Development of a Concourse for a Q-Method Study about Midwives’ 2perspectives of Woman-Centered Care

Objective: To transparently describe the development of a Q-set for a Q-method study about midwives’ perspectives of woman-centered care.Research design: Q-methodology is a relevant study approach to identify key viewpoints that are relevant for practitioners and for educational purposes. The development of a set of statements (Q-sample) is the first phase of this study’s methodology, forming the research instrument – and being the focus of this paper.Methods: Q-set development and construction included four steps: (1) Collections of items, (2) Q sample selection, (3) Formulating the Q statements, (4) Validation of the Q sample. Methods to collect items included a systematic review, a scoping review and personal narratives.Results: We used scientific literature, Dutch midwifery journals, international governmental and healthcare professional reports and guidelines, practising midwives, midwifery lecturers, media, fiction and art as sources to collect items. A collection of 45 Q-statements was formulated according the Attitude, Social influence & self-Efficacy (ASE) model. The statements were pre-tested among student midwives and pilot-tested by midwifery Master students and two individual midwives, resulting in a final Q-set of 39 statements.Conclusion: We systematically, thoroughly and transparently developed a valid and robust Q-set. Albeit a time consuming process and granting that the Q-statements might not represent thoughts of midwives in other countries than the Netherlands, we have constructed a concourse based on rich and detailed information that is appropriate for a Q-method study among Dutch midwives about their perspectives of woman-centered care

The experiential knowledge of migrant women about vulnerability during pregnancy: A woman-centred mixed-methods study

Problem: Within maternity care policies and practice, pregnant migrant women are regarded as a vulnerable population.Background: Women’s experiential knowledge is a key element of woman-centred care but is insufficiently addressed in midwifery practice and research that involves migrant women.Aim: To examine if pregnant migrant women’s experiential knowledge of vulnerability corresponds with sets of criteria of vulnerability, and to explore how migrant women make sense of vulnerability duringpregnancy.Methods: A sequential two-phased mixed-methods study, conducted in the Netherlands, integrating survey data of 89 pregnant migrant women and focus group data obtained from 25 migrant mothers -living in deprived areas according to the Dutch socio-economic index.Results: Criteria associated with vulnerability were reported by 65.2% of the participants and 62.9% of the participants reported adverse childhood experiences. On a Visual Analogue Scale, ranging from 0 (not vulnerable)to 10 (very vulnerable), participants self reported sense of vulnerability showed a mean score of 4.2 (2.56). Women’s experiential knowledge of vulnerability significantly correlated with the mean sum score of clinical criteria of vulnerability (r .46, p .002) and with the mean sum score of adverse childhood experiences (r .48, p<.001). Five themes emerged from the focus group discussions: “Look beyond who you think I am and see and treat me for who I really am”, “Ownership of truth and knowledge”, “Don’t punish me for being honest”, “Projection of fear” and “Coping with labelling”.Conclusion: Pregnant migrant women’s experiential knowledge of vulnerability is congruent with the criteria. Calling upon experiential knowledge is an attribute of the humane woman-midwife relationshi

Midwives’ perceptions of influences on their behaviour of woman-centered care: a qualitative study

Aim: To explore Dutch pregnant women’s experiences of shared-decision making about place of birth to better understand this process for midwifery care purposes.Design: Qualitative exploratory study with a constant comparison/grounded theory design.Methods: We performed semi-structured interviews, including two focus groups and eight individual interviews among 16 primarous and multiparous women with uncomplicated pregnancies. Consent was obtained and interviews were audiotaped and fully transcribed. The interviews were analyzed utilizing a cyclical process of coding and categorizing, following which the themes were structured based on the three-step shared-decision making model of Elwyn.Results: We identified the three themes according to Elwyn’s model: Choice talk, Option talk and Decision talk. We expanded the model with one additional theme: Decision ownership. The four themes explained women’s decision making process about place of birth. Women perceived shared-decision making about place of birth as a decision to be taken with their partner instead of with the midwife. Women and their partners regarded the decision about place of birth as a choice to be made as a couple and expecting parents; not as a decision in which the midwife needs to be actively involved. Women and their partners considered their options and developed a strong preference about where to give birth; even before the initial contact with the midwife was made. Involvement of the midwife occurred during the later stages of the decision-making process, where the women sought acknowledgement of their choice which was already made.Conclusion: Women considered their partners as the most and actively involved in the shareddecision making process regarding the place of birth. The women’s decision-making process about the place of birth did not fully occur during the antenatal care period. The midwife should ideally be involved before or during the early stages of pregnancy to facilitate the process

