Health professionals' experiences of whistleblowing in maternal and newborn healthcare settings: A scoping review and thematic analysis

PROBLEM

Whistleblowing, which involves raising concerns about wrongdoing, carries risks yet can be crucial to ensuring the safety of health service users in maternal and newborn healthcare settings. Understanding of the experiences of health care professionals that enact whistleblowing in this context is currently limited.

BACKGROUND

Notable inquiries involving maternity services such as those reported upon by Ockenden and Kirkup and the Lucy Letby case in the United Kingdom have shone an international spotlight on whistleblowing failures.

AIM

To identify and synthesise available literature addressing the experiences of healthcare professionals enacting whistleblowing in maternal and newborn care settings.

METHODS

This scoping review followed Arksey and O'Malley's framework. Five academic databases were systematically searched for documents published between January 2013 and October 2023 with additional searches of Google Scholar and related reference lists.

FINDINGS

Whilst 35 papers from international sources were identified, the majority originated from the United Kingdom, where recent high-profile incidents have occurred. Thematic analysis identified three main themes: 'Structural Power', 'Perfectionism' and 'Bravery, Hope and Disappointment', each with sub-themes.

DISCUSSION

Whistleblowing is frequently an altruistic act in a hierarchical system. It exposes poor practices and disrupts power dynamics, especially in challenging workplace cultures. Open disclosure, however, requires psychological safety. Obstacles persist, emphasising the need for a culture of trust and transparency led by individuals who embody the desired values.

CONCLUSION

Primary research on whistleblowing in maternal and newborn healthcare settings is limited. This study sheds light on power dynamics and factors that affect whistleblowing.

Exploring the barriers to pregnant women’s engagement in the childbirth process from Iranian midwives’ point of view: A qualitative study

Purpose:

Pregnant women’s engagement in the childbirth process increases their satisfaction with childbirth, and in turn leads to a reduction in the frequency of cesarean sections and adverse pregnancy consequences. This study aimed to explore the barriers to pregnant women’s engagement in the childbirth process based on midwives' perspective.

Methods:

This qualitative study was conducted on 24 midwives working in Urmia hospitals in 2019. Data were collected through semi-structured in-depth individual interviews with the midwives. The participants were selected through purposeful sampling. Data analysis was performed using conventional content analysis with MAXQDA 10.

Results:

Analysis of the data resulted in two main categories “weakness of pregnant women’s participatory culture” (negative attitude of healthcare staff towards pregnant women’s engagement, ineffective relationships, insufficient engagement in respectful care, lack of pregnant women’s awareness of their rights and low health literacy of the pregnant women, and “managerial factors” (neglect of physiological childbirth aspects and hospital rules).

Conclusion:

Pregnant women’s participation in childbirth can be enhanced by promoting pregnant women’s participatory culture by making mothers aware of their rights and providing in-service training for healthcare staff to observe the rights and dignity of pregnant women. Moreover, the promotion of physiological childbirth and the correction of hospital rules can promote pregnant women’s engagement in childbirth.

Shared decision-making for women facing an unplanned pregnancy: A qualitative study

This study aimed to explore the competencies of health care practitioners who promote shared decision-making (SDM)-based care for women facing an unplanned pregnancy in Japan. We conducted semistructured interviews with 12 care providers who are pioneers in care for women facing an unplanned pregnancy and adopted a modified grounded theory approach for data analysis. A three-step model for shared decision making in practice (team talk, option talk, and decision talk) was used as a reference. The answers given by the care providers were analyzed to identify the competencies involved in shared decision making. We identified three stages: (i) building trust and promoting women's expression; (ii) discussing women's real needs; and (iii) exploring the intentions and goals expressed by women and finding the best choices while promoting women's autonomy in decision-making. The coordination between the support of partners, families, and professionals, and the care provided to strengthen women's identities facilitated shared decision making. Women facing an unplanned pregnancy can benefit from interventions designed to improve shared decision making. A key component of shared decision making-based care relates to practitioners' raised awareness toward their roles and responsibilities: developing good communication skills and fostering collaboration between all stakeholders.

