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Moncrieff G, Downe S, Maxwell M, Cheyne H. Mapping factors that may influence attrition and retention of midwives: a scoping review protocol. BMJ Open 2023; 13:e076686. [PMID: 37865412 PMCID: PMC10603492 DOI: 10.1136/bmjopen-2023-076686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION An appropriately staffed midwifery workforce is essential for the provision of safe and high-quality maternity care. However, there is a global and national shortage of midwives. Understaffed maternity services are frequently identified as contributing to unsafe care provision and adverse outcomes for mothers and babies. While there is a need to recruit midwives through pre-registration midwifery programmes, this has significant resource implications, and is counteracted to a large extent by the high number of midwives leaving the workforce. It is increasingly recognised that there is a critical need to attend to retention in midwifery in order to develop and maintain safe staffing levels. The objective of this review is to collate and map factors that have been found to influence attrition and retention in midwifery. METHODS AND ANALYSIS Joanna Briggs Institute guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to guide the review process and reporting of the review. CINAHL, MEDLINE, PsycINFO and Scopus databases will be searched for relevant literature from date of inception to 21 July 2023. Research from high-income countries that explores factors that influence leaving intentions for midwives will be included. Literature from low-income and middle-income countries, and studies where nursing and midwifery data cannot be disaggregated will be excluded. Two reviewers will screen 20% of retrieved citations in duplicate, the first author will screen the remaining results. Data will be extracted using a preformed data extraction tool by the first author. Findings will be presented in narrative, tabular and graphical formats. ETHICS AND DISSEMINATION The review will collate data from existing research, therefore ethics approval is not required. Findings will be published in journals, presented at conferences and will be translated into infographics and other formats for online dissemination.
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Affiliation(s)
| | - Soo Downe
- University of Central Lancashire, Preston, UK
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Moncrieff G, Cheyne H, Downe S, Hunter B. Factors that influence midwives' leaving intentions: A moral imperative to intervene. Midwifery 2023; 125:103793. [PMID: 37633108 DOI: 10.1016/j.midw.2023.103793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Affiliation(s)
- Gill Moncrieff
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom.
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Billie Hunter
- School of Healthcare Sciences, College of Biomedical and Life Sciences, University of Cardiff, Cardiff, United Kingdom
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Neal S, Stone L, Moncrieff G, Matthews Z, Kingdon C, Topalidou A, Balaam MC, Cordey S, Crossland N, Feeley C, Powney D, Sarian A, Fenton A, Heazell AEP, de Jonge A, Severns A, Thomson G, Downe S. Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework. BMC Health Serv Res 2023; 23:675. [PMID: 37349751 DOI: 10.1186/s12913-023-09669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts. METHODS We undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care. RESULTS The ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges. Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility. During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine clinical and staffing data were not always available and personalised care and user and staff experiences were poorly captured. CONCLUSIONS The COVID-19 crisis magnified pre-pandemic problems and in particular, poor staffing levels. Maintaining services took a significant toll on staff wellbeing. There is some evidence that these pressures are continuing. There was marked variation in Trust responses. Lack of accessible and timely data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 framework could be useful for modelling the impact of future crises on routine care.