Portrayal of Shared Decision-Making in Lifetime Documentary Series 'One Born Every Minute'

Background: Pregnant women use childbirth reality programs to prepare themselves for childbirth. It is unknown how shared decision-making in intrapartum midwifery care is represented in televised birth. We aimed to explore the portrayal of shared decision-making during labour and birth in lifetime documentary series One born every minute. Methods: We analysed a total of 41 labour and birth storylines, triangulating deductive and inductive content analysis methods. We described the participants’ personal and birth details. We coded, quantified and organised woman-midwife dialogues and selected the shared-decision making data. Content analysis of shared decision-making fragments was organised following the three-steps of shared decision-making.Results: A first investigation resulted in a classification of: ‘building-a-relationship’ and ‘decision-making’. The decision-making fragments included ‘unilateral decision-making’ and ‘shared decision-making’. 287 shared decision-making fragments were ordered in three themes: 1. Choice talk: Women presented their personal wishes, resonating their awareness of having intrapartum care options. More often, midwives introduced decision-making with implicit referral to the proposal of choices. 2. Option talk: Midwives predominantly provided detailed information of various options and the consequences of these options. 3. Decision talk mainly included the midwife’s support of women’s decisions for which consent was obtained, albeit it in a rather informal way. Choice talk and decision talk most often occurred, sometimes simultaneously. Listing women’s options, exploring her preferences, wishes and values and deliberation of women’s intrapartum choices were underexposed.Conclusion: Shared decision-making is being portrayed as both woman and midwife-initiated. The midwives in this study did not always follow the linear stepwise model but tended to utilise a more fluid transition between choice, option and decision talk. Shared decision-making is facilitated by the relationship between the woman and the midwife during the intrapartum period, requiring evaluation and reflection. Birth partners should not be disregarded in intrapartum shared decision-making processes

Portrayal of Shared Decision-Making in Lifetime Documentary Series 'One Born Every Minute'

Background: Pregnant women use childbirth reality programs to prepare themselves for childbirth. It is unknown how shared decision-making in intrapartum midwifery care is represented in televised birth. We aimed to explore the portrayal of shared decision-making during labour and birth in lifetime documentary series One born every minute. Methods: We analysed a total of 41 labour and birth storylines, triangulating deductive and inductive content analysis methods. We described the participants’ personal and birth details. We coded, quantified and organised woman-midwife dialogues and selected the shared-decision making data. Content analysis of shared decision-making fragments was organised following the three-steps of shared decision-making.Results: A first investigation resulted in a classification of: ‘building-a-relationship’ and ‘decision-making’. The decision-making fragments included ‘unilateral decision-making’ and ‘shared decision-making’. 287 shared decision-making fragments were ordered in three themes: 1. Choice talk: Women presented their personal wishes, resonating their awareness of having intrapartum care options. More often, midwives introduced decision-making with implicit referral to the proposal of choices. 2. Option talk: Midwives predominantly provided detailed information of various options and the consequences of these options. 3. Decision talk mainly included the midwife’s support of women’s decisions for which consent was obtained, albeit it in a rather informal way. Choice talk and decision talk most often occurred, sometimes simultaneously. Listing women’s options, exploring her preferences, wishes and values and deliberation of women’s intrapartum choices were underexposed.Conclusion: Shared decision-making is being portrayed as both woman and midwife-initiated. The midwives in this study did not always follow the linear stepwise model but tended to utilise a more fluid transition between choice, option and decision talk. Shared decision-making is facilitated by the relationship between the woman and the midwife during the intrapartum period, requiring evaluation and reflection. Birth partners should not be disregarded in intrapartum shared decision-making processes

