1
|
Cummins A, Gibberd A, McLaughlin K, Foureur M. Midwifery continuity of care for women with perinatal mental health conditions: A cohort study from Australia. Birth 2024. [PMID: 38778777 DOI: 10.1111/birt.12838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/01/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Perinatal mental health (PMH) conditions are associated with adverse outcomes such as maternal suicide, preterm birth and longer-term childhood sequelae. Midwifery continuity of care (one midwife or a small group of midwives) has demonstrated benefits for women and newborns, including a reduction in preterm birth and improvements in maternal anxiety/worry and depression. AIM To determine if midwifery care provided through a Midwifery Group Caseload Practice model is associated with improved perinatal outcomes for women who have anxiety and depression and/or other perinatal mental health conditions. An EPDS ≥ 13, and/or answered the thought of harming myself has occurred to me and/or women who self-reported a history compared to standard models of care (mixed midwife/obstetric fragmented care). METHODS A retrospective cohort study using data routinely collected via an electronic database between 1 January 2018 31st of January 2021. The population were women with current/history of PMH, who received Midwifery Caseload Group Practice (MCP), or standard care (SC). Data were analysed using descriptive statistics for maternal characteristics and logistic regression for birth outcomes. One-to-one matching of the MCP group with the SC group was based on propensity scores. RESULTS 7,359 births were included MCP 12% and SC 88%. Anxiety was the most common PMH with the same proportion affected in MCP and SC. Adjusted odds of preterm birth and adverse perinatal outcomes were lower in the MCP group than the SC group (aOR (95%CI): 0.77 (0.55, 1.08) and 0.81 (0.68, 0.97), respectively) and higher for vaginal birth and full breastfeeding (aOR (95% CI): 1.87 (1.60, 2.18) and 2.06 (1.61, 2.63), respectively). In the matched sample the estimate of a relationship between MCP and preterm birth (aOR (95% CI): 0.88 (0.56, 1.42), adverse perinatal outcomes (aOR (95% CI): 0.83 (0.67, 1.05)) and breastfeeding at discharge (aOR (95% CI): 1.82 (1.30, 2.51)), stronger for vaginal birth (aOR (95% CI): 2.22 (1.77, 2.71)). CONCLUSION This study supports positive associations between MCP and breastfeeding and vaginal birth. MCP was also associated with lower risk of adverse perinatal outcomes, though in the matched sample with a smaller sample size, the confidence interval included 1. The direction of the association MCP and preterm birth was negative (protective). However, in the matched sample analysis, the confidence interval was wide, and the finding was also consistent with no benefit from MCP. Randomised controlled trials are required to answer questions around preterm birth and adverse perinatal outcomes and further research is being planned.
Collapse
Affiliation(s)
- Allison Cummins
- College of Health, Medicine and Wellbeing, School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - Alison Gibberd
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute (HMRI), New Lambton, Australia
| | - Karen McLaughlin
- College of Health, Medicine and Wellbeing, School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - Maralyn Foureur
- College of Health, Medicine and Wellbeing, School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| |
Collapse
|
2
|
Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024; 4:CD004667. [PMID: 38597126 PMCID: PMC11005019 DOI: 10.1002/14651858.cd004667.pub6] [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] [Indexed: 04/11/2024]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016. OBJECTIVES To compare the effects of midwife continuity of care models with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (17 August 2022), as well as the reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife continuity of care models or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion criteria, scientific integrity, and risk of bias, and carried out data extraction and entry. Primary outcomes were spontaneous vaginal birth, caesarean section, regional anaesthesia, intact perineum, fetal loss after 24 weeks gestation, preterm birth, and neonatal death. We used GRADE to rate the certainty of evidence. MAIN RESULTS We included 17 studies involving 18,533 randomised women. We assessed all studies as being at low risk of scientific integrity/trustworthiness concerns. Studies were conducted in Australia, Canada, China, Ireland, and the United Kingdom. The majority of the included studies did not include women at high risk of complications. There are three ongoing studies targeting disadvantaged women. Primary outcomes Based on control group risks