Medical technologies and abortion care in Eastern Uganda

Manual Vacuum Aspirators (MVA), Dilation and Curettage (D&C), and medical abortifacients (Misoprostol, Mifepristone and Divabo) are available in clinical settings that offer abortion and post-abortion care in Uganda. While these technologies imply appropriate and safe abortion care, legal and policy ambiguities impact health outcomes. In this article, we draw on an ethnography of abortion care delivery practice conducted in one district in Eastern Uganda between August 2018 and March 2019, with data from interviews and observations, both of interactions and during quality of care improvement and training meetings. We illuminate how, in the context of a financialized healthcare system and legal restrictions, the meanings and use of medical technologies and abortion care vary across different health facility types. In public health facilities, health workers become state agents in the control of women's bodies. In private health facilities, they become transgressors, who use medical technologies to help women attain termination surreptitiously. Health workers offset risks associated with any involvement in termination, such that pecuniary interests dominate their motivation. Normalized and disciplinary power enact and reproduce unsafe and risky conditions, leading to poor abortion care outcomes. We illustrate the mechanisms of domination and tactics of resistance in abortion care, and expose conditions upon which unsafe and risky outcomes are contingent.

Fear of childbirth from the perspective of midwives working in hospitals in Norway: A qualitative study

AIM

To illuminate the perceptions of hospital-based midwives who support women suffering from moderate to severe fear of childbirth during an expected vaginal birth.

DESIGN

A qualitative descriptive and explorative study.

METHODS

Focus group interviews were conducted with 18 midwives representing four different hospitals in Norway.

RESULTS

Encountering fear of childbirth evoked the desire to protect and help, although the ability to provide optimal support was dependent on several circumstances, several of which were beyond the midwives̕ control. The main theme "Midwives finding their own strength when encountering the vulnerability of women with fear of childbirth" consisted of two themes: "Being present" and "Being alone." The midwives described being present as a prerequisite for continuity of care and affirmation. The emphasis on continuity of care could give rise to a sense of loneliness and guilt during and after demanding situations in the birthing room.

Links between patient safety and fear of childbirth-A meta-study of qualitative research

AIM

To conduct a meta-study of qualitative empirical research to explore the links between patient safety and fear of childbirth in the maternity care context. The review questions were: How are patient safety and fear of childbirth described? and What are the links between patient safety and fear of childbirth in the maternity care context?

DESIGN

Meta-study.

DATA SOURCES

The CINAHL, Cochrane, PubMed, Webb of Science, Proquest and Medline (Ovid) electronic databases were searched for articles published between June 2000-June 2016.

REVIEW METHODS

A meta-study of qualitative research with a thematic analysis followed by a synthesis.

RESULTS

Four descriptive themes emerged: "Physical risks associated with giving birth vaginally"; "Control and safety issues"; "Preventing psychological maternal trauma and optimizing foetal well-being"; and "Fear of the transition to motherhood due to lack of confidence". The two overarching analytical themes: "Opting for safety" and "An insecure environment breeds fear of childbirth", represent a deeper understanding and constitute the synthesis of the links between patient safety and fear of childbirth. This meta-study indicates the need for increased commitment to safe care and professional support to reduce risks and prevent unnecessary harm in maternity care.

Women's experiences with giving birth before arrival

OBJECTIVE

To explore women's experiences with giving birth before arrival.

DESIGN

A qualitative interview study.

SETTING

Individual semi structured interviews with women from Western Norway conducted in their homes in 2015.

PARTICIPANTS

10 women who experienced BBA-births in 2014, or the beginning of 2015. Two primiparous and eight multiparous women participated in the study.

KEY FINDINGS

Three themes were generated from the analysis. In the encounter with the healthcare services, the women described midwives as gatekeepers defining active labour. Giving birth before arrival was dramatic, but at some point fear of giving birth alone was replaced by feelings of coping, and in hindsight they felt empowered. The women described giving birth before arrival to be a special experience, but this was not always acknowledged by the midwives.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The findings in this study question the cost-benefit of today's maternity care system pointing towards a more differentiated and decentralised care. To enhance patient safety adequate capacity of midwives in the maternity care is essential. Furthermore, good communication skills are key to improving practice and enhancing safety. Further research must be conducted.