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Medway P, Hutchinson A, Sweet L. In what ways does maternity care in Australia align with the values and principles of the national maternity strategy? A scoping review. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100900. [PMID: 37634300 DOI: 10.1016/j.srhc.2023.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/13/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
Australia's national maternity strategy Woman-centred care: strategic directions for Australian maternity services (the Strategy) was released by the federal government in November 2019. It was developed to provide national guidance on the effective provision of woman-centred maternity care. The Strategy is structured around four values of safety, respect, choice, and access, and underpinned by twelve principles of woman-centred care. By examining previous research, this review aims to provide a baseline understanding of how maternity care provision is being met in relation to these core values. A systematic search of Australian literature was undertaken via four databases using the Strategy's values and 41 articles met the selection criteria. Include articles were predominantly published pre-2019, providing a baseline understanding of Australian maternity care provision prior to the Strategy's publication. Findings suggest that the four values align with those of women; however, women were not always receiving care in accordance with the values, particularly among women from priority populations. Women prioritised safety for themselves and their babies, articulated the need for respectful relationships with maternity care providers, wanted autonomy to make their own decisions, and desired access to appropriate, local, maternity services. Additionally, while pockets of appropriate care do exist, these are more likely to occur at a single-service level than more broadly at a population level. This implies the Strategy is needed, and its operationalisation must be prioritised through a coordinated national response to better meet the maternity care needs of Australian women. Further research is warranted to determine the Strategy's effectiveness.
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Affiliation(s)
- Paula Medway
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia. https://twitter.com/@PaulaMedway
| | - Alison Hutchinson
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia
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Miller YD, Tone J, Talukdar S, Martin E. A direct comparison of patient-reported outcomes and experiences in alternative models of maternity care in Queensland, Australia. PLoS One 2022; 17:e0271105. [PMID: 35819947 PMCID: PMC9275696 DOI: 10.1371/journal.pone.0271105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
We aimed to directly compare women’s pregnancy to postpartum outcomes and experiences across the major maternity models of care offered in Queensland, Australia. We conducted secondary analyses of self-reported data collected in 2012 from a state-wide sample of women who had recently given birth in Queensland (response rate = 30.4%). Logistic regression was used to estimate the odds of outcomes and experiences associated with three models (GP Shared Care, Public Midwifery Continuity Care, Private Obstetric Care) compared with Standard Public Care, adjusting for relevant maternal characteristics and clinical covariates. Of 2,802 women, 18.2% received Standard Public Care, 21.7% received GP Shared Care, 12.9% received Public Midwifery Continuity Care, and 47.1% received Private Obstetric Care. There were minimal differences for women in GP Shared Care. Women in Public Midwifery Continuity Care were less likely to have a scheduled caesarean and more likely to have an unassisted vaginal birth, experience freedom of mobility during labour and informed consent processes for inducing labour, vaginal examinations, fetal monitoring and receiving Syntocinon to birth their placenta, and report highest quality interpersonal care. They had fewer vaginal examinations, lower odds of perineal trauma requiring sutures and anxiety after birth, shorter postpartum hospital stays, and higher odds of a home postpartum care visit. Women in Private Obstetric Care were more likely to have their labour induced, a scheduled caesarean birth, experience informed consent processes for caesarean, and report highest quality interpersonal care, but less likely to experience unassisted vaginal birth and informed consent for Syntocinon to birth their placenta. There is an urgent need to communicate variations between maternity models across the range of outcome and experiential measures that are important to women; build more rigorous comparative evidence for Private Midwifery Care; and prioritise experiential and out-of-pocket cost comparisons in further research to enable woman-centred informed decision-making.