Woman-centered care 2.0: Bringing the concept into focus

INTRODUCTION Woman-centered care has become a midwifery concept with implied meaning. In this paper we aim to provide a clear conceptual foundation of woman-centered care for midwifery science and practice. METHODS An advanced concept analysis was undertaken. At the outset, a systematic search of the literature was conducted in PubMed, OVID and EBSCO. This was followed by an assessment of maturity of the retrieved data. Principle-based evaluation was done to reveal epistemological, pragmatic, linguistic and logic principles, that attribute to the concept. Summative conclusions of each respective component and a detailed analysis of conceptual components (antecedents, attributes, outcomes, boundaries) resulted in a definition of woman-centered care. RESULTS Eight studies were selected for analyses. In midwifery, woman-centered care has both a philosophical and a pragmatic meaning. There is strong emphasis on the woman-midwife relationship during the childbearing period. The concept demonstrates a dual and equal focus on physical parameters of pregnancy and birth, and on humanistic dimensions in an interpersonal context. The concept is epistemological, dynamic and multi-dimensional. The results reveal the concept's boundaries and fluctuations regarding equity and control. The role of the unborn child is not incorporated in the concept. CONCLUSION An in-depth understanding and a broad conceptual foundation of woman-centered care has evolved. Now, the concept is ready for research and educational purposes as well as for practical utility

Non-medical prescribing behaviour in midwifery practice: a mixed-methods review

Background: Non-medical prescribing is a new skill in midwifery practice. Information is needed on whether this is an activity that is feasible, appropriate, meaningful and effective. Aim: To report on the determinants of midwife prescribing behaviour to inform midwifery practice. Method: A mixed-methods review using an integrated approach combining methodologically diverse data into a single mixed-methods synthesis. A systematic search of the literature was conducted. Data were categorised according the feasibility-appropriateness-meaningfulness-effectiveness (FAME) scale and thematised according the attitude, social-influence, self-efficacy (ASE) model. A thematic analysis, a Bayesian descriptive analysis and Bayesian Pearson correlations of the FAME-categories and ASE-themes were performed. Findings: Seven studies showing moderate to good quality were included for synthesis. The FAME categories feasibility and appropriateness tended to affect the utility of midwife prescribing; meaningfulness and effectiveness were related to non-utility of prescribing. There were weak to moderate correlations between the FAME categories and the ASE themes social influence, intention, barriers and supportive factors and perceived knowledge (r-.41 to-.34 and r.37 to .56). ASE themes showed a strong negative correlation between attitude and self-efficacy (r-.70); weak positive correlations between attitude and social influence (r.31) and perceived knowledge (r.30); a weak positive correlation between self-efficacy and social influence (r.30), and a weak negative correlation with intention (r-.31); a moderate negative correlation between social influence and barriers/ supportive factors (r-.50); a weak negative correlation between barriers/supportive factors and perceived knowledge (r-.38). Conclusion: Prescribing fits the midwife's professional role and maternity services and is enhanced by the midwife's willingness and supportive practice. Prescribing requires collaborative practice, meaningful relationships with women, (applied) knowledge, expertise, and theoretical, practical and logistic support in the clinical area. Implications. Midwives who consider prescribing or who are autonomous prescribers should be aware of their role and position as autonomous prescriber. They should reflect on their willingness to prescribe, self-efficacy, perceived knowledge, their cognitive beliefs about prescribing and the effect of prescribing on women in their care

Non-medical prescribing behaviour in midwifery practice: a mixed-methods review

Background: Non-medical prescribing is a new skill in midwifery practice. Information is needed on whether this is an activity that is feasible, appropriate, meaningful and effective. Aim: To report on the determinants of midwife prescribing behaviour to inform midwifery practice. Method: A mixed-methods review using an integrated approach combining methodologically diverse data into a single mixed-methods synthesis. A systematic search of the literature was conducted. Data were categorised according the feasibility-appropriateness-meaningfulness-effectiveness (FAME) scale and thematised according the attitude, social-influence, self-efficacy (ASE) model. A thematic analysis, a Bayesian descriptive analysis and Bayesian Pearson correlations of the FAME-categories and ASE-themes were performed. Findings: Seven studies showing moderate to good quality were included for synthesis. The FAME categories feasibility and appropriateness tended to affect the utility of midwife prescribing; meaningfulness and effectiveness were related to non-utility of prescribing. There were weak to moderate correlations between the FAME categories and the ASE themes social influence, intention, barriers and supportive factors and perceived knowledge (r-.41 to-.34 and r.37 to .56). ASE themes showed a strong negative correlation between attitude and self-efficacy (r-.70); weak positive correlations between attitude and social influence (r.31) and perceived knowledge (r.30); a weak positive correlation between self-efficacy and social influence (r.30), and a weak negative correlation with intention (r-.31); a moderate negative correlation between social influence and barriers/ supportive factors (r-.50); a weak negative correlation between barriers/supportive factors and perceived knowledge (r-.38). Conclusion: Prescribing fits the midwife's professional role and maternity services and is enhanced by the midwife's willingness and supportive practice. Prescribing requires collaborative practice, meaningful relationships with women, (applied) knowledge, expertise, and theoretical, practical and logistic support in the clinical area. Implications. Midwives who consider prescribing or who are autonomous prescribers should be aware of their role and position as autonomous prescriber. They should reflect on their willingness to prescribe, self-efficacy, perceived knowledge, their cognitive beliefs about prescribing and the effect of prescribing on women in their care

