Salutogenic qualities of midwifery care: A best-fit framework synthesis

Being touched by death while giving birth to life: A meta-ethnography exploring women's experiences with postpartum hemorrhage

INTRODUCTION

Postpartum hemorrhage (PPH) is a serious complication following childbirth and the most common cause of maternal mortality globally. Women who survive PPH have an increased risk of enduring long-term physical and psychological consequences. This meta-ethnography aimed to investigate women's experiences of postpartum hemorrhage to develop new insights and understanding of women's needs for care and follow-up after a PPH.

METHODS

A meta-ethnography was carried out in accordance with Noblit and Hare's seven phases and the eMERGe reporting guidance. Comprehensive literature searches were conducted in MEDLINE, CINAHL, and Maternity and Infant Care, in January 2024. A PRISMA flowchart was used to illustrate the search process and quality assessment was performed according to CASP.

RESULTS

Eight studies were included based on specific inclusion criteria. The analysis and synthesis led to the overarching metaphor of 'Being touched by death while giving birth to life' encompassing three main themes. The first theme, 'When death roams by' described women's experiences with PPH as an encounter with death, leading to fear and severe pain. The second theme 'Living on with an emotional scar' indicated how PPH was an experience leaving deep impact in a person. The final theme, 'Healthcare providers as anchors amid the chaos', described that women valued healthcare professionals who demonstrated empathy and good communication skills.

CONCLUSIONS

Our study emphasizes the importance of healthcare providers, particularly midwives, providing empathetic care to aid women in recovering from postpartum hemorrhage.

A mixed methods study protocol to develop an educational program based on salutogenesis theory to improve the postpartum quality of life among nulliparous women

Research on postpartum quality of life (QoL) often focuses on preventing adverse health outcomes rather than promoting positive health and well-being (salutogenesis). While Salutogenesis theory (ST) has been shown to enhance the sense of coherence (SOC), its application in pregnancy and childbirth is limited. This paper presents a mixed-methods protocol for developing a salutogenic educational program to improve postpartum QoL and maternal health outcomes. Data will gather from healthcare centres in Ahvaz city, Khuzestan province, Iran. In the first phase (qualitative approach), nulliparous women's experiences of determinants of postpartum QoL will be explored by semi-structured in-depth interviews. In the second phase literature review will be conducted to identify factors which affected postpartum QoL. In the third phase, the content of the educational program will be developed. In the fourth phase (a Randomized Controlled Trial), 110 nulliparous women will be randomly allocated to intervention and control groups using blocked randomization. Two groups will be compared in terms of primary and secondary outcomes by validated instruments at baseline, immediately after the intervention, 4 weeks, and 8 weeks after delivery.

Development and Validation of the Midwifery Interventions Classification for a Salutogenic Approach to Maternity Care: A Delphi Study

Background/Objectives: This study aims to develop and validate a Midwifery Interventions Classification (MIC), which is an evidence-based, standardized taxonomy and classification of core midwifery interventions based on a salutogenic perspective for maternity care. Methods: This study described the consensus process up to the results regarding the validation of the MIC through a two-round Delphi survey involving three panels of stakeholders: Midwives, Healthcare Researchers, and Maternity Service Users. Results: The resulting MIC comprises 135 core midwifery interventions classified into Direct Midwifery care (n = 80 interventions), Indirect Midwifery Care (n = 43 interventions), and Community Midwifery Care (n = 12 interventions), reaching an overall consensus rate among experts equal to 87%. These interventions were, therefore, adapted specifically for the Italian midwifery care context, with potential for international transferability, implementation, and scalability. Conclusions: The MIC is pivotal to boosting quality improvement, education, and comparable data collection for research, sustaining midwives' role in promoting optimal health for women, newborns, and families at large.

Women's experiences of online antenatal education: An integrative literature review

AIM

To identify what is currently known about how women experience online antenatal education.

DESIGN

Integrative literature review.

REVIEW METHODS

This integrative review applied the five-stage methodological framework outlined by Whittemore and Knafl (2005), supporting rigour in problem identification, selection and critical appraisal of quality literature, data analysis and synthesis of findings.

