27 research outputs found
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Where do women birth during a pandemic? Changing perspectives on Safe Motherhood during the COVID-19 pandemic
During the coronavirus disease 2019 (COVID-19) pandemic, health systems all over the world are either stressed to their maximum capacity or anticipating becoming overwhelmed. The population is advised not to attend hospital unless strictly necessary, yet this advice seems to apply to all but healthy women during childbirth.
Specialized hospital care during childbirth can be lifesaving in case of obstetric complications or for COVID-19 symptomatic women, while strong evidence suggests the appropriateness of midwifery units that are integrated into the healthcare system for eligible women. We must ask ourselves whether obstetric units are the appropriate birthing facilities for healthy women during the pandemic.
We have learned from previous crises that the needs of women and children are often badly served during disasters. The COVID-19 pandemic raises concerns over escalation of mistreatment and abuse media are already reporting on restrictions to the rights of birthing women in Europe and the US. In addition, concerns have emerged over increased risk of infection to COVID-19 among birthing women and familied by concentrating all women in obstetric units and lack of optimal care due to pressure on staff and resources. Women's rights in childbirth are being threatened by lack of care during labor, restrictions on accompaniment, unnecessary interventions including inductions, separation of mother and baby and prohibition on breastfeeding.
An effective response to the crisis depends on strong and coordinated health care systems where mothers can birth safely, and the needs of the newborn babies are met. The interpretation of what constitute safe care is a stimulus for a strong debate between those who argue for strengthening community and primary care services and those who recommend for centralization of all births in hospitals. This debate is particularly salient during this pandemic and in preparation of future pandemics.
We propose a strategic response in the face of the pandemic by expanding the use of midwifery units both alongside the obstetric unit and freestanding (in the community). Where midwifery units are absent pop-up units can be created quickly following the example of the Netherlands. This strategy in high income countries is evidence-based and also serves as a response to the surge in requests of safe childbirths pathways away from the obstetric unit by concerned women at unprecedented rates. We urge policy makers to consider replicating this model in low- and middle-income countries where hospital conditions are more precarious.
A strong collaboration between midwives, nurses, obstetricians and neonatologists and the integration of primary care and acute services could ensure safety while maximizing the rational use of resources. Immediate strategic action would ensure that women are able to access appropriate care at the appropriate time, while hospitals continue to respond to the COVID-19 crisis and obstetric units are kept for women needing specialist care
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An ethnographic study of the philosophy, culture and practices within an urban freestanding midwifery unit
Summary
Service users and providers deserve to engage with healthcare systems that are functional, evidence-based and engender positive experiences. Current and recurrent maternity scandals urge us to explore the key characteristics of well-performing services as well as those which fail. Theory generation is important for the progress of maternity care, safety improvement, and enhancing organisational culture. This ethnographic study explored the key characteristics of a well-functioning FMU and also embedded a systematic review of evidence on MUs in high-income settings, to create logic models.
Background and rationale
Research evidence suggests that midwifery units (MUs) are associated with optimal clinical outcomes, experiences and cost-effectiveness. On the basis of this, NICE guideline G190, provided clear recommendations about the birthplace information to be provided to healthy women and birthing people eligible for midwife-led care birth settings. The NICE Quality Standards6 also recommend commissioners and providers to ensure that the four birth settings (home, AMU, FMU and OU) are made available to service users.
However, to date there is a knowledge gap regarding key elements in midwifery pracVce, environment, and organisaVon of care, which may potenVally affect the care outcomes in MUs as well as staff job saVsfacVon and wellbeing. This ethnographic study aimed at contribuVng to knowledge and theory-generaVon in the field of midwifery-led birth seZngs and parVcularly midwifery units.
