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Chen LL, Pan WL, Mu PF, Gau ML. Birth environment interventions and outcomes: A scoping review. Birth 2023; 50:735-748. [PMID: 37650526 DOI: 10.1111/birt.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The physical environments in which women give birth can contribute positively to meeting both physiologic and psychosocial needs during labor. Most studies on the labor and delivery processes have focused on mitigating pain and providing psychological support. Fewer have explored the influence of the physical birth environment. In this study, we performed a scoping review to compile and examine qualitative and quantitative studies related to the characteristics of physical birth environments and their effects on labor outcomes. METHODS We searched the PubMed, CINHAL, Cochrane, Web of Science, and MEDLINE databases from inception to May 2022. A total of 13 studies met the criteria for inclusion in our review. Two reviewers screened the titles and full-text articles and extracted data from the included studies. We used summary statistics and narrative summaries to describe the study characteristics, intervention implementation guidelines, intervention selection and tailoring rationale, and intervention effects. RESULTS In previous research, several elements of birth environments have been shown to provide physical and psychological support to birthing people and to improve outcomes related to the experience of care and pain management. We identified five main themes in the included studies: (1) "hominess;" (2) whether spaces are comfortable for activity; (3) demedicalization of the birth environment; (4) accommodations for birth partners; and (5) providing women with a sense of control over their birth environment. CONCLUSIONS Birth environments should be designed to promote positive birthing experiences, both physiologically and psychologically. Facilities and those who manage them can improve the experiences and outcomes of service users by modifying or designing spaces that are "homey," comfortable for activity, demedicalized, and include natural elements. In addition, policies that allow the birthing person to control her own environment are key to promoting positive outcomes and satisfaction with the birth experience.
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Affiliation(s)
- Li-Li Chen
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Wan-Lin Pan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Pei-Fan Mu
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan, ROC
- Taiwan Evidence Based Practice Center: A Joanna Briggs Center of Excellence, Taipei, Taiwan, ROC
| | - Meei-Ling Gau
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
- Core staff of the Taiwan Holistic Care Evidence Implementation Center, a JBI-Affiliated Center, Taipei, Taiwan, ROC
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Carlsson IM, Larsson I, Jormfeldt H. Place and space in relation to childbirth: a critical interpretive synthesis. Int J Qual Stud Health Well-being 2021; 15:1667143. [PMID: 33103631 PMCID: PMC7594831 DOI: 10.1080/17482631.2019.1667143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: In nursing and midwifery, the concept of environment is considered a meta-concept. Research findings suggest that the location is not the only important factor, as both place and space influence the practices of midwives. Moreover, research on the geography of health suggests a connection between place and health that could be extended to reproductive health. Therefore, to move beyond and expand traditional research expressions, it is beneficial to illuminate the concepts of place and space in relation to childbirth. Purpose: This study was undertaken to produce a synthesis of previous qualitative research of issues in childbirth in relation to the concepts of place and space. Method: In this Critical Interpretive Synthesis (CIS), four electronic databases; CINAHL, Medline, PsycINFO and Sociological abstracts, were used for the literature search. In total 734 papers were screened, and 27 papers met the final inclusion criteria after assessment. Results: The synthesis reveals a need to create a space for childbirth underpinned by four aspects; a homely space, a spiritual space, a safe space, and a territorial space. Conclusion: Findings from this review will provide a basis for useful dialogue in midwifery education and in clinical settings.