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Affiliation(s)
- Yvette D. Miller
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
- * E-mail:
| | - Jessica Tone
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Sutapa Talukdar
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Elizabeth Martin
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
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Shee AW, Frawley N, Robertson C, McKenzie A, Lodge J, Versace V, Nagle C. Accessing and engaging with antenatal care: an interview study of teenage women. BMC Pregnancy Childbirth 2021; 21:693. [PMID: 34629069 PMCID: PMC8504060 DOI: 10.1186/s12884-021-04137-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pregnant teenagers in rural and regional areas experience distinct disadvantages, that are not simply a function of their age, and these have a substantial impact on their health and that of their baby. Studies demonstrate that antenatal care improves pregnancy outcomes amongst pregnant women, especially adolescents. Understanding teenager’s views and experiences of pregnancy and motherhood is important to ensure antenatal care meets young women’s needs. This study explored teenage women’s experiences and perceptions of barriers and facilitators to engaging in pregnancy care in rural and regional Victoria, Australia. Methods Between February–October 2017, pregnant women aged ≤19 years were purposively recruited from one regional and two rural health services in Victoria. Semi-structured, face-to-face interviews guided by naturalistic inquiry were conducted and an inductive approach to analysis was applied. Results Four key themes emerged from the analysis of the transcripts of 16 interviews: Valuing pregnancy care, Interactions with Maternity Service, Woman-centred care, and Support systems. Teenage women primary motivation to attend care was to ensure their baby’s wellbeing and lack of engagement occurred when the relevance of antenatal care was not understood. Appointment flexibility and an accessible location was important; most participants were reliant on others for transport. Continuity of carer and respectful, non-judgement communication by staff was highly valued. Many young women had fractured families with pregnancy diminishing their social world, yet having a baby gave them purpose in their lives. Conclusion Maternity services and health professionals that provide flexible, adaptable women-centred care and support through pregnancy and early motherhood will assist young women’s engagement in antenatal care. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04137-1.
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Affiliation(s)
- Anna Wong Shee
- Primary and Community Care, Ballarat Health Services, Ballarat, Victoria, 3350, Australia. .,Deakin Rural Health, Deakin University, Warrnambool, Australia.
| | - Natasha Frawley
- Primary and Community Care, Ballarat Health Services, Ballarat, Victoria, 3350, Australia
| | - Carolyn Robertson
- Primary and Community Care, Ballarat Health Services, Ballarat, Victoria, 3350, Australia
| | - AnneMarie McKenzie
- Primary and Community Care, Ballarat Health Services, Ballarat, Victoria, 3350, Australia
| | - Julie Lodge
- Primary and Community Care, Ballarat Health Services, Ballarat, Victoria, 3350, Australia
| | - Vincent Versace
- Deakin Rural Health, Deakin University, Warrnambool, Australia
| | - Cate Nagle
- James Cook University, Centre for Nursing and Midwifery Research, 1 James Cook Drive, Townsville, 4814, Australia.,Townsville Hospital and Health Service, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
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Beecher C, Devane D, White M, Greene R, Dowling M. Women’s experiences of their maternity care: A principle- based concept analysis. Women Birth 2020; 33:419-425. [DOI: 10.1016/j.wombi.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/03/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE High-quality maternity care is key to long-term improvements in population health. However, even within developed welfare systems, some mothers and babies experience poorer care and outcomes. This study aimed to explore whether women's experiences of maternity care in Scotland differs by their physical or sociodemographic characteristics. DESIGN Secondary analysis of the 2015 Scottish Maternity Care Experience Survey. The questionnaire was based on the Care Quality Commission English maternity survey. SETTING National Health Service maternity care in Scotland. PARTICIPANTS The survey was distributed to 5025 women who gave birth in Scotland during February and March 2015 with 2036 respondents (41%). MAIN OUTCOME MEASURES The questionnaire explored aspects of care processes and interpersonal care experienced from the first antenatal contact (booking) to 6 weeks following the birth. The analysis investigated whether experiences were related to age, parity, deprivation, rurality, self-reported general health or presence of a health condition that limited daily activities. Analysis used mixed effect multilevel models incorporating logistic regression. RESULTS There were associations between parity, age and deprivation with gestation at booking indicating that younger women, women from more deprived areas and multiparous women booked later. Women reporting generally poorer health were more likely to describe poorer care experiences in almost every domain including continuity, pain relief in labour, communication with staff, support and advice, involvement in decision making, confidence and trust and overall rating of care. CONCLUSIONS We found few differences in maternity care experience for women based on their physical or socioeconomic characteristics. Our findings indicate that maternity care in Scotland is generally equitable. However, the link between poorer general health after childbirth and poorer experience of maternity care is an important finding requiring further study.