DATA SOURCES

A literature search was conducted in May/June 2022, utilizing databases including OVID Embase, CINAHL, Joanna Briggs Institute EBP database, Nursing and Allied Health database, Wiley Online Library, Google scholar search engine and related reference lists. The search was limited to English language and primary research articles published in the last 10-year period (2012-2022).

RESULTS

12 articles met inclusion criteria. Three primary themes were identified: Comprehensibility: Looking back - understanding women's needs and preferences; Manageability: In the moment - flexibility versus social connection; and Meaningfulness & sustainability: Looking forward - the future of digital maternity education.

CONCLUSION

Findings identified a marked digital divide for women accessing online antenatal education, placing vulnerable women at risk of continuing inequity. E-health literacy frameworks need to be implemented to create genuine accessibility, comprehensibility and cultural responsiveness to best meet the needs of users.

IMPLICATIONS FOR THE PROFESSION AND/OR HEALTH CARE CONSUMER

As digital health is an emerging field, there is strong evidence that online antenatal education requires further evaluation to better meet the needs of pregnant women and their support people. Enhancing digital health literacy for health professionals will also promote a greater understanding for how to uphold and support the socio-technical dimensions of online service delivery.

PATIENT OR PUBLIC CONTRIBUTION

There were no patient or public contributions as part of this integrative review of the literature.

The perception of childbearing sense of coherence among Chinese couples: a qualitative study

BACKGROUND

Although childbearing health care is wellness-based and promotes normal physiology, it is in a medical model and focuses on risk aversion and disease prevention. The salutogenic theory might provide an alternative perspective to health care concerning childbearing, supporting health-promoting factors, not solely on avoiding adverse events. However, there is a dearth of qualitative research exploring couples' perceptions of childbearing from the salutogenic lens. This study aimed to explore perceptions and experiences concerning childbearing among couples in the perinatal period and identify salutogenic aspects of it.

METHODS

The qualitative descriptive study adopted a directed content analysis to analyse data from a semi-structured and individual interview with 25 purposively selected Chinese couples between July 2022 and December 2022. The concepts of the sense of coherence (SOC) from the salutogenic theory were used as the theory framework for coding.

RESULTS

Definitions and content for the salutogenic aspects of Chinese couples' perception of childbearing sense of coherence were developed. For comprehensibility of childbearing, four subthemes were extracted (the challenge to health and endurance; transition to and identification with the new role; conflict and reconciliation in relationships; resistance and compromise between social culture and personal development). For manageability of childbearing, two subthemes were extracted (helplessness and hope of childbearing; self-doubt and self-assurance of childbearing). For meaningfulness of childbearing, three subthemes were extracted (personal realisation; family bonding and harmony; the continuation of life).

CONCLUSIONS

The findings of this study could give a greater understanding in maintaining couples' health in the perinatal period from the salutogenic lens and provide a guide to further research that the salutogenic theory could bring a health and wellness-focused agenda in practice and policy-making in the perinatal period.

Midwifery care during labor and birth in the United States

The intrapartum period is a crucial time in the continuum of pregnancy and parenting. Events during this time are shaped by individuals' unique sociocultural and health characteristics and by their healthcare providers, practice protocols, and the physical environment in which care is delivered. Childbearing people in the United States have less opportunity for midwifery care than in other high-income countries. In the United States, there are 4 midwives for every 1000 live births, whereas, in most other high-income countries, there are between 30 and 70 midwives. Furthermore, these countries have lower maternal and neonatal mortality rates and have consistently lower costs of care. National and international evidences consistently report that births attended by midwives have fewer interventions, cesarean deliveries, preterm births, inductions of labor, and more vaginal births after cesarean delivery. In addition, midwifery care is consistently associated with respectful care and high patient satisfaction. Midwife-physician collaboration exists along a continuum, including births attended independently by midwives, births managed in consultation with a physician, and births attended primarily by a physician with a midwife acting as consultant on the normal aspects of care. This expert review defined midwifery care and provided an overview of midwifery in the United States with an emphasis on the intrapartum setting. Health outcomes associated with midwifery care, specific models of intrapartum care, and workforce issues have been presented within national and international contexts. Recommendations that align with the integration of midwifery have been suggested to improve national outcomes and reduce pregnancy-related disparities.

