Continuity of care: what matters to women when they are referred from primary to secondary care during labour? a qualitative interview study in the Netherlands

Background: Continuity of care during labour is important for women. Women with an intrapartum referral from primary to secondary care look back more negatively on their birh experience compared to those who are not referred. It is not clear which aspects of care contribute to this negative birth experience. This study aimed to explore in-depth the experiences of women who were referred during labour from primary to secondary care with regard to the different aspects of continuity of care.Methods: A qualitative interview study was conducted in the Netherlands among women who were in primary care at the onset of labour and were referred to secondary care before the baby was born. Through purposive sampling 27 women were selected. Of these, nine women planned their birth at home, two in an alongside midwifery unit and 16 in hospital. Thematic analysis was used.Results: Continuity of care was a very important issue for women because it contributed to their feeling of safety during labour. Important details were sometimes not handed over between professionals within and between primary and secondary care, in particular about women's personal preferences. In case of referral of care from primary to secondary care, it was important for women that midwives handed over the care in person and stayed until they felt safe with the hospital team. Personal continuity of care, in which case the midwife stayed until the end of labour, was highly appreciated but not always expected.Fear of transportion during or after labour was a reason for women to choose hospital birth but also to opt for home birth. Choice of place of birth emerged as a fluid concept; most women planned their place of birth during pregnancy and were aware that they would spend some time at home and possibly some time in hospital.Conclusions: In case of referral from primary to secondary care during labour, midwives should hand over their care in person and preferrably stay with women throughout labour. Planned place of birth should be regarded as a fluid concept rather than a dichotomous choice. © 2014 De Jonge et al.; licensee BioMed Central Ltd

Reproductive Health

The present study was undertaken to explore knowledge and attitudes of adolescent boys across India. The study was undertaken across three states in India, chosen to represent a wide cultural and socio-economic range of the population. Qualitative data were gathered using focus group discussions with 85 boys aged 13-17 years, from 8 schools. Data were analysed using thematic analysis. We found there were three main themes: boys’ knowledge of menstruation, how they obtained their knowledge, and their thoughts about menstruation and menstruating girls. Specifically, the boys poorly understood menstruation in terms of the biology; however, they understood some of the cultural restrictions placed on girls during menstruation, and they also knew that menstruation affected girls in a negative way. Some boys learned about puberty and menstruation as part of the school programme, but they felt strongly that they were not given enough information. Most boys obtained their knowledge from listening to women and girls talking, or from watching them. Although a few boys thought that menstruation was a disease, most of them did not think negatively about menstruation, were kind to girls who were menstruating and wanted to support them. From our data, we are hopeful that boys and men can become involved in this gender issue, and help support menstrual issues for girls and women in the future