the leading cause of maternal and fetal morbidity and mortality. The range of HPDs include white-coat hypertension, chronic hypertension, gestational hypertension, mild-to-moderate and severe preeclampsia and eclampsia. Current evidence implicates an imbalance of circulating anti- and angiogenic factors in HPDs emanating from the placental vasculature, impacting on angiogenesis. Delivery of the fetus is thus far the only curative measure, albeit with increased risk. Resultant endothelial dysfunction caused by the excessive production of placental soluble fms-like tyrosine kinase-1 has been the basis of many studies to find a safer treatment strategy. Metformin, used historically in the treatment of diabetes mellitus has also found its therapeutic reach in many other disease states. These include, but are not limited to, improving blood flow in certain cancer types, treatment of polycystic ovarian disease, improving vasodilation, and reducing inflammation. Metformin is used to treat hyperglycemic endothelial dysfunction through the enhancement of the nitric oxide system, endothelin-derived hyperpolarizing factor and sirtuin 1. Similarly, endothelial dysfunction in preeclampsia and other HPDs leads to a hypoxic state and elevated blood pressures. Dubbed as the new "aspirin" of current times, the retardation of the antiangiogenic status by metformin provides an exciting and promising alternate strategy in treating these pregnancy disorders.
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Affiliation(s)
- Nerolen Soobryan
- 1 Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saravanakumar Murugesan
- 1 Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Arunagiri Pandiyan
- 1 Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- 2 Department of Obstetrics and Gynaecology and Women's Health and HIV Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Irene Mackraj
- 1 Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
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