observed in the studies, midwife continuity of care models, as compared to other models of care, likely increase spontaneous vaginal birth from 66% to 70% (risk ratio (RR) 1.05, 95% confidence interval (CI) 1.03 to 1.07; 15 studies, 17,864 participants; moderate-certainty evidence), likelyreduce caesarean sections from 16% to 15% (RR 0.91, 95% CI 0.84 to 0.99; 16 studies, 18,037 participants; moderate-certainty evidence), and likely result in little to no difference in intact perineum (29% in other care models and 31% in midwife continuity of care models, average RR 1.05, 95% CI 0.98 to 1.12; 12 studies, 14,268 participants; moderate-certainty evidence). There may belittle or no difference in preterm birth (< 37 weeks) (6% under both care models, average RR 0.95, 95% CI 0.78 to 1.16; 10 studies, 13,850 participants; low-certainty evidence). We arevery uncertain about the effect of midwife continuity of care models on regional analgesia (average RR 0.85, 95% CI 0.79 to 0.92; 15 studies, 17,754 participants, very low-certainty evidence), fetal loss at or after 24 weeks gestation (average RR 1.24, 95% CI 0.73 to 2.13; 12 studies, 16,122 participants; very low-certainty evidence), and neonatal death (average RR 0.85, 95% CI 0.43 to 1.71; 10 studies, 14,718 participants; very low-certainty evidence). Secondary outcomes When compared to other models of care, midwife continuity of care models likely reduce instrumental vaginal birth (forceps/vacuum) from 14% to 13% (average RR 0.89, 95% CI 0.83 to 0.96; 14 studies, 17,769 participants; moderate-certainty evidence), and may reduceepisiotomy 23% to 19% (average RR 0.83, 95% CI 0.77 to 0.91; 15 studies, 17,839 participants; low-certainty evidence). When compared to other models of care, midwife continuity of care models likelyresult in little to no difference inpostpartum haemorrhage (average RR 0.92, 95% CI 0.82 to 1.03; 11 studies, 14,407 participants; moderate-certainty evidence) and admission to special care nursery/neonatal intensive care unit (average RR 0.89, 95% CI 0.77 to 1.03; 13 studies, 16,260 participants; moderate-certainty evidence). There may be little or no difference in induction of labour (average RR 0.92, 95% CI 0.85 to 1.00; 14 studies, 17,666 participants; low-certainty evidence), breastfeeding initiation (average RR 1.06, 95% CI 1.00 to 1.12; 8 studies, 8575 participants; low-certainty evidence), and birth weight less than 2500 g (average RR 0.92, 95% CI 0.79 to 1.08; 9 studies, 12,420 participants; low-certainty evidence). We are very uncertain about the effect of midwife continuity of care models compared to other models of care onthird or fourth-degree tear (average RR 1.10, 95% CI 0.81 to 1.49; 7 studies, 9437 participants; very low-certainty evidence), maternal readmission within 28 days (average RR 1.52, 95% CI 0.78 to 2.96; 1 study, 1195 participants; very low-certainty evidence), attendance at birth by a known midwife (average RR 9.13, 95% CI 5.87 to 14.21; 11 studies, 9273 participants; very low-certainty evidence), Apgar score less than or equal to seven at five minutes (average RR 0.95, 95% CI 0.72 to 1.24; 13 studies, 12,806 participants; very low-certainty evidence) andfetal loss before 24 weeks gestation (average RR 0.82, 95% CI 0.67 to 1.01; 12 studies, 15,913 participants; very low-certainty evidence). No maternal deaths were reported across three studies. Although the observed risk of adverse events was similar between midwifery continuity of care models and other models, our confidence in the findings was limited. Our confidence in the findings was lowered by possible risks of bias, inconsistency, and imprecision of some estimates. There were no available data for the outcomes: maternal health status, neonatal readmission within 28 days, infant health status, and birth weight of 4000 g or more. Maternal experiences and cost implications are described narratively. Women receiving care from midwife continuity of care models, as opposed to other care models, generally reported more positive experiences during pregnancy, labour, and postpartum. Cost savings were noted in the antenatal and intrapartum periods in midwife continuity of care models. AUTHORS' CONCLUSIONS Women receiving midwife continuity of care models were less likely to experience a caesarean section and instrumental birth, and may be less likely to experience episiotomy. They were more likely to experience spontaneous vaginal birth and report a positive experience. The certainty of some findings varies due to possible risks of bias, inconsistencies, and imprecision of some estimates. Future research should focus on the impact on women with social risk factors, and those at higher risk of complications, and implementation and scaling up of midwife continuity of care models, with emphasis on low- and middle-income countries.
