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Nouwens SPH, Veldwijk J, Pilli L, Swait JD, Coast J, de Bekker-Grob EW. A socially interdependent choice framework for social influences in healthcare decision-making: a study protocol. BMJ Open 2024; 14:e079768. [PMID: 38458790 DOI: 10.1136/bmjopen-2023-079768] [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: 03/10/2024] Open
Abstract
OBJECTIVES Current choice models in healthcare (and beyond) can provide suboptimal predictions of healthcare users' decisions. One reason for such inaccuracy is that standard microeconomic theory assumes that decisions of healthcare users are made in a social vacuum. Healthcare choices, however, can in fact be (entirely) socially determined. To achieve more accurate choice predictions within healthcare and therefore better policy decisions, the social influences that affect healthcare user decision-making need to be identified and explicitly integrated into choice models. The purpose of this study is to develop a socially interdependent choice framework of healthcare user decision-making. DESIGN A mixed-methods approach will be used. A systematic literature review will be conducted that identifies the social influences on healthcare user decision-making. Based on the outcomes of a systematic literature review, an interview guide will be developed that assesses which, and how, social influences affect healthcare user decision-making in four different medical fields. This guide will be used during two exploratory focus groups to assess the engagement of participants and clarity of questions and probes. The refined interview guide will be used to conduct the semistructured interviews with healthcare professionals and users. These interviews will explore in detail which, and how, social influences affect healthcare user decision-making. Focus group and interview transcripts will be analysed iteratively using a constant comparative approach based on a mix of inductive and deductive coding. Based on the outcomes, a social influence independent choice framework for healthcare user decision-making will be drafted. Finally, the Delphi technique will be employed to achieve consensus about the final version of this choice framework. ETHICS AND DISSEMINATION This study was approved by the Erasmus School of Health Policy and Management Research Ethics Review Committee (ESHPM, Rotterdam, The Netherlands; reference ETH2122-0666).
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Affiliation(s)
- Sven P H Nouwens
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Luis Pilli
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Joffre D Swait
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Joanna Coast
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Esther W de Bekker-Grob
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
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Palau-Costafreda R, García Gumiel S, Eles Velasco A, Jansana-Riera A, Orus-Covisa L, Hermida González J, Algarra Ramos M, Canet-Vélez O, Obregón Gutiérrez N, Escuriet R. The first alongside midwifery unit in Spain: A retrospective cohort study of maternal and neonatal outcomes. Birth 2023; 50:1057-1067. [PMID: 37589398 DOI: 10.1111/birt.12749] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/07/2022] [Accepted: 06/28/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Midwife-led units have been shown to be safer and reduce interventions for women at low risk of complications at birth. In 2017, the first alongside birth center was opened in Spain. The aim of this study was to compare outcomes for women with uncomplicated pregnancies giving birth in the Midwife-led unit (MLU) and in the Obstetric unit (OU) of the same hospital. METHODS Retrospective cohort study comparing birth outcomes between low-risk women, depending on their planned place of birth. Data were analyzed with an intention-to-treat approach for women that gave birth between January 2018 and December 2020. RESULTS A total of 878 women were included in the study, 255 women chose to give birth in the MLU and 623 in the OU. Findings showed that women in the MLU were more likely to have a vaginal birth (91.4%) than in the OU (83.8%) (aOR 2.98 [95%CI 1.62-5.47]), less likely to have an instrumental delivery, 3.9% versus 11.2% (0.25 [0.11-0.55]), to use epidural analgesia, 19.6% versus 77.9% (0.15 [0.04-0.17]) and to have an episiotomy, 7.4% versus 15.4% (0.27 [0.14-0.53]). There were no differences in rates of postpartum hemorrhage, retained placenta, or adverse neonatal outcomes. Intrapartum and postpartum transfer rates from the MLU to the OU were 21.1% and 2.4%, respectively. CONCLUSIONS The high rate of obstetric interventions in Spain could be reduced by implementing midwife-led units across the whole system, without an increase in maternal or neonatal complications.