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Affiliation(s)
- Ing-Marie Carlsson
- Department of Health and Welfare, Halmstad University , Halmstad, Sweden
| | - Ingrid Larsson
- Department of Health and Welfare, Halmstad University , Halmstad, Sweden
| | - Henrika Jormfeldt
- Department of Health and Welfare, Halmstad University , Halmstad, Sweden
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Symon A, Shinwell S. Qualitative evaluation of an innovative midwifery continuity scheme: Lessons from using a quality care framework. Birth 2020; 47:378-388. [PMID: 33263206 DOI: 10.1111/birt.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Innovative midwifery schemes must be robustly evaluated to establish whether they should be modified or can be replicated. Assessing quality of care can help to ascertain a scheme's acceptability and effectiveness. We used an established quality care framework as a benchmark in our qualitative evaluation of a combined continuity of caregiver and planned home birth scheme in Scotland. METHODS Qualitative evaluation of stakeholder perceptions using the Quality Maternal and Newborn Care Framework was the basis for six focus groups and two one-to-one interviews with stakeholders (new mothers, partners, midwives). A thematic analytical approach was used. RESULTS The qualitative evaluation found universal approval among participants. Flexible working patterns helped to nurture positive relationships, and information and support were highly valued. The principal themes-Organization of Care/Work Culture; Information and Support; Relationships-were strongly inter-related. They shared several subthemes, notably continuity of caregiver, flexible family-centered care, and the benefits of being at home. Flexibility and mutual respect helped women to express autonomy and develop agency. Women related their birth experiences to friends, family, and colleagues, thereby helping to normalize home birth. CONCLUSIONS This qualitative evaluation of an innovative scheme used an established quality framework as a benchmark against which to assess stakeholder experiences. This approach helped to identify the critical codependence of factors involved in care delivery, which in turn helps to identify lessons for others considering similar schemes. Although our evaluation relates to one specific scheme, identifying the scheme's critical quality care aspects may assist others when planning similar schemes.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Shona Shinwell
- Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, UK
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Gu C, Wang X, Li L, Ding Y, Qian X. Midwives’ views and experiences of providing midwifery care in the task shifting context: a meta-ethnography approach. GLOBAL HEALTH JOURNAL 2020. [DOI: 10.1016/j.glohj.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Reszel J, Sidney D, Peterson WE, Darling EK, Van Wagner V, Soderstrom B, Rogers J, Graves E, Khan B, Sprague AE. The Integration of Ontario Birth Centers into Existing Maternal-Newborn Services: Health Care Provider Experiences. J Midwifery Womens Health 2018; 63:541-549. [PMID: 30088845 PMCID: PMC6221115 DOI: 10.1111/jmwh.12883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 05/16/2018] [Accepted: 05/24/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In 2014, 2 freestanding, midwifery-led birth centers opened in Ontario, Canada. The purpose of this study was to qualitatively investigate the integration of the birth centers into the local, preexisting intrapartum systems from the perspective of health care providers and managerial staff. METHODS Focus groups or interviews were conducted with health care providers (paramedics, midwives, nurses, physicians) and managerial staff who had experienced urgent and/or nonurgent maternal or newborn transports from a birth center to one of 4 hospitals in Ottawa or Toronto. A descriptive qualitative approach to data analysis was undertaken. RESULTS Twenty-four health care providers and managerial staff participated in a focus group or interview. Participants described positive experiences transporting women and/or newborns from the birth centers to hospitals; these positive experiences were attributed to the collaborative planning, training, and communication that occurred prior to opening the birth centers. The degree of integration was dependent on hospital-specific characteristics such as history, culture, and the presence or absence of midwifery privileging. Participants described the need for only minor improvements to administrative processes as well as the challenge of keeping large numbers of staff updated with respect to urgent transport policies. Planning and opening of the birth centers was seen as a driving force in further integrating midwifery care and improving interprofessional practice. DISCUSSION The collaborative approach for the planning and implementation of the birth centers was a key factor in the successful integration into the existing maternal-newborn system and contributed to improving integrated professional practice among midwives, paramedics, nurses, and physicians. This approach may be used as a template for the integration of other new independent health care facilities and programs into the existing health care system.