Collapse
Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Declan Devane
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, School of Business and Economics, Institute for Lifecourse and Society, University of Galway, Galway, Ireland
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Leanne V Jones
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Hannah Rayment-Jones
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| |
Collapse
|
3
|
Khan Z, Vowles Z, Fernandez Turienzo C, Barry Z, Brigante L, Downe S, Easter A, Harding S, McFadden A, Montgomery E, Page L, Rayment-Jones H, Renfrew M, Silverio SA, Spiby H, Villarroel-Williams N, Sandall J. Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review. Int J Equity Health 2023; 22:131. [PMID: 37434187 DOI: 10.1186/s12939-023-01948-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this population, in high-income countries (HIC). The review aimed to identify and evaluate the current evidence related to targeted health and social care service interventions in HICs which can improve health inequalities experienced by childbearing women and infants at disproportionate risk of poor outcomes and experiences. METHODS Twelve databases searched for studies across all HICs, from any methodological design. The search concluded on 8/11/22. The inclusion criteria included interventions that targeted disadvantaged populations which provided a component of clinical care that differed from standard maternity care. RESULTS Forty six index studies were included. Countries included Australia, Canada, Chile, Hong Kong, UK and USA. A narrative synthesis was undertaken, and results showed three intervention types: midwifery models of care, interdisciplinary care, and community-centred services. These intervention types have been delivered singularly but also in combination of each other demonstrating overlapping features. Overall, results show interventions had positive associations with primary (maternal, perinatal, and infant mortality) and secondary outcomes (experiences and satisfaction, antenatal care coverage, access to care, quality of care, mode of delivery, analgesia use in labour, preterm birth, low birth weight, breastfeeding, family planning, immunisations) however significance and impact vary. Midwifery models of care took an interpersonal and holistic approach as they focused on continuity of carer, home visiting, culturally and linguistically appropriate care and accessibility. Interdisciplinary care took a structural approach, to coordinate care for women requiring multi-agency health and social services. Community-centred services took a place-based approach with interventions that suited the need of its community and their norms. CONCLUSION Targeted interventions exist in HICs, but these vary according to the context and infrastructure of standard maternity care. Multi-interventional approaches could enhance a targeted approach for at risk populations, in particular combining midwifery models of care with community-centred approaches, to enhance accessibility, earlier engagement, and increased attendance. TRIAL REGISTRATION PROSPERO Registration number: CRD42020218357.
Collapse
Affiliation(s)
- Zahra Khan
- Department of Women & Children's Health, King's College London, London, UK.
| | - Zoe Vowles
- Department of Women & Children's Health, King's College London, London, UK
| | | | - Zenab Barry
- Patient and Public Involvement and Engagement, NIHR ARC South London, London, UK
| | | | - Soo Downe
- University of Central Lancashire, Lancashire, UK
| | - Abigail Easter
- Department of Women & Children's Health, King's College London, London, UK
| | - Seeromanie Harding
- Department of Population Health Sciences, King's College London, London, UK
| | | | | | | | | | | | - Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK
| | | | | | - Jane Sandall
- Department of Women & Children's Health, King's College London, London, UK
| |
Collapse
|
4
|
Cummins A, Baird K, Melov SJ, Melhem L, Hilsabeck C, Hook M, Elhindi J, Pasupathy D. Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia. Women Birth 2023; 36:e270-e275. [PMID: 35941058 DOI: 10.1016/j.wombi.2022.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Perinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions. AIM To compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth. METHODS A retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 - 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care. RESULTS The cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24-0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93-3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10-4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57-1.09). CONCLUSIONS This evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.
Collapse
Affiliation(s)
- Allison Cummins
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia.
| | - Kathleen Baird
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia
| | - Sarah J Melov
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, NSW, Australia
| | - Lena Melhem
- Women's and Newborn's Health, Westmead Hospital, Western Sydney Local Health Districts, Australia
| | - Carolyn Hilsabeck
- Women's and Newborn's Health, Westmead Hospital, Western Sydney Local Health Districts, Australia
| | - Monica Hook
- Women's and Newborn's Health, Westmead Hospital, Western Sydney Local Health Districts, Australia
| | - James Elhindi
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, NSW, Australia
| |
Collapse
|
5
|
Lawther L, Close C. Socioeconomic, ethnic inequalities and adverse pregnancy outcomes: time for the disparities to disappear. Evid Based Nurs 2023; 26:42. [PMID: 36198475 DOI: 10.1136/ebnurs-2022-103514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Lorna Lawther
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, County Down, UK
| | - Ciara Close
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, County Down, UK
| |
Collapse
|
6
|
Simoncic V, Deguen S, Enaux C, Vandentorren S, Kihal-Talantikite W. A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416592. [PMID: 36554473 PMCID: PMC9779203 DOI: 10.3390/ijerph192416592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 05/12/2023]
Abstract
Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.