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Affiliation(s)
- Sarah Neal
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
| | - Lucy Stone
- Faculty of Medicine, Health & Life Sciences, Swansea University Medical School, Swansea University, Swansea, UK
| | - Gill Moncrieff
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Zoë Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Carol Kingdon
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Anastasia Topalidou
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Marie-Clare Balaam
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Sarah Cordey
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- MAINN Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Claire Feeley
- Nursing, Midwifery & Palliative Care, Methodologies Division, King's College London, London, UK
| | - Deborah Powney
- School of Justice, University of Central Lancashire, Preston, PR1, UK
| | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Alan Fenton
- Newcastle Neonatal Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Gill Thomson
- MAINN Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Soo Downe
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
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Moncrieff G, Martin CH, Norris G, MacVicar S. "It's no ordinary job": Factors that influence learning and working for midwifery students placed in continuity models of care. Women Birth 2023; 36:e328-e334. [PMID: 36208992 DOI: 10.1016/j.wombi.2022.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 04/24/2023]
Abstract
BACKGROUND Maternity policy and guidelines increasingly recommend or stipulate the increased provision of midwifery continuity of carer as a priority model of care. The scale up and sustainability of this model will require that student midwives are competent to provide continuity of carer at the point of qualification. Guidance relating to how to optimally prepare student midwives to work within continuity models is lacking. AIM To explore perspectives and experiences of working within and learning from student placement within continuity models of care. METHODS An online mixed methods survey aimed at midwifery students and qualified midwives with experience of working within or providing education relating to continuity models. Quantitative results were analysed through descriptive statistics while free text responses were brought together in themes. FINDINGS Benefits and challenges to placement within continuity models were identified. These provide recommendations that will enhance learning from and skill development within continuity models of care. CONCLUSION There is a need for continuity of mentorship and strong relationships between education and practice, and the provision of flexible curriculum content around this to enable students to prioritise appointments with women in their care. System level evaluation and support is needed to guide the optimal provision of continuity models, so that they are effective in improving outcomes and experiences. Foregrounding woman centred care as foundational to education and facilitating the critical deconstruction of dominant discourses that conflict with, and may prevent this form of practice, will promote the provision of care that is integral to these models.
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Affiliation(s)
- Gill Moncrieff
- School of Health & Social Care, Sighthill Campus, Edinburgh Napier University, EH11 4BN, United Kingdom.
| | - Caroline Hollins Martin
- School of Health & Social Care, Sighthill Campus, Edinburgh Napier University, EH11 4BN, United Kingdom
| | - Gail Norris
- School of Health & Social Care, Sighthill Campus, Edinburgh Napier University, EH11 4BN, United Kingdom
| | - Sonya MacVicar
- School of Health & Social Care, Sighthill Campus, Edinburgh Napier University, EH11 4BN, United Kingdom
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Elaraby S, Altieri E, Downe S, Erdman J, Mannava S, Moncrieff G, Shamanna BR, Torloni MR, Betran AP. Behavioural factors associated with fear of litigation as a driver for the increased use of caesarean sections: a scoping review. BMJ Open 2023; 13:e070454. [PMID: 37076154 PMCID: PMC10124311 DOI: 10.1136/bmjopen-2022-070454] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To explore the behavioural drivers of fear of litigation among healthcare providers influencing caesarean section (CS) rates. DESIGN Scoping review. DATA SOURCES We searched MEDLINE, Scopus and WHO Global Index (1 January 2001 to 9 March 2022). DATA EXTRACTION AND SYNTHESIS Data were extracted using a form specifically designed for this review and we conducted content analysis using textual coding for relevant themes. We used the WHO principles for the adoption of a behavioural science perspective in public health developed by the WHO Technical Advisory Group for Behavioural Sciences and Insights to organise and analyse the findings. We used a narrative approach to summarise the findings. RESULTS We screened 2968 citations and 56 were included. Reviewed articles did not use a standard measure of influence of fear of litigation on provider's behaviour. None of the studies used a clear theoretical framework to discuss the behavioural drivers of fear of litigation. We identified 12 drivers under the three domains of the WHO principles: (1) cognitive drivers: availability bias, ambiguity aversion, relative risk bias, commission bias and loss aversion bias; (2) social and cultural drivers: patient pressure, social norms and blame culture and (3) environmental drivers: legal, insurance, medical and professional, and media. Cognitive biases were the most discussed drivers of fear of litigation, followed by legal environment and patient pressure. CONCLUSIONS Despite the lack of consensus on a definition or measurement, we found that fear of litigation as a driver for rising CS rates results from a complex interaction between cognitive, social and environmental drivers. Many of our findings were transferable across geographical and practice settings. Behavioural interventions that consider these drivers are crucial to address the fear of litigation as part of strategies to reduce CS.
