8 research outputs found
A multi-actor perspective of humanised midwifery care excellence: An exploratory survey
Get PDFHumanised midwifery care is a fundamental human right and need. This exploratory online survey presents a collective perception of meaningful standards of humanised midwifery care for excellent daily practice obtained from an international multi-actor group of maternity service users and providers. After performing a literature review, 137 key elements of humanised midwifery were extracted, listed, and rephrased into criteria. The criteria were distributed, and participants added 38 criteria. The perceived level of humanised midwifery performance was scored from 1 (low/substandard) to 10 (excellent). The 9–10 scores benchmarked humanised midwifery care excellence. 312 care professionals benchmarked 42 criteria, and 277 pregnant and postpartum women benchmarked 23 criteria showing a 30 % overlap. A total set of 50 criteria emerged, promoting humanised midwifery excellence. The benchmarking criteria suggest a shared conceptual thinking of person-centeredness and meaningfulness and provide a practical paradigm for the provision and receipt of humanised midwifery care
Midwifery-led care: A single mixed-methods synthesis
Get PDFBackground: Midwifery Led Care (MLC) has shown to be beneficial for women and for midwives. The implementation of MLC remains challenging. Objective: To explore the utility of MLC and midwives' behavioural determinants. Methods: A systematic mixed-methods review was conducted, integrating data derived from methodologically different studies into a single mixed-methods synthesis. Data were organized using the Feasibility-Appropriateness-Meaningfulness-Effectiveness (FAME) scale. Behavioural MLC determinants were grouped in an extended Attitude-Social influence-Self-efficacy (ASE) model. After a synthesis and summary of the data and a descriptive thematic analysis, all FAME/ASE variables were quantified for a Bayesian Pearson correlation analysis. Results: The relationships between the FAME scales and ASE themes showed very strong evidence (BF 31.1-41.6), strong (BF 11.2-28.5) and to a lesser degree moderate (BF 3.1-9.7), and anecdotal evidence (BF 1.5-2.9). MLC utility was predominantly explained by the appropriateness and effectiveness of MLC and their correlations with the midwife's attitude, the perceived social influence of the public, supportive factors, regulation, professional and personal norms, and intention. Conclusion: To implement, scale up, and maintain MLC, a multipronged approach is needed. Midwives need to stand up for their professional identity in the wider culture and climate of maternity services to push the change for MLC
What influences women's experiences of childbirth in Flanders? A quantitative cross-sectional analysis of the Babies Born Better survey
No full textWhat influences women's experiences of childbirth in Flanders? – A quantitative cross-sectional analysis of the Babies Born Better survey
Get PDFObjective
Labour and birth experiences are of great importance since these can have positive, but also negative effects on women's health and wellbeing. This is the first study, which investigated the factors that influence women's experiences of childbirth in Flanders, Belgium.
Design
A cross-sectional quantitative analysis was used to examine primary data obtained by the Babies Born Better project. Data collection took place via an online survey from April 2018 until August 2018 in Flanders.
Participants
1414 women that gave birth across all birth settings between 2013 and 2018, who speak Flemish/Dutch were included. Participants were self-selected by filling out the Babies Born Better survey in 2018.
Findings
The majority of the Flemish women included in this study reported a positive labour and birth experience. Analysis of the demographic variables showed that women who were single or not co-habiting reported a worse experience of labour and birth (P = 0.012). All obstetric factors included showed significant differences (P<0.01). Lastly, women were more likely to report a better experience when birth took place at home or in a midwifery unit and when the main care provider was a midwife (P<0.01). When controlled for significant variables from the univariate analysis, an impact on the birth experience was only found with the obstetric factors. A preterm (OR 0.544, 95%CI 0.362–0.817) and post term birth (OR 0.664, 95% CI 0.462–0.953) were found to reduce the chance of a good experience compared to a birth at term. In case of complications during pregnancy, women were less likely to report having had a good experience (OR 0.632, 95% CI 0.470 – 0.849). Medical interventions such as induction- (OR 0.346, 95% CI 0.241 – 0.497) and augmentation of labour (OR 0.318, 95% CI 0.218–0.463), an instrumental birth (OR 0.318, 95% CI 0.218–0.463) or a planned- (OR 0.349, 95% CI 0.205–0.596) or emergency caesarean section (OR 0.190, 95% CI 0.109–0.329) reduced the chances of women reporting to have had a good experience with care around labour and birth.