Collapse
Affiliation(s)
- Valentin Simoncic
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
- Correspondence:
| | - Séverine Deguen
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
| | - Christophe Enaux
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
| | - Stéphanie Vandentorren
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
- Santé Publique France, French National Public Health Agency, 94410 Saint-Maurice, France
| | - Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
| |
Collapse
|
7
|
Rayment-Jones H, Harris J, Harden A, Turienzo CF, Sandall J. Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation. Women Birth 2022; 36:e314-e327. [PMID: 36443217 DOI: 10.1016/j.wombi.2022.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. AIM To evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. METHODS Realist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. FINDINGS Experiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women's anxiety, enabled the development of a supportive network and improved women's ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. CONCLUSION The identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole.
Collapse
|
8
|
Dube M, Gao Y, Steel M, Bromley A, Ireland S, Kildea S. Effect of an Australian community-based caseload midwifery group practice service on maternal and neonatal outcomes for women from a refugee background. Women Birth 2022; 36:e353-e360. [PMID: 36344389 DOI: 10.1016/j.wombi.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Women from a refugee background who resettle in high-income countries experience poorer perinatal outcomes in comparison to women from host countries. There is a paucity of research on how best to improve these outcomes. AIM To report on the effectiveness of an Australian Refugee Midwifery Group Practice service on perinatal outcomes. METHODS We used inverse probability of treatment weighting to balance confounders and calculate treatment effect and compare maternal and neonatal outcomes for women from a refugee background who received Refugee Midwifery Group Practice care (n = 625), to those receiving standard care (n = 634) at a large tertiary hospital (1 January 2016-31 December 2019). Prespecified primary outcomes included: proportion of women attending ≥ 5 antenatal visits, preterm birth (<37 weeks), spontaneous onset of labour, epidural analgesia in the first stage of labour, normal birth (term, spontaneous onset, vertex, spontaneous vaginal birth, no epidural, no episiotomy), and exclusively breast-feeding at discharge. FINDINGS Women who received Refugee Midwifery Group Practice care were more likely to have spontaneous onset of labour (adjusted odds ratio 2·20, 95% CI 1·71-2·82; p < 0·0001), normal birth (1·55, 1·23-1·95; p < 0·0001), and less likely to use epidural analgesia (0·67, 0·50-0·89; p = 0·0067) and have a preterm baby (0·60, 0·36-0·99; p = 0·047). There was no difference between groups in women attending ≥ 5 antenatal visits and exclusive breastfeeding at discharge from hospital. DISCUSSION A Refugee Midwifery Group Practice is feasible and clinically effective. CONCLUSION Similar services could potentially improve outcomes for women from a refugee background who resettle in high-income countries.
Collapse
Affiliation(s)
- Mpho Dube
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Michelle Steel
- Mater Mothers Hospital, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Angela Bromley
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sarah Ireland
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia.
| |
Collapse
|
9
|
Vedam S, Titoria R, Niles P, Stoll K, Kumar V, Baswal D, Mayra K, Kaur I, Hardtman P. Advancing quality and safety of perinatal services in India: opportunities for effective midwifery integration. Health Policy Plan 2022; 37:1042-1063. [PMID: 35428886 PMCID: PMC9469892 DOI: 10.1093/heapol/czac032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/12/2022] Open
Abstract
India has made significant progress in improving maternal and child health. However, there are persistent disparities in maternal and child morbidity and mortality in many communities. Mistreatment of women in childbirth and gender-based violence are common and reduce women's sense of safety. Recently, the Government of India committed to establishing a specialized midwifery cadre: Nurse Practitioners in Midwifery (NPMs). Integration of NPMs into the current health system has the potential to increase respectful maternity care, reduce unnecessary interventions, and improve resource allocation, ultimately improving maternal-newborn outcomes. To synthesize the evidence on effective midwifery integration, we conducted a desk review of peer-reviewed articles, reports and regulatory documents describing models of practice, organization of health services and lessons learned from other countries. We also interviewed key informants in India who described the current state of the healthcare system, opportunities, and anticipated challenges to establishing a new cadre of midwives. Using an intersectional feminist theoretical framework, we triangulated the findings from the desk review with interview data to identify levers for change and recommendations. Findings from the desk review highlight that benefits of midwifery on outcomes and experience link to models of midwifery care, and limited scope of practice and prohibitive practice settings are threats to successful integration. Interviews with key informants affirm the importance of meeting global standards for practice, education, inter-professional collaboration and midwifery leadership. Key informants noted that the expansion of respectful maternity care and improved outcomes will depend on the scope and model of practice for the cadre. Domains needing attention include building professional identity; creating a robust, sustainable education system; addressing existing inter-professional issues and strengthening referral and quality monitoring systems. Public and professional education on midwifery roles and scope of practice, improved regulatory conditions and enabling practice environments will be key to successful integration of midwives in India.