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Affiliation(s)
- Roser Palau-Costafreda
- Biomedicine Programme, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra - affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Sara García Gumiel
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Amaranta Eles Velasco
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Anna Jansana-Riera
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain
| | - Lluna Orus-Covisa
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Júlia Hermida González
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Miriam Algarra Ramos
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Olga Canet-Vélez
- Department of Nursing, Faculty of Health Sciences, Universitat Ramon Llull, Barcelona, Spain
| | | | - Ramón Escuriet
- Directorate General of Health Planning, Ministry of Health of the Government of Catalonia, Barcelona, Spain
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Neerland CE, Delkoski SL, Skalisky AE, Avery MD. Prenatal care in US birth centers: Midwives' perceptions of contributors to birthing People's confidence in physiologic birth. Birth 2023; 50:535-545. [PMID: 36226921 DOI: 10.1111/birt.12676] [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: 09/10/2021] [Revised: 07/19/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to describe US freestanding birth center models of prenatal care and to examine how the components of this care contribute to birthing people's confidence in their ability to have a physiologic birth. DESIGN This was a qualitative descriptive study utilizing semi-structured interviews with birth center midwives. Data were analyzed using thematic analysis, constant comparative method and consensus coding to ensure rigor. SETTING AND PARTICIPANTS Midwives from six urban and rural freestanding birth centers in a Midwestern US state were interviewed. Twelve birth center midwives participated. FINDINGS Six themes emerged: the birth center physical space and organization of care, dimensions of midwifery care within the birth center, continuity of care and seamless service, the empowered birthing person, physiologic birth as normative, and the hospital paradigm and US cultures of birth. KEY CONCLUSIONS We identified significant components of birth center models of prenatal care that midwives believe enhance birthing people's confidence for physiologic childbirth. These components may be considered for application to other settings and may improve perinatal care and outcomes.
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Affiliation(s)
- Carrie E Neerland
- The University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | | | - Arielle E Skalisky
- The University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Melissa D Avery
- The University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
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Baquero A. Is Customer Satisfaction Achieved Only with Good Hotel Facilities? A Moderated Mediation Model. ADMINISTRATIVE SCIENCES 2023. [DOI: 10.3390/admsci13040108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Modern hotel business models tend to split ownership of the property and its business operations. It can be assumed that a good-quality hotel facility per se can easily achieve high customer satisfaction. The purpose of this research was to investigate the effect of customer perception of hotel facilities on customer satisfaction by integrating the mediating effect of customer perception of the personnel and business organization and the moderating effect of the customers’ family income. Three-hundred and seventy-six surveys were completed in two four-star Spanish hotels in June 2022. The PROCESS macro for SPSS was used to test the hypothesis in a moderated mediation model, using a bootstrapping method. The results showed that customer perceptions of facilities had a positive effect on their overall satisfaction, which was partially mediated by both personnel and business organization. Family income moderated the relationship between the perception of facilities and satisfaction in such a way that it was more intense in high-income customers. Medium-income customers had a more intense relationship with the perception of the personnel and business organization, together with the hotel facilities being to their satisfaction. Therefore, not only facilities, but also personnel and business organizations are important key players for achieving customer satisfaction in hotels, and family income should also be considered.
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Affiliation(s)
- Asier Baquero
- Faculty of Business and Communication, International University of La Rioja, 26006 Logrono, Spain
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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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Lindgren H, Erlandsson K. The MIDWIZE conceptual framework: a midwife-led care model that fits the Swedish health care system might after contextualization, fit others. BMC Res Notes 2022; 15:306. [PMID: 36138471 PMCID: PMC9503192 DOI: 10.1186/s13104-022-06198-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Familiarity with the unique tradition and experience of Swedish midwives during the more than 300 years in which midwife-led care has contributed to one of the lowest maternal and neonatal mortality and morbidity ratio in the world might encourage professionals in other countries to follow the Swedish example. The framework described below, reflecting the midwife's role in the Swedish health care system, might, after implementation, strengthen maternal and neonatal outcomes if contextualized to other settings. RESULTS Using a four-step procedure we identified our topic, made a literature review, identified the key components and their internal relationship, and finally developed the MIDWIZE conceptual framework. In this framework, the midwives in collaboration with obstetricians, provide evidence-based care with continuous quality improvements during the whole reproductive life cycle. Teamwork including specialists for referral and a responsive, relational, trust-based practice is the foundation for provision of midwife-led care for healthy women with a normal pregnancy. The well-educated midwife, of high academic standard, promoting gender equality and equity is the hub in the team and the primary care provider.