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Affiliation(s)
- Helen Cheyne
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - David Hill
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Milburn
- Health and Care Analysis Division, Scottish Government, Edinburgh, UK
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Wyles K, Miller YD. Does it get better with age? Women's experience of communication in maternity care. Women Birth 2018; 32:e366-e375. [PMID: 30206041 DOI: 10.1016/j.wombi.2018.08.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Communication with maternity care providers is one of the strongest predictors of the perceived quality of maternity care. There is evidence that older mothers experience better communication than younger mothers, but no evidence for why this occurs. AIM To identify differences between younger (<35 years) and older (35+ years) mother's perceived quality of communication and any apparent age-related differences. METHODS We analysed cross-sectional data from 2504 first-time mothers in the Having a Baby in Queensland Survey 2012. Binary logistic regression assessed associations between maternal age and perceived optimal communication (information, participation, and connection) from care providers during women's most recent pregnancy and birth. Multivariable logistic regression modelling determined the effect of potential confounders (model of care, mode of birth, maternal age, and risk perceptions) on associations between age and communication quality. FINDINGS After adjustment for confounders, older mothers were more likely to report experiencing optimal information (e.g., not receiving conflicting information) and connection with caregivers (e.g., comfortable asking questions) in both pregnancy and birth. There were no age-related differences in the perception of participation. Model of care and mode of birth were more influential than maternal age in predicting communication perceptions. Women who used midwifery or private obstetric models and had unassisted vaginal births were more likely to perceive optimal communication. CONCLUSION Given the benefits of communication on maternity care, redressing these age-related differences should be a focus of future communication training for care providers to ensure that women receive optimal communication, regardless of their age.
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Affiliation(s)
- Katy Wyles
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Yvette D Miller
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia.
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O'Brien D, Casey M, Butler MM. Women's experiences of exercising informed choices as expressed through their sense of self and relationships with others in Ireland: A participatory action research study. Midwifery 2018; 65:58-66. [PMID: 30118977 DOI: 10.1016/j.midw.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/27/2018] [Accepted: 07/22/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore women's experiences of the concept of informed choice during pregnancy and childbirth. METHODS A three-phase action research approach. In the second phase of the study (reported in this paper), 15 women were interviewed to establish their experiences of informed choice. SETTING Dublin, Ireland in a large maternity hospital. FINDINGS We found that multiple factors influence how women experience informed choice including; their sense of self and the quality of their relationships with maternity care professionals. Women's experiences as expressed through their sense of self reveal that informed choice, is not only defined by but contingent on the quality of women's relationships with their caregiver and their ability to engage in a process of shared decision-making with them. KEY CONCLUSIONS Informed choice is experienced as a relational construct women's relationships with maternity care professionals can influence their perceptions of their sense of self following childbirth. Supportive relationships are key to supporting the concept of informed choice.
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Affiliation(s)
- Denise O'Brien
- School of Nursing and Midwifery and Health Systems, University College Dublin, Ireland.
| | - Mary Casey
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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Nolan S, Hendricks J, Williamson M, Ferguson S. Social networking sites (SNS) as a tool for midwives to enhance social capital for adolescent mothers. Midwifery 2018; 62:119-127. [DOI: 10.1016/j.midw.2018.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022]
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Henderson J, Redshaw M. Worries About Labor and Birth: A Population-Based Study of Outcomes for Young Primiparous Women. Birth 2016; 43:151-8. [PMID: 26806273 DOI: 10.1111/birt.12219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pregnancy at a young age is a continuing public health concern strongly associated with socioeconomic deprivation, social isolation, and stigma. The objectives were to see whether, compared with women aged 21 or more, women aged 20 years or younger worried more about labor and birth, and had poorer maternal outcomes. Another objective was to investigate the extent to which worries about labor and birth mediated the associations between young age and outcomes. METHODS A secondary analysis of data was conducted relating to 2,598 primiparous women's experience of maternity care in England in 2010. The survey collected data on care in the antenatal, intrapartum, and postnatal periods, and sociodemographic factors. A validated checklist measured worries about labor and birth. RESULTS Compared with women aged 21 or more, women aged 20 years or younger worried more about labor and birth. The pain and duration of labor worried all women and those aged 20 years or younger were particularly worried about the uncertainty of labor onset, cesarean section birth, and about embarrassment. In logistic regression, after adjusting for potential confounders, young age was a significant independent risk factor for worries about pain and distress in labor, and self-reported depression at 1 and 3 months. However, young age was also significantly associated with having a normal vaginal delivery. CONCLUSIONS It may be appropriate to focus support on women experiencing multiple disadvantage, rather than young age alone.
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Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Hennegan J, Kruske S, Redshaw M. Remote access and care: A comparison of Queensland women's maternity care experience according to area of residence. Women Birth 2014; 27:281-91. [DOI: 10.1016/j.wombi.2014.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/28/2014] [Accepted: 06/29/2014] [Indexed: 11/28/2022]
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Sandall J. Culture, context and the implementation challenge to achieve a better birth experience. Midwifery 2014; 30:803. [DOI: 10.1016/j.midw.2014.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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