Collapse
Affiliation(s)
- Saraswathi Vedam
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Reena Titoria
- Population Health Observatory, Fraser Health Authority, Suite 400, Central City Tower 13450 – 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Paulomi Niles
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010, USA
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Vishwajeet Kumar
- Community Empowerment Lab, 26/11 Wazir Hasan Road, Gokhale Marg, Lucknow, UP 226001, India
| | - Dinesh Baswal
- MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, New Delhi 110048, India
| | - Kaveri Mayra
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Inderjeet Kaur
- Fernandez Foundation, Fernandez Hospital, 4-1-120, Bogulkunta, Hyderabad 500001, India
| | - Pandora Hardtman
- Johns Hopkins Program for International Education in Gynecology and Obstetrics, John Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA
| |
Collapse
|
10
|
Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents. CHILDREN 2022; 9:children9071077. [PMID: 35884061 PMCID: PMC9324486 DOI: 10.3390/children9071077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022]
Abstract
Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes in the U.S. The purpose of this study was to determine the rural availability of evidence-based supports and services that promote maternal and infant health. We developed and conducted a national survey of a sample of rural hospitals. We determined for each responding hospital the county-level scores on the 2018 CDC Social Vulnerability Index (SVI). The sample’s (n = 93) median SVI score [IQR] was 0.55 [0.25–0.88]; for majority-BIPOC counties (n = 29) the median SVI score was 0.93 [0.88–0.98] compared with 0.38 [0.19–0.64] for majority-White counties (n = 64). Among counties where responding hospitals were located, 86.2% located in majority-BIPOC counties ranked in the most socially vulnerable quartile of counties nationally (SVI ≥ 0.75), compared with 14.1% of majority-White counties. In analyses adjusted for geography and hospital size, certified lactation support (aOR 0.36, 95% CI 0.13–0.97), midwifery care (aOR 0.35, 95% CI 0.12–0.99), doula support (aOR 0.30, 95% CI 0.11–0.84), postpartum support groups (aOR 0.25, 95% CI 0.09–0.68), and childbirth education classes (aOR 0.08, 95% CI 0.01–0.69) were significantly less available in the most vulnerable counties compared with less vulnerable counties. Residents in the most socially vulnerable rural counties, many of whom are BIPOC and thus at higher risk for poor birth outcomes, are significantly less likely to have access to evidence-based supports for maternal and infant health.
Collapse
|
11
|
Stacey T, Samples J, Leadley C, Akester L, Jenney A. 'I don't need you to criticise me, I need you to support me'. A qualitative study of women's experiences of and attitudes to smoking cessation during pregnancy. Women Birth 2022; 35:e549-e555. [PMID: 35115246 DOI: 10.1016/j.wombi.2022.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Smoking is associated with health inequalities and is the most important modifiable risk factor for poor outcome in pregnancy. AIM To explore women's experiences of smoking during pregnancy, examine their attitudes and barriers to smoking cessation, and to discover what support they feel might enable them to have a smoke-free pregnancy in future. METHODS A qualitative study was conducted with nineteen women in the United Kingdom who had smoked at some stage in pregnancy during the last five years. Data were collected through in-depth telephone interviews between June and August 2021. The interviews were audio-recorded, transcribed verbatim, and thematically analysed. FINDINGS Four key themes were identified: the complex relationship with smoking, being ready to quit, the need for support and understanding, and ideas to support a smoke free pregnancy. The findings revealed that there were two distinct avenues for enabling the support process: encouraging a readiness to quit through identifying individual context, personalised support, and educational risk perception, and, supporting the process of quitting, and offering a range of options, underpinned by a personalised, non-judgemental approach. CONCLUSION Smoking in pregnancy is a complex issue resulting from a combination of social, emotional, and physical factors. The findings from this study suggest that a combination of approaches should be made available to enable pregnant women who smoke to select the best options for their individual needs. Irrespective of the practical support offered, there is a need for informed, sensitive, individualised support system that women can identify with.
Collapse
Affiliation(s)
- Tomasina Stacey
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, UK.
| | - Jayne Samples
- University of Huddersfield, School of Health and Human Science, UK
| | - Chelsea Leadley
- University of Huddersfield, School of Health and Human Science, UK
| | | | | |
Collapse
|