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Affiliation(s)
- Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Department of Health, Care and Wellbeing, Dalarna University, Falun, Sweden
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Murray-Davis B, Grenier LN, Mattison CA, Malott A, Cameron C, Hutton EK, Darling EK. Promoting safety and role clarity among health professionals on Canada's First Alongside Midwifery Unit (AMU): A mixed-methods evaluation. Midwifery 2022; 111:103366. [DOI: 10.1016/j.midw.2022.103366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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Lessons learned from the implementation of Canada's first alongside midwifery unit: A qualitative explanatory study. Midwifery 2021; 103:103146. [PMID: 34592575 DOI: 10.1016/j.midw.2021.103146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/03/2021] [Accepted: 09/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In July 2018, Canada's first midwife-led alongside midwifery unit (AMU) opened at Markham Stouffville Hospital (MSH) in Markham, Ontario. Our objectives were to examine how the conditions at MSH made it possible for the hospital to create the first AMU in Canada and to identify lessons to inform spread by examining how characteristics of the intervention, the inner and outer settings, the individuals involved, and the processes used influenced the MSH-AMU implementation process. METHODS We conducted key informant interviews and document analysis using Yin's research methods. We used the Consolidated Framework for Implementation Research to conceptualize the study and develop semi-structured interview guides. We recruited key informants, including midwives and other health professionals, hospital leaders, leaders of midwifery organizations, and consumers, by email using both purposive and respondent driven sampling. Interviews were digitally recorded and professionally transcribed. We identified documents through key informants and searches of Nexis Uni, Hansard, and Google databases. We analyzed the data using a coding framework based on Greenhalgh et al.'s evidence-informed theory of the diffusion of innovations. RESULTS Between November 2018 and February 2019, we conducted fifteen key informant interviews. We identified thirteen relevant documentary sources of evidence, including news media coverage, website content, Ontario parliamentary records, and hospital documents. Conditions that influenced implementation of the AMU fell within the following domains from Greenhalgh's diffusion of innovations theory: the innovation, the outer context, the inner context - system antecedents for innovation and system readiness for innovation, communication and influence, linkage - design phase and implementation stage, and the implementation process. While several unique features of MSH supported innovation, factors that could be adopted elsewhere include organizational investment in the development of midwifery leadership skills, intentional use of change management theory, broad stakeholder involvement in the design and implementation processes, and frequent, open communication. CONCLUSIONS The example of the MSH-AMU illustrates the value of utilizing best practices with respect to change management and system transformation and demonstrates the potential value of using implementation theory to drive the successful implementation of AMUs. Lessons learned from the MSH-AMU can inform successful spread of this innovative service model.
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Callander EJ, Bull C, McInnes R, Toohill J. The opportunity costs of birth in Australia: Hospital resource savings for a post-COVID-19 era. Birth 2021; 48:274-282. [PMID: 33580537 PMCID: PMC8014177 DOI: 10.1111/birt.12538] [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] [Received: 08/04/2020] [Revised: 11/03/2020] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND COVID-19 caused significant disruptions to health systems globally; however, restricting the family presence during birth saw an increase in women considering community birth options. This study aimed to quantify the hospital resource savings that could occur if all low-risk women in Australia gave birth at home or in birth centers. METHODS A whole-of-population linked administrative data set containing all women (n = 44 498) who gave birth in Queensland, Australia, between 01/07/2012 and 30/06/2015 was reweighted to represent all Australian women giving birth in 2017. A static microsimulation model of woman and infant health service resource use was created based on 2017 data. The model was comprised of a base model, representing "current" care, and a counterfactual model, representing hypothetical scenarios where all low-risk Australian women gave birth at home or in birth centers. RESULTS If all low-risk women gave birth at home in 2017, cesarean rates would have reduced from 13.4% to 2.7%. Similarly, there would have been 860 fewer inpatient bed days and 10.1 fewer hours of women's intensive care unit time per 1000 births. If all women gave birth in birth centers, cesarean rates would have reduced to 6.7%. In addition, over 760 inpatient bed days would have been saved along with 5.6 hours of women's intensive care unit time per 1000 births. CONCLUSIONS Significant health resource savings could occur by shifting low-risk births from hospitals to home birth and birth center services. Greater examination of Australian women's preferences for home birth and birth center birth models of care is needed.