An educational programme based on salutogenesis theory on childbirth fear and delivery method among nulliparous women: A mixed methods research protocol

AIM

Designing, executing and testing a training intervention based on enhanced concepts of salutogenesis theory for managing fear of childbirth and choice of delivery method among nulliparous women.

DESIGN

A Sequential-Exploratory Mixed Methods Research.

METHODS

In the first phase (qualitative approach), the determinants of childbirth fear among nulliparous women will be explored. In the second phase (systematic review), the factors of childbirth fear among them will be summarized. In the third phase, the content of the educational intervention is developed based on the common factors of childbirth fear obtained from the previous two phases of the study. In the fourth phase (randomized controlled trial), two intervention and the control groups will be compared based on primary and secondary outcomes.

DISCUSSION

Using salutogenesis theory in a few interventional studies on various health areas has produced promising results. Based on the evidence, women had less sense of coherence with a strong childbirth fear. Therefore, developing an effective intervention based on this theory can probably help manage childbirth fear and reduce the costs of any potential consequences.

Have we lost sight of the women? An observational study about normality-centred care in Australian maternity services

BACKGROUND

Prioritising normal birth has led to harm in some instances in the United Kingdom. While Australian organisations also promote normal birth, its negative impact is less well understood here.

AIMS

This study explores the problems that may arise from the promotion of normal birth and the quality of clinical incident investigations.

MATERIALS AND METHODS

This study uses a survey-based research design and has received 1278 responses. The main outcome measures include perceptions on bias against interventions, delays in interventions, systemic attempts to reduce caesarean rates, and clinical incident investigations.

RESULTS

The perception among both obstetric and midwifery cohorts is that the promotion of normal birth may sometimes or frequently lead to bias against intervention for women (93.8% vs 63.2%), bias against intervention for clinicians (81.1% vs 53.1%), delays in interventions (86.8% vs 37.4%), maternal request caesarean sections being discouraged (81.2% vs 66.9%), an increased emphasis on vaginal birth after caesarean (88.1% vs 69.3%), and a culture of vaginal births 'at all costs' leading to poor outcomes for mothers and babies (79.5% vs 24.7%). Respondents believe clinical incident investigations to be 'frequently' independent (48% vs 48.2%) but engagement of women in these processes is often missing or 'rarely' seen (46.6% vs 51.7%).

CONCLUSIONS

This study finds that Australian maternity healthcare providers believe institutional encouragement of normal birth has created work practices in maternity care that compromise patient safety and reduce the agency of the woman in the choices she makes. Current regulatory standards must change to reflect core ethical and legal obligations around informed consent.

Current Resources for Evidence-Based Practice, September 2021

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes an assessment of safety of birth centers in the United States and commentaries on reviews focused on aspirin prophylaxis in pregnancy and the new gestational weight gain evidence summary from the United States Preventive Services Task Force.

Challenges in using Mental Contrasting with Implementation Intentions (MCII) for preparation for natural birth: A feasibility study

OBJECTIVE

Women who plan a natural birth can benefit from strategies and/or resources that help them prepare for and cope with labour pain. This study aims to identify the feasibility of using Mental Contrasting with Implementation Intentions (MCII) for preparation of primiparous women for natural childbirth. Secondary aims are to test the acceptability of a health-focused information leaflet, and to describe how participants with high natural birth intentions cognitively prepare for birth.

METHODS

In third trimester, ten primiparous women participated in this interventional study with follow-up. A health-focused information leaflet on physiological childbirth, MCII, a mental strategy that helps people achieve a desired goal by envisioning obstacles and how to overcome them, and a researcher-developed questionnaire which contained the CBSEI-C32, was used. Survey data were analysed using a combination of descriptive statistics and deductive theoretical thematic analysis.

RESULTS

The health-focused leaflet was exclusively judged positively. Nine women did not use MCII as instructed, they did not find it helpful for childbirth preparation and wished to have a more positive, health-focused approach towards childbirth. Two themes emerged from the participants' responses: 'the ability to give birth' which was supported through childbirth preparedness, coping strategies, confidence and external supports and 'the uncertainty of giving birth' which included fears and worries about possible adverse events and the baby's health.

CONCLUSION

MCII was not a promising tool for natural childbirth preparation among primiparous women in Germany. Our findings show that women prefer a positive, health-focused approach, rather than thinking about overcoming obstacles, when they prepare for childbirth.