The comparison of the interpersonal action component of woman-centred care reported by healthy pregnant women in different sized practices in the Netherlands: A cross-sectional study

Background: The number of interventions is lower, and the level of satisfaction is higher among women who receive midwife-led primary care from one or two midwives, compared to more midwives. This suggests that midwives in small-sized practices practice more women-centred. This has yet to be explored.Objective: To examine pregnant women’s perceptions, of the interpersonal action component of woman-centred care by primary care midwives, working in different sized practices.Methods: A cross-sectional study using the Client Centred Care Questionnaire (CCCQ), administered during the third trimester of pregnancy among Dutch women receiving midwife-led primary care from midwives organised in small-sized practices (1-2 midwives), medium-sized (3-4 midwives) and large-sized practices (≥5 midwives). A Welch ANOVA with post hoc Bonferroni correction was performed to examine the differences.Results: 553 completed questionnaires were received from 91 small-sized practices/104 women, 98 medium-sized practices/258 women and 65 large-sized practices/191 women. The overall sum scores varied between 57–72 on a minimum/maximum scoring range of 15-75. Women reported significantly higher woman-centred care scores of midwives in small-sized practices (score 70.7) compared with midwives in medium-sized practices (score 63.6) (p<.001) and large-sized practices (score 57.9) (p<.001), showing a large effect (d .88; d 1.56). Women reported statistically significant higher woman-centred care scores of midwives in medium-sized practices compared with large-sized practices (p<.001), showing a medium effect (d .69).Conclusion: There is a significant variance in woman-centred care based on women’s perceptions of woman-midwife interactions in primary care midwifery, with highest scores reported by womenreceiving care from a maximum of two midwives. Although the CCCQ scores of all practices are relatively high, the significant differences in favour of small-sized practices may contribute to moving woman centred care practice from ‘good’ to ‘excellent’ practice

Reports of work-related traumatic events: a mixed-methods study

INTRODUCTION There is limited evidence of the effect and impact on midwives of being involved or witnessing traumatic work-related events. We categorised midwives’ selfreported traumatic work-related events and responses to an event and explored the impact on the midwives’ professional and personal life.METHODS A sequential explanatory mixed-methods study, consisting of a questionnaire and semi-structured interviews for midwives who practised or who had practised in the Netherlands or Flanders.RESULTS In total, 106 questionnaires were completed. We categorised various workrelated traumatic events: witnessing birth trauma/complications (34%), death (28.3%), (mis)management of care (19.8%), events related to the perceived social norm of maternity services’ practitioners (9.5%), events related to environmental and contextual issues (5.6%) and to (mis)communication (2.8%). Sharing the experience with colleagues, family and friends, a supervisor or the woman involved in the event, was the most common response. In all, 74.5% of the participants still experienced the influence of work-related events in day-to-day practice and 37.5% still experienced the effects in their personal life. The scores of three participants (3.2%) indicated the likelihood of post-traumatic stress. Twenty-four interviews were conducted. Four themes emerged from the content analysis: 1) Timeline, 2) Drawing up the balance of relations with others, 3) Fretting and worrying, and 4) Lessons learned. CONCLUSIONS Various work-related traumatic events can impact on midwives’ professional and/or personal life. Although not all midwives reported experiencing (lasting) effects of the events, the impact was sometimes far-reaching. Therefore, midwives’ experiences and impact of work-related traumatic events cannot be ignored in midwifery practice, education and in supervision or mentoring