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Affiliation(s)
- Sarah Elaraby
- Community Medicine Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
- Behavioural Insights Unit, World Health Organization, Geneve, Switzerland
| | - Elena Altieri
- Behavioural Insights Unit, World Health Organization, Geneve, Switzerland
| | - Soo Downe
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | - Joanna Erdman
- Schulich School of Law, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sunny Mannava
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Gill Moncrieff
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | - B R Shamanna
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | | | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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van den Berg LMM, Balaam MC, Nowland R, Moncrieff G, Topalidou A, Thompson S, Thomson G, de Jonge A, Downe S, Ellison G, Fenton A, Heazell A, de Jonge A, Kingdon C, Matthews Z, Severns A, Thomson G, Topalidou A, Wright A, Akooji N, Balaam MC, Cull J, van den Berg L, Crossland N, Feeley C, Franso B, Heys S, Moncrief G, Nowland R, Sarian A, Booker M, Sandall J, Thornton J, Lynskey-Wilkie T, Wilson V, Abe R, Awe T, Adeyinka T, Bender-Atik R, Brigante L, Brione R, Cadée F, Duff E, Draycott T, Fisher D, Francis A, Franx A, Erasmus M, Frith L, Griew L, Harmer C, Homer C, Knight M, Mansfield A, Marlow N, Mcaree T, Monteith D, Reed K, Richens Y, Rocca-Ihenacho L, Ross-Davie M, Talbot S, Taylor M, Treadwell M. The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study. Women Birth 2023; 36:127-135. [PMID: 35422406 PMCID: PMC8979792 DOI: 10.1016/j.wombi.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/17/2022] [Accepted: 03/31/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. AIM To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. METHOD A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. FINDINGS Both countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers' fear of contracting COVID-19; the extent to which community- and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. CONCLUSION We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women's and families' values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.
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Affiliation(s)
- Lauri M M van den Berg
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands.
| | - Marie-Clare Balaam
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Rebecca Nowland
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Gill Moncrieff
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Anastasia Topalidou
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Suzanne Thompson
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands; Research Centre of Midwifery Science Maastricht, Zuyd University, The Netherlands
| | - Gill Thomson
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Ank de Jonge
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development, The Netherlands
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
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Cordey S, Moncrieff G, Cull J, Sarian A. 'There's only so much you can be pushed': Magnification of the maternity staffing crisis by the 2020/21 COVID-19 pandemic. BJOG 2022; 129:1408-1409. [PMID: 35544311 PMCID: PMC9321880 DOI: 10.1111/1471-0528.17203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
This article includes Author Insights, a video abstract available at: https://vimeo.com/bjogabstracts/authorinsights17203
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Affiliation(s)
- Sarah Cordey
- School of Community Health and Midwifery, THRIVE Centre, University of Central Lancashire, Preston, UK
| | - Gill Moncrieff
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK
| | - Joanne Cull
- School of Community Health and Midwifery, THRIVE Centre, University of Central Lancashire, Preston, UK
| | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, UK
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Moncrieff G, Gyte GM, Dahlen HG, Thomson G, Singata-Madliki M, Clegg A, Downe S. Routine vaginal examinations compared to other methods for assessing progress of labour to improve outcomes for women and babies at term. Cochrane Database Syst Rev 2022; 3:CD010088. [PMID: 35244935 PMCID: PMC8896079 DOI: 10.1002/14651858.cd010088.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Routine vaginal examinations are undertaken at regular time intervals during labour to assess whether labour is progressing as expected. Unusually slow progress can be due to underlying problems, described as labour dystocia, or can be a normal variation of progress. Evidence suggests that if mother and baby are well, length of labour alone should not be used to decide whether labour is progressing normally. Other methods to assess labour progress include intrapartum ultrasound and monitoring external physical and behavioural cues. Vaginal examinations can be distressing for women, and overdiagnosis of dystocia can result in iatrogenic morbidity due to unnecessary intervention. It is important to establish whether routine vaginal examinations are effective, both as an accurate measure of physiological labour progress and to distinguish true labour dystocia, or whether other methods for assessing labour progress are more effective. This Cochrane Review is an update of a review first published in 2013. OBJECTIVES To compare the effectiveness, acceptability, and consequences of routine vaginal examinations compared with other methods, or different timings, to assess labour progress at term. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, and conference proceedings) and ClinicalTrials.gov (28 February 2021). We also searched the reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of vaginal examinations compared with other methods of assessing labour progress and studies assessing different timings of vaginal examinations. Quasi-RCTs and cluster-RCTs were eligible for inclusion. We excluded cross-over trials and conference abstracts. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all studies identified by the search for inclusion in the review. Four review authors independently extracted data. Two review authors assessed risk of bias and certainty of the evidence using GRADE. MAIN RESULTS We included four studies that randomised a total of 755 women, with data analysed for 744 women and their babies. Interventions used to assess labour progress were routine vaginal examinations, routine ultrasound assessments, routine rectal examinations, routine vaginal examinations at different frequencies, and vaginal examinations as indicated. We were unable to conduct meta-analysis as there was only one study for each comparison. All studies were at high risk of performance bias due to difficulties with blinding. We assessed two studies as high risk of bias and two as low or unclear risk of bias for other domains. The overall certainty of the evidence assessed using GRADE was low or very low. Routine vaginal examinations versus routine ultrasound to assess labour progress (one study, 83 women and babies) Study in Turkey involving multiparous women with spontaneous onset of labour. Routine vaginal examinations may result in a slight increase in pain compared to routine ultrasound (mean difference -1.29, 95% confidence interval (CI) -2.10 to -0.48; one study, 83 women, low certainty evidence) (pain measured using a visual analogue scale (VAS) in reverse: zero indicating 'worst pain', 10 indicating no pain). The study did not assess our other primary outcomes: positive birth experience; augmentation of labour; spontaneous vaginal birth; chorioamnionitis; neonatal infection; admission to neonatal intensive care unit (NICU). Routine vaginal examinations versus routine rectal examinations to assess labour progress (one study, 307 women and babies) Study in Ireland involving women in labour at term. We assessed the certainty of the evidence as very low. Compared with routine rectal examinations, routine vaginal examinations may have little or no effect on: augmentation of labour (risk ratio (RR) 1.03, 95% CI 0.63 to 1.68; one study, 307 women); and spontaneous vaginal birth (RR 0.98, 95% CI 0.90 to 1.06; one study, 307 women). We found insufficient data to fully assess: neonatal infections (RR 0.33, 95% CI 0.01 to 8.07; one study, 307 babies); and admission to NICU (RR 1.32, 95% CI 0.47 to 3.73; one study, 307 babies). The study did not assess our other primary outcomes: positive birth experience; chorioamnionitis; maternal pain. Routine four-hourly vaginal examinations versus routine two-hourly examinations (one study, 150 women and babies) UK study involving primiparous women in labour at term. We assessed the certainty of the evidence as very low. Compared with routine two-hourly vaginal examinations, routine four-hourly vaginal examinations may have little or no effect, with data compatible with both benefit and harm, on: augmentation of labour (RR 0.97, 95% CI 0.60 to 1.57; one study, 109 women); and spontaneous vaginal birth (RR 1.02, 95% CI 0.83 to 1.26; one study, 150 women). The study did not assess our other primary outcomes: positive birth experience; chorioamnionitis; neonatal infection; admission to NICU; maternal pain. Routine vaginal examinations versus vaginal examinations as indicated (one study, 204 women and babies) Study in Malaysia involving primiparous women being induced at term. We assessed the certainty of the evidence as low. Compared with vaginal examinations as indicated, routine four-hourly vaginal examinations may result in more women having their labour augmented (RR 2.55, 95% CI 1.03 to 6.31; one study, 204 women). There may be little or no effect on: • spontaneous vaginal birth (RR 1.08, 95% CI 0.73 to 1.59; one study, 204 women); • chorioamnionitis (RR 3.06, 95% CI 0.13 to 74.21; one study, 204 women); • neonatal infection (RR 4.08, 95% CI 0.46 to 35.87; one study, 204 babies); • admission to NICU (RR 2.04, 95% CI 0.63 to 6.56; one study, 204 babies). The study did not assess our other primary outcomes of positive birth experience or maternal pain. AUTHORS' CONCLUSIONS Based on these findings, we cannot be certain which method is most effective or acceptable for assessing labour progress. Further large-scale RCT trials are required. These should include essential clinical and experiential outcomes. This may be facilitated through the development of a tool to measure positive birth experiences. Data from qualitative studies are also needed to fully assess whether methods to evaluate labour progress meet women's needs for a safe and positive labour and birth, and if not, to develop an approach that does.
