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Vermeulen J, Fobelets M, Schoentjes A, Boucher L, Depuydt L, D’haenens F. Maternity care in the Brussels Capital Region: Towards a paradigm shift? Eur J Midwifery 2024; 8:EJM-8-21. [PMID: 38774061 PMCID: PMC11107092 DOI: 10.18332/ejm/186405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/30/2024] [Indexed: 05/24/2024] Open
Affiliation(s)
- Joeri Vermeulen
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Health Care, Brussels Expertise Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
| | - Maaike Fobelets
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Health Care, Brussels Expertise Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
- Brussels Institute for Teacher Education, Vrije Universiteit Brussel, Brussels, Belgium
| | - Aline Schoentjes
- Amala Espace Naissance, Brussels, Belgium
- Projet d’accompagnement des structures hospitalières et de première ligne dans l’implémentation de la réforme des normes hospitalières en région bruxelloise (Volet périnatal), Brussels, Belgium
| | - Laura Boucher
- Amala Espace Naissance, Brussels, Belgium
- Projet d’accompagnement des structures hospitalières et de première ligne dans l’implémentation de la réforme des normes hospitalières en région bruxelloise (Volet périnatal), Brussels, Belgium
| | - Laure Depuydt
- Department of Obstetrics and Gynecology, The Brussels University Hospital Brussels, Le Cocon, Brussels, Belgium
| | - Florence D’haenens
- Department of Health Care, Brussels Expertise Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
- Midwifery Department, Odisee University of Applied Sciences, Sint Niklaas, Belgium
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Alcaraz-Vidal L, Velasco I, Pascual M, I Gomez RG, Escuriet R, Comas C. First alongside midwifery led unit in a high complexity public hospital in Spain: Maternal and neonatal outcomes. Women Birth 2024; 37:101577. [PMID: 38296744 DOI: 10.1016/j.wombi.2024.01.003] [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: 07/14/2023] [Revised: 12/23/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
PROBLEM Midwifery led units are rare in Spain. BACKGROUND Midwife-Led Care (MLC) is a widely extended model of care and, within this, the alongside midwifery-led units (AMLU) are those hospital-based and located in close connection with obstetric units. In Spain, CL is the first center belonging to the National Health System of these characteristics. AIM To evaluate the first year of activity of this pioneering unit. METHODS An observational cross-sectional study was carried out to assess maternal and neonatal outcomes of births facilitated at CL by comparing with those births that fulfilled the criteria to be admitted at the AMLU but were assisted at the standard obstetric care unit of the hospital. FINDINGS 174 (20,3%) women and birthing people decided to give birth at CL, whereas 684 (79,7%) gave birth at the Obstetric Unit of the Hospital. Women assisted at the AMLU had lower intervention rates (episiotomy, epidural analgesia) and a higher rate of breastfeeding practice. There were no statistical differences in maternal outcomes (postpartum hemorrhage, third-or-four-degree laceration) or neonatal outcomes (Apgar< 7 at 5 min; birth weight < 2500 gr; macrosomia; shoulder dystocia, neonatal care transfer). DISCUSSION There were differences in transfers from MLU to OU between nulliparous and multiparous; the main reason for transfer is the request for analgesia. Epidural analgesia should be considered when analyzing maternal outcomes. CONCLUSION An alongside midwifery-led unit is a safe option with a low incidence of complications. This model of care can be positively implemented at the Public Healthcare System.
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Affiliation(s)
- Lucía Alcaraz-Vidal
- Department of Gender and Social Determinants in Health, Sevilla University. Sevilla. Spain; Department of Obstetrics and Gynecology, University Hospital Germans Trias i Pujol, Badalona, Spain; Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), 08007 Barcelona, Spain
| | - Inés Velasco
- Department of Obstetrics and Gynecology, University Hospital Germans Trias i Pujol, Badalona, Spain; Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain.