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Affiliation(s)
- Emily J. Callander
- Faculty of Medicine, Nursing and Health SciencesSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Claudia Bull
- School of Nursing and MidwiferyGriffith UniversityGold CoastQLDAustralia
| | - Rhona McInnes
- School of Nursing and MidwiferyGriffith UniversityGold CoastQLDAustralia
| | - Jocelyn Toohill
- Clinical Excellence DivisionQueensland HealthBrisbaneQLDAustralia
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Adelson P, Fleet JA, McKellar L, Eckert M. Two decades of Birth Centre and midwifery-led care in South Australia, 1998-2016. Women Birth 2020; 34:e84-e91. [PMID: 32518041 DOI: 10.1016/j.wombi.2020.05.005] [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: 02/13/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Birth Centres (BC) are underpinned by a philosophy of woman- centred care and were pivotal in growing models of midwifery-led care in South Australia (SA). AIM To describe BC utilisation and the growth of midwifery-led care in SA over the past two decades. METHODS The SA Perinatal Statistics Collection was used to describe women birthing from 1998 to 2016. Number of births through midwifery-led services from 2004 to 2016 were obtained from unit managers. Analyses are descriptive. FINDINGS Women who birthed in BC in SA from 1998 to 2016 comprised approximately 6% of all births per year, and numbers have remained static. Three BC models operate in SA, all with different capacity. Proportionally, women not born in Australia are as likely to birth in BC as labour wards. The proportion of women who received midwifery-led care (whether affiliated with a BC or not), increased from 8.3% in 1998 to 19.2% of all births in 2016. Of the women who received midwifery-led care in 2016, 15.3% went on to birth in a midwifery-led model of care. CONCLUSION Whilst the overall number of BC births has not increased, women seeking midwifery-led care has more than doubled over the past two decades. BC encompass the midwifery philosophy, quality of care, and a physical home-like environment. The BC models in SA are managed through the three tertiary maternity units enabling women to access publicly funded midwifery care and should be more widely available.
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Affiliation(s)
- Pamela Adelson
- Rosemary Bryant AO Research Centre, Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia.
| | - Julie-Anne Fleet
- Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Lois McKellar
- Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
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Abstract
Background Midwifery-led care is a high-certainty, evidence-based strategy to improve maternity care. Midwife-led units (MLUs) are one example of how the midwifery model of care is being integrated into existing health systems to transform maternal health around the world. Purpose To promote global investment in MLUs by describing the benefits, current advances and future directions of this model of care. Method A viewpoint based on prevalent notions of midwifery, research findings, guidance from professional organizations and authors' professional experience. Conclusion Renewed commitment to research and the implementation of MLUs across a variety of settings is needed to address the practice, education and policy issues associated with this evidence-based strategy. The World Health Organization "Year of the Nurse and Midwife-2020" is an opportune time to invest in midwifery models of care that are fundamental to achieving core global health initiatives such as Universal Healthcare 2030.
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Bączek G, Tataj-Puzyna U, Sys D, Baranowska B. Freestanding Midwife-Led Units: A Narrative Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:181-188. [PMID: 32724762 PMCID: PMC7299417 DOI: 10.4103/ijnmr.ijnmr_209_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/04/2020] [Accepted: 03/09/2020] [Indexed: 11/04/2022]
Abstract
Background Strengthening of midwives' position and support for freestanding birth centers, frequently referred to as Freestanding Midwife-led Units (FMUs), raise hopes for a return to humanized labor. Our study aimed to review published evidence regarding FMUs to systematize the knowledge of their functioning and to identify potential gaps in this matter. Materials and Methods A structured integrative review of theoretical papers and empirical studies was conducted. The literature search included MEDLINE, Cochrane, Scopus, and Embase databases. The analysis included papers published in 1977-2017. Relevant documents were identified using various combinations of search terms and standard Boolean operators. The search included titles, abstracts, and keywords. Additional records were found through a manual search of reference lists from extracted papers. Results Overall, 56 out of 107 originally found articles were identified as eligible for the review. Based on the critical analysis of published data, six groups of research problems were identified and discussed, namely, 1) specifics of FMUs, 2) costs of perinatal care at FMUs, 3) FMUs as a place for midwife education, 4) FMUs from midwives' perspective, 5) perinatal, maternal, and neonatal outcomes, and 6) FMUs from the perspective of a pregnant woman. Conclusions FMUs offers a home-like environment and complex midwifery support for women with uncomplicated pregnancies. Although emergency equipment is available as needed, FMU birth is considered a natural spontaneous process. Midwives' supervision over low-risk labors may provide many benefits, primarily related to lower medicalization and fewer medical interventions than in a hospital setting.