Aim
The aim of this study was to shed light on philosophy, organisaVonal culture and pracVces within a FMU model of care, by highlighVng the key landmarks, which describe wellfuncVoning FMUs
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Pop-up’ birth centers? Considering COVID-19 responses and place of birth in England
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The Midwifery Unit Network: creating a community of practice to enhance maternity services
The Midwifery Unit Network (MUNet) is a community of practice which aims to promote and support the implementation and improvement of midwifery units (MUs) in the UK and internationally. It was launched in April 2016 and has been growing fast since its inception. In this article the co-leads of the MUNet describe how they established the network, and the challenges that they had to overcome. The aim of this article is to inspire more midwives and parent advocates to consider establishing a community of practice, and to offer some guidance on the key aspects involved
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Challenging the status quo: women's experiences of opting for a home birth in Andalucia, Spain
Objective
To explore the perceptions, beliefs and attitudes of women who opted for a home birth in Andalusia (Spain).
Background
Home birth is currently an unusual choice among Spanish women. It is not an option covered by the Spanish National Health Service and women who opt for a home birth have to pay for an independent midwife.
Design
A qualitative study with a phenomenological approach was adopted. All participants who took part in this study had chosen to have a home birth and given written consent to take part in the study.
Methods
Data collection was conducted in 2015–16. Face-to-face, semi-structured interviews were undertaken with women who chose a home birth in the last 5 years.
Findings
The sample consisted of thirteen women. Seven themes were created through analysis: 1. Getting informed about home birth; 2. Home birth as a choice, despite feeling unsupported; 3. The best way to have a personalized and a physiological birth; 4. Seeking a healing and empowering experience 5. The need for emotional safety, establishing a relationship and trusting the midwife; 6. Preparing for birth and working on fears; 7. Inequality of access (because of financial implications).
Conclusions
Women opted to plan birth at home because they wanted a personalised birth and control over their decision-making in labour, which they felt would not have been afforded to them in hospital settings. Andalusian maternity care leaders should strive to ensure that all pregnant women receive respectful and high-quality personalised care, by appropriately trained staff, both in the hospital and in the community
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Survey of women׳s experiences of care in a new freestanding midwifery unit in an inner city area of London, England: 2. Specific aspects of care
Objective
to describe and compare women׳s experiences of specific aspects of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area.
Design
telephone surveys undertaken in late pregnancy and about six weeks after birth. Two separate waves of interviews were conducted, Phase 1 before the birth centre opened and Phase 2 after it had opened.
Setting
Tower Hamlets, a deprived inner city borough in east London, 2007–2010.
Participants
620 women who were resident in Tower Hamlets and who satisfied the Barts and the London Trust’s eligibility criteria for using the birth centre. Of these, 259 women were recruited to Phase 1 and 361 to Phase 2.
Measurements and findings
the replies women gave show marked differences between the model of care in the birth centre and that at the obstetric unit at the Royal London Hospital with respect to experiences of care and specific practices. Women who initially booked for birth centre care were more likely to attend antenatal classes and find them useful and were less likely to be induced. Women who started labour care at the birth centre in spontaneous labour were more likely to use non-pharmacological methods of pain relief, most notably water and less likely to use pethidine than women who started care at the hospital. They were more likely to be able to move around in labour and less likely to have their membranes ruptured or have continuous CTG. They were more likely to be told to push spontaneously when they needed to rather than under directed pushing and more likely to report that they had been able to choose their position for birth and deliver in places other than the bed, in contrast to the situation at the hospital. The majority of women who had a spontaneous onset of labour delivered vaginally, with 28.6 per cent of women at the birth centre but no one at the hospital delivering in water. Primiparous women who delivered at the birth centre were less likely to have an episiotomy. Most women who delivered at the birth centre reported that they had chosen whether or not to have a physiological third stage, whereas a worrying proportion at the hospital reported that they had not had a choice. A higher proportion of women at the birth centre reported skin to skin contact with their baby in the first two hours after birth.
Key conclusions and implications for practice
significant differences were reported between the hospital and the birth centre in practices and information given to the women, with lower rates of intervention, more choice and significant differences in women’s experiences. This case study of a single inner-city freestanding midwifery unit, linked to the Birthplace in England Research Programme, indicates that this model of care also leads to greater choice and a better experience for women who opted for it
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Relationships and trust: Two key pillars of a well-functioning freestanding midwifery unit
Background
Despite strong evidence supporting the expansion of midwife‐led unit provision, as a result of optimal maternal and perinatal outcomes, cost‐effectiveness, and positive service user and staff experiences, scaling‐up has been slow. Systemic barriers associated with gender, professional, economic, cultural, and social factors continue to constrain the expansion of midwifery as a public health intervention globally. This article aimed to explore relationships and trust as key components of a well‐functioning freestanding midwifery unit (FMU).