| | - Montse Pascual
- Management of Organization and Management Systems, Metropolitana North Region. Catalan Health Institute, Barcelona. Spain
| | - Roser Gol I Gomez
- Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), 08007 Barcelona, Spain; Primary Care Management in Sexual and Reproductive Healthcare, Metropolitana North Region, Catalan Health Institute, Barcelona. Spain
| | - Ramón Escuriet
- Head of the Affective, Sexual and Reproductive Health Plan of the Ministry of Health, Government of Catalonia, Spain; Global Health, Gender and Society Research Group, Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Carmina Comas
- Department of Obstetrics and Gynecology, University Hospital Germans Trias i Pujol, Badalona, Spain
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Stone NI, Thomson G, Tegethoff D. Skills and knowledge of midwives at free-standing birth centres and home birth: A meta-ethnography. Women Birth 2023; 36:e481-e494. [PMID: 37037696 DOI: 10.1016/j.wombi.2023.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
PROBLEM When midwives offer birth assistance at home birth and free-standing birth centres, they must adapt their skill set. Currently, there are no comprehensive insights on the skills and knowledge that midwives need to work in those settings. BACKGROUND Midwifery care at home birth and in free-standing birth centres requires context specific skills, including the ability to offer low-intervention care for women who choose physiological birth in these settings. AIM To synthesise existing qualitative research that describes the skills and knowledge of certified midwives at home births and free-standing birth centres. STUDY DESIGN We conducted a systematic review that included searches on 5 databases, author runs, citation tracking, journal searches, and reference checking. Meta-ethnographic techniques of reciprocal translation were used to interpret the data set, and a line of argument synthesis was developed. RESULTS The search identified 13 papers, twelve papers from seven countries, and one paper that included five Nordic countries. Three overarching themes and seven sub-themes were developed: 'Building trustworthy connections,' 'Midwife as instrument,' and 'Creating an environment conducive to birth.' CONCLUSION The findings highlight that midwives integrated their sensorial experiences with their clinical knowledge of anatomy and physiology to care for women at home birth and in free-standing birth centres. The interactive relationship between midwives and women is at the core of creating an environment that supports physiological birth while integrating the lived experience of labouring women. Further research is needed to elicit how midwives develop these proficiencies.
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Affiliation(s)
- Nancy Iris Stone
- Evangelische Hochschule Berlin, Department of Midwifery Sciences, Teltower Damm 118-122, 14167 Berlin, Germany.
| | - Gill Thomson
- School of Community Health & Midwifery, University of Central Lancashire, Preston PR1 2HE, Germany
| | - Dorothea Tegethoff
- Universitätsmedizin Rostock, Ernst-Heydemann-Straße 8, 18057 Rostock, Germany
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Katinaitė-Vaitkevičienė J, Patapas A. Assessment of the Quality of Obstetric Services From the Perspective of Maternity Patients and Service Providers in a Tertiary Care Obstetric Unit in Lithuania. Health Serv Insights 2023; 16:11786329231180790. [PMID: 37377885 PMCID: PMC10291411 DOI: 10.1177/11786329231180790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Although largely focused on the patient, the provision of healthcare services is a 2-way process and its success hinges on the interactions between patients and physicians. Given the growing role of subjective, patient-dependent assessment of the quality of care received, which is increasingly influenced by the individual aspects of the interaction between patients and care providers, in addition to the explicitly measurable, objective assessment of the quality of care received based on clinical indicators, quality assessment of services should especially consider and explore the attitudes, needs and dynamics of all the parties involved in the healthcare process. This study was designed to assess the attitudes of maternity patients and healthcare providers towards the quality of obstetric care. A quantitative questionnaire survey was conducted in a tertiary level healthcare facility providing obstetric services in Lithuania. Research findings suggested that maternity patients rate both the technical and functional quality of obstetric services higher than the staff providing it. Midwives and obstetricians-gynaecologists view quality assurance as a complex process, rather than focus solely on quantitative indicators. Since midwives were rated slightly higher than physicians in terms of services they provide, it may be appropriate to ensure and encourage a wider use of midwife-only deliveries in low-risk births. A comprehensive assessment of the quality assurance aspects as viewed by the patients and the staff should be included in the regular quality assessments of healthcare facilities as one of the most informative assessment tools on the service quality.