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Affiliation(s)
- Gill Moncrieff
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Gillian Ml Gyte
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, University of the Witwatersrand/University of Fort Hare/East London Hospital complex, East London, South Africa
| | - Andrew Clegg
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Soo Downe
- Research in Childbirth and Health (ReaCH) unit, University of Central Lancashire, Preston, UK
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Thomson G, Balaam MC, Nowland Harris R, Crossland N, Moncrieff G, Heys S, Sarian A, Cull J, Topalidou A, Downe S. Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives. BMJ Open 2022; 12:e051965. [PMID: 35017241 PMCID: PMC8753093 DOI: 10.1136/bmjopen-2021-051965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore stakeholders' and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE) COVID-19 UK study. SETTING Maternity care provision in England. PARTICIPANTS Interviews were held with 26 national governmental, professional and service-user organisation leads (July-December 2020). Other data included public-facing outputs logged from 25 maternity Trusts (September/October 2020) and data extracted from 78 documents from eight key governmental, professional and service-user organisations that informed national maternity care guidance and policy (February-December 2020). RESULTS Six themes emerged: 'Postcode lottery of care' highlights variations in companionship and visiting practices between trusts/locations, 'Confusion and stress around 'rules'' relates to a lack of and variable information concerning companionship/visiting, 'Unintended consequences' concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, 'Need for flexibility' highlights concerns about applying companionship and visiting policies irrespective of need, ''Acceptable' time for support' highlights variations in when and if companionship was 'allowed' antenatally and intrapartum and 'Loss of human rights for gain in infection control' emphasises how a predominant focus on infection control was at a cost to psychological safety and human rights. CONCLUSIONS Policies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Marie-Claire Balaam
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Rebecca Nowland Harris
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Gill Moncrieff
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | | | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Joanne Cull
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Anastasia Topalidou
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Soo Downe
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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Moncrieff G, Finlayson K, Cordey S, McCrimmon R, Harris C, Barreix M, Tunçalp Ö, Downe S. First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers. PLoS One 2021; 16:e0261096. [PMID: 34905561 PMCID: PMC8670688 DOI: 10.1371/journal.pone.0261096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. Methods We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. Findings From 7076 hits, we included 80 papers (1994–2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. Conclusion Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.