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Sosa GA, Crozier KE, Stockl A. The experiences of midwives and women during intrapartum transfer from one-to-one midwife-led birth environments to obstetric-led units. Midwifery 2018; 65:43-50. [PMID: 30055404 DOI: 10.1016/j.midw.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/13/2018] [Accepted: 07/02/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the transition from midwifery one-to-one support in labour within a midwife-led birth environment to an obstetric-led unit from the perspectives of midwives and women. DESIGN Ethnographic study. Data was collected from eleven transfers to an obstetric-led unit. The transfer process was observed for four women. Semi-structured interviews were completed following the births with eleven women and eleven midwives. Nine maternity records were also analysed. SETTING An alongside midwife-led unit, freestanding midwife-led unit, women's homes in England. FINDINGS Territorial behaviour was the main theme experienced by midwives when transferring women to obstetric-led units. Territorial behaviour manifested itself as a feeling of 'us versus them' behaviours, 'feeling under scrutiny' and being aware of 'conflicting ideologies'. For women there were four themes that had an impact on their experiences of transfer obstetric-led units including: (1) their midwife continuing the care on the labour ward, (2) having time to adjust to their new situation, (3) all staff introducing themselves and (4) not being separated from their baby for long periods of time. CONCLUSION AND IMPLICATIONS FOR PRACTICE Transfer from a midwife-led birth environment to an obstetric-led unit is a stressful situation for midwives and women. This paper highlights how territorial behaviours impacted negatively for midwives during transfer to an obstetric-led unit. More research is required to understand territorial behaviours within the maternity services and how more respectful compassionate working relationships can be created. Additionally, from the perspective of women this paper highlights four aspects of care that positively impacted on the experiences of women and even helped them to build resilience to cope with the change of location, situation, medical interventions and new carers when transferring to an obstetric-led unit.
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Affiliation(s)
- Georgina A Sosa
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ England, United Kingdom.
| | - Kenda E Crozier
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, England, United Kingdom.
| | - Andrea Stockl
- Faculty of Medicine and Health Sciences, University of East Anglia, NR4 7TJ, England, United Kingdom.
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Kuliukas LJ, Hauck YC, Lewis L, Duggan R. The woman, partner and midwife: An integration of three perspectives of labour when intrapartum transfer from a birth centre to a tertiary obstetric unit occurs. Women Birth 2017; 30:e125-e131. [DOI: 10.1016/j.wombi.2016.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 08/22/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
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Ball C, Hauck Y, Kuliukas L, Lewis L, Doherty D. Under scrutiny: Midwives' experience of intrapartum transfer from home to hospital within the context of a planned homebirth in Western Australia. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 8:88-93. [DOI: 10.1016/j.srhc.2016.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/22/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
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Kuliukas L, Duggan R, Lewis L, Hauck Y. Women's experience of intrapartum transfer from a Western Australian birth centre co-located to a tertiary maternity hospital. BMC Pregnancy Childbirth 2016; 16:33. [PMID: 26857353 PMCID: PMC4745174 DOI: 10.1186/s12884-016-0817-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this Western Australian study was to describe the overall labour and birth experience of women who were transferred during the first and second stages of labour from a low risk woman-centred, midwifery-led birth centre to a co-located tertiary maternity referral hospital. METHODS Using a descriptive phenomenological design, fifteen women were interviewed up to 8 weeks post birth (July to October, 2013) to explore their experience of the intrapartum transfer. Giorgi's method of analysis was used. RESULTS The following themes and subthemes emerged: 1) The midwife's voice with subthemes, a) The calming effect and b) Speaking up on my behalf; 2) In the zone with subthemes, a) Hanging in there and b) Post birth rationalizing; 3) Best of both worlds with subthemes a) The feeling of relief on transfer to tertiary birth suite and b) Returning back to the comfort and familiarity of the birth centre; 4) Lost sense of self; and 5) Lost birth dream with subthemes a) Narrowing of options and b) Feeling of panic. Women found the midwife's voice guided them through the transfer experience and were appreciative of continuity of care. There was a sense of disruption to expectations and disappointment in not achieving the labour and birth they had anticipated. There was however appreciation that the referral facility was nearby and experts were close at hand. The focus of care altered from woman to fetus, making women feel diminished. Women were glad to return to the familiar birth centre after the birth with the opportunity to talk through and fully understand their labour journey which helped them contextualise the transfer as one part of the whole experience. CONCLUSIONS Findings can inform midwives of the value of a continuity of care model within a birth centre, allowing women both familiarity and peace of mind. Maternity care providers should ensure that the woman remains the focus of care after transfer and understand the significance of effective communication to ensure women are included in all care discussions.
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Affiliation(s)
- Lesley Kuliukas
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia. .,Family Birth Centre, King Edward Memorial Hospital, PO Box 134, Subiaco, 6904, Western Australia.
| | - Ravani Duggan
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia
| | - Lucy Lewis
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia.,Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, PO Box 134, Subiaco, 6904, Western Australia
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia.,Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, PO Box 134, Subiaco, 6904, Western Australia
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