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Nørstebø HS, Nilsen ABV, Blix E, Bakken KS, Eri TS. Births in freestanding midwifery-led units in Norway: What women view as important aspects of care. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100857. [PMID: 37247500 DOI: 10.1016/j.srhc.2023.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To describe what women view as important aspects of care when giving birth in freestanding midwifery-led units in Norway. METHODS Data from four open-ended questions in the Babies Born Better survey, Version 1, 2 and 3 was used. We performed inductive content analysis to explore and describe women's experiences with the care they received. RESULTS In all, 190 women who had given birth in midwifery-led units in Norway between 2010 and 2020 responded to the B3 survey. The final sample comprised 182 respondents. The analysis yielded three main categories: 1) The immediate birth surroundings, 2) Personal and safe support, and 3) Organisational conditions. CONCLUSION This study adds valuable knowledge regarding what women describe as important aspects of care in free-standing midwifery-led units. Women experience maternity services in these units as peaceful, flexible and family-friendly. However, some women perceive the freestanding midwifery-led unit as a vulnerable service, mainly due to lack of midwives on call and uncertainty around temporary closure of the freestanding midwifery-led units. This finding points to the importance of staffing of birth facilities to ensure that all women giving birth have available midwifery care at all times, which is recommended in the National guidelines for care during labour and birth. Predictability around place of birth for the upcoming birth is crucial for every woman and her family. These goals might be achieved by a stable, continuous maternity service in all geographical areas of the country.
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Affiliation(s)
- Heidi Strand Nørstebø
- The Freestanding Midwifery-led Unit at Tynset Hospital, Innlandet Hospital Trust (IHT), Tynset Sjukehusveien 9, 2500 Tynset, Norway.
| | - Anne Britt Vika Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, 5020 Bergen, Norway.
| | - Ellen Blix
- Research Group Midwifery Science, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway.
| | - Kjersti Sletten Bakken
- Women's Clinic at Lillehammer Hospital, Innlandet Hospital Trust, 2609 Lillehammer, Norway; Center of International Health, Faculty of Medicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway.
| | - Tine Schauer Eri
- Research Group Midwifery Science, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway.
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Batinelli L, McCourt C, Bonciani M, Rocca-Ihenacho L. Implementing midwifery units in a European country: Situational analysis of an Italian case study. Midwifery 2023; 116:103534. [PMID: 36395602 DOI: 10.1016/j.midw.2022.103534] [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: 07/20/2022] [Revised: 10/06/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Strong evidence recommends midwifery-led care for women with uncomplicated pregnancies. International research is now focusing on how to implement midwifery models of care in countries where they are not well established. In Europe, many countries like Italy are promoting midwifery-led care in national guidelines but often struggle to apply this change in practice. METHODS This study collected data on professional, organisational and service users' levels to conduct a situational analysis of an Italian service which is approaching the implementation of a midwifery unit. Participatory Action Research was used together with the support of the Consolidated Framework for Implementation Research to conduct data collection and analysis. RESULTS Forty-eight participants amongst professionals (midwives, obstetricians and neonatologists) and at organisational level (midwifery leaders and medical directors) were recruited; secondary data on service users' views was analysed via regional online surveys. Barriers and facilitators to the implementation were identified to assess the readiness of the local context. CONCLUSIONS This study is the first to include professionals, managers and service users in a European context such as Italy. Facilitators to the implementation of the alongside midwifery unit were found in national guidelines, allocated funding, collaborative engagement and medical support. Hierarchical structures, a prevalent medical model and lack of trust and awareness of the evidence of safety of midwifery-led models were main barriers.
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Affiliation(s)
- Laura Batinelli
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK.