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Affiliation(s)
- Gill Moncrieff
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
- * E-mail:
| | - Kenneth Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Sarah Cordey
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebekah McCrimmon
- School of Health and Community Studies, University of Central Lancashire, Preston, United Kingdom
| | - Catherine Harris
- Applied Health Research Hub, University of Central Lancashire, Preston, United Kingdom
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
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van den Berg L, Thomson G, de Jonge A, Balaam MC, Moncrieff G, Topalidou A, Downe S. 'Never waste a crisis': a commentary on the COVID-19 pandemic as a driver for innovation in maternity care. BJOG 2021; 129:3-8. [PMID: 34758179 PMCID: PMC8652457 DOI: 10.1111/1471-0528.16996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Lmm van den Berg
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G Thomson
- School of Community Health & Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - A de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M-C Balaam
- School of Community Health & Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - G Moncrieff
- School of Community Health & Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - A Topalidou
- School of Community Health & Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - S Downe
- School of Community Health & Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
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Moncrieff G, MacVicar S, Norris G, Hollins Martin CJ. Optimising the continuity experiences of student midwives: an integrative review. Women Birth 2021; 34:77-86. [DOI: 10.1016/j.wombi.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 01/15/2023]
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Pezaro S, Patterson J, Moncrieff G, Ghai I. A systematic integrative review of the literature on midwives and student midwives engaged in problematic substance use. Midwifery 2020; 89:102785. [PMID: 32570093 DOI: 10.1016/j.midw.2020.102785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/20/2020] [Accepted: 06/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this systematic integrative review was to review the literature in relation to problematic substance use (PSU) in midwifery populations. Associated aims were to aggregate existing knowledge about midwives and student midwives' personal engagement in PSU, to generate a holistic conceptualisation and synthesis of the existing literature regarding midwives and student midwives personally engaged in PSU and to present new understandings and perspectives to inform the development of future research questions. This review is the first of its kind. DESIGN Systematic searches were conducted in CINAHL, Academic Search Complete, MEDLINE, PSYCInfo, Scopus and the Cochrane Library. Findings were grouped into themes and subthemes relating to both midwives and student midwives and then analysed critically in relation to the wider literature. A quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). The PRISMA statement was used to guide reporting. SETTING Included studies were conducted in Scotland, Ireland, Australia and New Zealand. PARTICIPANTS Studies included a total of 6,182 participants. FINDINGS A total of 3 studies were included. All included study types comprised quantitative survey designs, yet one also included a mixed methods design with the use of semi structured interviews. Two overarching themes emerged relating to both midwives and student midwives engaged in problematic substance use. For midwives, three subthemes are described: harmful daily alcohol consumption, working hours and harmful daily alcohol consumption and features associated with harmful daily alcohol consumption. For student midwives, two subthemes are presented: escape avoidance and alcohol, tobacco and cannabis use. KEY CONCLUSIONS There is limited evidence available in relation to problematic substance use in midwifery populations in comparison to that available for other healthcare populations. Further research is required, and could usefully focus upon midwives and student midwives as distinct professions to be separated out from the wider healthcare workforce. IMPLICATIONS FOR PRACTICE Problematic substance use among the healthcare workforce is associated with an increase in medical errors and inadequate care. Those affected can be reluctant to seek help, experience psychological distress and even contemplate suicide. Whilst evidence remains lacking for midwifery populations, they form a part of the general healthcare workforce and are exposed to similar workplace stressors. As such, it is likely that they too would be affected in similar ways.
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Affiliation(s)
- Sally Pezaro
- School of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Coventry University, Coventry CV1 5FB, England.
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Moncrieff G, Cork M, Lawton S, Kokiet S, Daly C, Clark C. Use of emollients in dry-skin conditions: consensus statement. Clin Exp Dermatol 2013; 38:231-8; quiz 238. [DOI: 10.1111/ced.12104] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - S. Lawton
- Dermatology Department; Queen's Medical Centre; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - S. Kokiet
- Bedford House Medical Centre; Ashton-under-Lyne; Greater Manchester; UK
| | - C. Daly
- Mid Norfolk Clinical Commissioning Group; North Elmham; Norfolk; UK
| | - C. Clark
- Christine Clark Ltd; Rossendale; Lancashire; UK
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Moncrieff G. Lessons from dermatology. J R Coll Physicians Lond 1999; 33:485. [PMID: 10624675 PMCID: PMC9665716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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