Method(s)
A critical realist ethnographic study of an FMU located in East London, England, was conducted over a period of 15 months. Recruitment of the 82 participants was purposive. Data collection included participant observation and semi‐structured interviews, and data were analyzed thematically along with relevant local guidelines and documents.
Results
Twelve themes emerged. Relationships and Trust were identified as a core theme. The other 11 themes were grouped into six families, three of which: Ownership, Autonomy, and Continuous Learning; Team Spirit, Interdependency, and Power Relations; and Salutogenesis will be covered in this paper. The remaining three families: Friendly Environment; Having Time and Mindfulness; and Social Capital, will be covered in a separate paper.
Conclusions
A relationship‐based model of care was crucial for both the functioning of the FMU and service users’ satisfaction and may offer a compelling response to high levels of stress and burnout among midwives
Challenging the status quo: Women's experiences of opting for a home birth in Andalucia, Spain
Objective: To explore the perceptions, beliefs and attitudes of women who opted for a home birth in Andalusia (Spain). Background: Home birth is currently an unusual choice among Spanish women. It is not an option covered by the Spanish National Health Service and women who opt for a home birth have to pay for an independent midwife. Design: A qualitative study with a phenomenological approach was adopted. All participants who took part in this study had chosen to have a home birth and given written consent to take part in the study. Methods: Data collection was conducted in 2015–16. Face-to-face, semi-structured interviews were undertaken with women who chose a home birth in the last 5 years. Findings: The sample consisted of thirteen women. Seven themes were created through analysis: 1. Getting informed about home birth; 2. Home birth as a choice, despite feeling unsupported; 3. The best way to have a personalized and a physiological birth; 4. Seeking a healing and empowering experience 5. The need for emotional safety, establishing a relationship and trusting the midwife; 6. Preparing for birth and working on fears; 7. Inequality of access (because of financial implications). Conclusions: Women opted to plan birth at home because they wanted a personalised birth and control over their decision-making in labour, which they felt would not have been afforded to them in hospital settings. Andalusian maternity care leaders should strive to ensure that all pregnant women receive respectful and high-quality personalised care, by appropriately trained staff, both in the hospital and in the community
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What are the strategies for implementing primary care models in maternity? A systematic review on midwifery units
Background
Implementation depth, the extent to which innovations are implemented successfully, is a matter of great interest in healthcare practice. Yet, the way implementation depth is conceptualised varies between different studies, settings and contexts. The aim of this study is to report on the clarification and re-conceptualisation of implementation depth in healthcare, by synthesising the theoretic scientific literature from multiple disciplinary backgrounds.
Method
We applied a pragmatic utility concept analysis approach, a metaanalytic and interpretative method aiming at providing new insights of partially mature concepts using literature as data source. We followed the BeHEMoTh (Behaviour or phenomenon of interest, Health context, Exclusions, Models and Theories) approach for systematically searching for and identifying a comprehensive compilation of concepts from the scientific literature. The following databases were searched: Medline, Embase, CINAHL, PsychInfo, Global Health, HMIC, Business Source Complete, and Social Policy and Practice. In addition to handsearching references of selected publications, key textbooks and citation tracking. First order-concepts’ definitions, characteristics/attributes and boundaries/allied concepts were extracted and analysed to derive second-order concepts of implementation depth.
Results
We identified 66 publications that met our eligibility criteria. The preliminary results reveal the consolidated conceptualisation of implementation depth encompasses five concepts: low implementation depth (abandonment), high implementation depth (assimilation), normalising and sustaining innovation over time (sustainability), removal/reduction or substitution of an existing practice (deimplementation), and progression of implementation stages (stickiness of implementation stages). The second-order concepts of implementation depth clarify a unified structure to conceptualise the dynamic successes and/or failures of implementation efforts.
Conclusion
The consolidated framework of implementation depth delineates the type of implementation ‘success’. It offers a useful heuristic for operationalising shallow to deep implementation, that may be better suited for understanding challenge