Key conclusions
The majority of women included in this study reported a good experience of care during labour and at birth. Certain obstetric factors such as having a straightforward pregnancy without complications, a physiological onset of labour at term without the need for augmentation and to give birth vaginally (without instrument) have shown a positive impact on women's reported birth experiences.
Implications for practice
Women's involvement in decision-making, especially when medical interventions are wanted or needed can improve positive birth experiences. More research is needed on how to support women and empower them, even more so in case of complications to ensure a sense of control and achievement
The Midwifery Unit Self-Assessment (MUSA) Toolkit: embedding stakeholder engagement and co-production of improvement plans in European midwifery units
No full textBackground: For women with straightforward pregnancies midwifery units (MUs) are associated with improved maternal outcomes and experiences, similar neonatal outcomes, and lower costs than obstetric units. There is growing interest and promotion of MUs and midwifery-led care among European health policymakers and healthcare systems, and units are being developed and opened in countries for the first time or are increasing in number. To support this implementation, it is crucial that practice guidelines and improvement frameworks are in place, in order to ensure that MUs are and remain well-functioning.
Aims and objectives: This project focused on the stakeholder engagement and collaboration with MUs to implement the Midwifery Unit Self-Assessment (MUSA) Tool in European MUs. A rapid participatory appraisal was conducted with midwives and stakeholders from European MUs to explore the clarity and usability of the tool, to understand how it helps MUs identifying areas for further improvement, and to identify the degree of support maternity services need in this process.
Key conclusions: Engagement and co-production principles used in the case studies were perceived as empowering by all stakeholders. A fresh-eye view from the external facilitators on dynamics within the MU and its relationship with the obstetric unit was highly valued. However, micro-, meso- and macro-levels of organisational change and their associated stakeholders need to be further represented in the MUSA-Tool. The improvement plans generated from it should also reflect these micro-, meso- and macro-level considerations in order to identify the key actors for further implementation and integration of MUs into European health services.
Key messages
Engagement and co-production principles used in the case studies were perceived as empowering by all stakeholders.
A fresh-eye view from the external facilitators were highly valued by stakeholders.
Micro-meso-macro levels of change need to be further represented in the MUSA-Tool.
The high impact actions need to reflect the micro-meso-macro levels to identify the correct players
Midwifery-led care: A single mixed-methods synthesis
No full textBackground: Midwifery Led Care (MLC) has shown to be beneficial for women and for midwives. The implementation of MLC remains challenging. Objective: To explore the utility of MLC and midwives' behavioural determinants. Methods: A systematic mixed-methods review was conducted, integrating data derived from methodologically different studies into a single mixed-methods synthesis. Data were organized using the Feasibility-Appropriateness-Meaningfulness-Effectiveness (FAME) scale. Behavioural MLC determinants were grouped in an extended Attitude-Social influence-Self-efficacy (ASE) model. After a synthesis and summary of the data and a descriptive thematic analysis, all FAME/ASE variables were quantified for a Bayesian Pearson correlation analysis. Results: The relationships between the FAME scales and ASE themes showed very strong evidence (BF 31.1-41.6), strong (BF 11.2-28.5) and to a lesser degree moderate (BF 3.1-9.7), and anecdotal evidence (BF 1.5-2.9). MLC utility was predominantly explained by the appropriateness and effectiveness of MLC and their correlations with the midwife's attitude, the perceived social influence of the public, supportive factors, regulation, professional and personal norms, and intention. Conclusion: To implement, scale up, and maintain MLC, a multipronged approach is needed. Midwives need to stand up for their professional identity in the wider culture and climate of maternity services to push the change for MLC