| | - Christine McCourt
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
| | - Manila Bonciani
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, CAP 56127 Pisa, Italy
| | - Lucia Rocca-Ihenacho
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
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Marques MJP, Zangão O, Miranda L, Sim-Sim M. Childbirth Experience Questionnaire: Cross-cultural validation and psychometric evaluation for European Portuguese. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221128121. [PMID: 36255072 PMCID: PMC9583229 DOI: 10.1177/17455057221128121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Self-reported measures are relevant both for the clinic and for health evaluation because they provide an interpretation of quality parameters. Women who experience labour can express themselves through these measures, identifying indicators that need improvement. OBJECTIVE The objective of this study is to adapt the Childbirth Experience Questionnaire to the Portuguese context and to determine its psychometric properties. METHOD A methodological study carried out with a convenience sample where the participants were 161 female users of a hospital in southern Portugal. They were aged between 20 and 43 years (M = 31.05, SD = 4.87) and answered a questionnaire approximately 48 h postpartum, preserving the ethical principles. The original instrument, with 22 items, underwent the linguistic and cultural adequacy process. RESULTS Factor analysis with Varimax rotation was performed, revealing a set of 19 items with factor weights above .400. The set of items remained four-dimensional as the original, explaining 62.517% of the variance. In the retest, the reliability results showed that similar characteristics to the original study are maintained in the two subscales that express 'Participation' (three items) and 'Professional Support' (four items), with internal consistency values of .807 and .782. The 'Own Performance' and 'Own Threshold' subscales were elaborated from the results of the Varimax rotation, presenting Cronbach's alpha coefficients of .840 and 714, respectively. The total scale showed alpha values of .873 and .823 in the test and retest, respectively. Time stability showed a positive association, with r = .659 (p < .001). Accuracy through the split-half method reached an alpha value of .880 with Spearman-Brown correction. The floor effect was high in the 'Participation' subscale, both in the test and in the retest. Convergent validity between the instrument and the 'Index of Strategies for Pain Relief in Labour' discrete variable showed a Spearman's rho value of .209 (p = .011) in the total scale. In discriminating validity, the Mann-Whitney test reveals that the women who recognize interactions with the midwife have more favourable scores in Childbirth Experience Questionnaire (U = 2748.000; Z = 2.905; p = .004). CONCLUSION The current version in European Portuguese suggests that it is a valid and reliable measure. This study may facilitate other validation processes in Lusophony countries.
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Affiliation(s)
| | - Otília Zangão
- Comprehensive Health Research Centre
(CHRC), University of Évora, Évora, Portugal,Nursing Department, University of
Évora, Évora, Portugal,Otília Zangão, Nursing Department,
University of Évora, 7000-811 Évora, Portugal.
| | - Luis Miranda
- Centro Hospitalar Barreiro Montijo
(CHBM), Hospital do Barreiro, Barreiro, Portugal
| | - Margarida Sim-Sim
- Comprehensive Health Research Centre
(CHRC), University of Évora, Évora, Portugal,Nursing Department, University of
Évora, Évora, Portugal
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Cicero RV, Colaceci S, Amata R, Spandonaro F. Cost analysis of planned out-of-hospital births in Italy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022227. [PMID: 36043966 PMCID: PMC9534258 DOI: 10.23750/abm.v93i4.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIM In Italy, the main birthplace is a hospital, and only a few women choose an out-of-hospital setting. This study assessed the costs related to delivery in different birthplaces in Italy. METHODS The cost analysis considered direct and amortizable costs associated with mother-child care in physiological conditions. An analysis of the hospital births considered the Diagnoses-Related Groups 373 and 391. To estimate the cost of the births assisted privately by freelance midwives, an evaluation based on an experts' opinion was carried out. RESULTS Childbirth hospital care in Italy amounts to € 1832.00, and birth in an out-of-hospital setting accredited with the National Health System has a full cost of € 1345.19 in the 'maternity home' and € 909.60 at home. The average cost of the birth in 'private maternity homes' amounted to € 3260.00, while at-home births amounted to € 2910.00. CONCLUSIONS Any accreditation of out-of-hospital settings by the NHS would considerably reduce the waste of economic resources compared to hospital childbirth.
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Affiliation(s)
- Roberta Vittoria Cicero
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy - Departmental faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy
| | - Sofia Colaceci
- Departmental faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy
| | - Rosanna Amata
- Department of Economics and Business, University of Catania, Catania, Italy
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Rocca-Ihenacho L, Yuill C, McCourt C. Relationships and trust: Two key pillars of a well-functioning freestanding midwifery unit. Birth 2021; 48:104-113. [PMID: 33314346 DOI: 10.1111/birt.12521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Lucia Rocca-Ihenacho
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Cassandra Yuill
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Christine McCourt
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
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