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Affiliation(s)
- Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Warszawa, Poland
| | - Urszula Tataj-Puzyna
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Warszawa, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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Home and Birth Center Birth in the United States: Time for Greater Collaboration Across Models of Care. Obstet Gynecol 2020; 133:1033-1050. [PMID: 31022111 DOI: 10.1097/aog.0000000000003215] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There has been a small, but significant, increase in community births (home and birth-center births) in the United States in recent years. The rate increased by 20% from 2004 to 2008, and another 59% from 2008 to 2012, though the overall rate is still low at less than 2%. Although the United States is not the only country with a large majority of births occurring in the hospital, there are other high-resource countries where home and birth-center birth are far more common and where community midwives (those attending births at home and in birth centers) are far more central to the provision of care. In many such countries, the differences in perinatal outcomes between hospital and community births are small, and there are lower rates of maternal morbidity in the community setting. In the United States, perinatal mortality appears to be higher for community births, though there has yet to be a national study comparing outcomes across settings that controls for planned place of birth. Rates of intervention, including cesarean delivery, are significantly higher in hospital births in the United States. Compared with the United States, countries that have higher rates of community births have better integrated systems with clearer national guidelines governing risk criteria and planned birth location, as well as transfer to higher levels of care. Differences in outcomes, systems, approaches, and client motivations are important to understand, because they are critical to the processes of person-centered care and to risk reduction across all birth settings.
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Cheyney M, Bovbjerg ML, Leeman L, Vedam S. Community Versus Out-of-Hospital Birth: What's in a Name? J Midwifery Womens Health 2019; 64:9-11. [DOI: 10.1111/jmwh.12947] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Melissa Cheyney
- Department of Anthropology; Oregon State University; Corvallis Oregon
| | - Marit L. Bovbjerg
- Epidemiology Program, College of Public Health & Human Sciences; Oregon State University; Corvallis Oregon
| | - Lawrence Leeman
- Department of Family and Community Medicine and Department of Obstetrics and Gynecology; University of New Mexico School of Medicine; Albuquerque New Mexico
| | - Saraswathi Vedam
- Division of Midwifery, Department of Family Practice; University of British Columbia; Vancouver British Columbia
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Organising safe and sustainable care in alongside midwifery units: Findings from an organisational ethnographic study. Midwifery 2018; 65:26-34. [DOI: 10.1016/j.midw.2018.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/18/2022]
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Wiegers TA, Hermus MA, Verhoeven CJ, Rijnders ME, van der Pal-de Bruin KM. Job satisfaction of maternity care providers in the Netherlands: Does working in or with a birth centre influence job satisfaction? Eur J Midwifery 2018; 2:11. [PMID: 33537572 PMCID: PMC7846039 DOI: 10.18332/ejm/94279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In the Netherlands birth centres have recently become an alternative option as places where women with uncomplicated pregnancies can give birth. This article focusses on the job satisfaction of three groups of maternity care providers (community midwives, clinical care providers and maternity care assistants) working in or with a birth centre compared to those working only in a hospital or at home. METHODS In 2015, an existing questionnaire was adapted and distributed to maternity care providers and 4073 responses were received. Using factor analyses, two composite measures were constructed, a Composite Job Satisfaction scale and an Assessment-of-Working-in-or-with-a-Birth-Centre scale. Differences between groups were tested with Student’s t-test and MANOVA with post hoc test and linear regression analyses. RESULTS The overall score on the Composite Job Satisfaction scale did not differ between community midwives or clinical care providers working in or with a birth centre and those working in a different setting. For maternity care assistants there was a small but significantly higher score for those not working in a birth centre. Maternity care assistants’ overall job satisfaction score was higher than that of both other groups. In a linear regression analysis working or not working in or with a birth centre was related to the overall job satisfaction score, but repeated for the three professional groups separately, this relation was only found for maternity care assistants. CONCLUSIONS Job satisfaction is generally high, but, except for maternity care assistants, not related to the setting (working or not working in or with a birth centre).
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Affiliation(s)
- Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research), The Netherlands
| | - Marieke A Hermus
- Department of Child Health, TNO, The Netherlands, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands, Midwifery Practice Verloskundigen Oosterhout, The Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam, Public Health Research Institute, VU University Medical Center, Amsterdam, Department of Obstetrics and Gynaecology Maxima Medical Centre, Veldhoven, The Netherlands
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Boesveld IC, Hermus MAA, van der Velden-Bollemaat EC, Hitzert M, de Graaf HJ, Franx A, Wiegers TA. An approach to assessing the quality of birth centres results of the Dutch birth centre study. Midwifery 2018; 66:36-48. [PMID: 30121477 DOI: 10.1016/j.midw.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/10/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE to determine the usability of a recently developed set of 30 structure and process birth centre quality indicators. DESIGN an explorative study using mixed-methods including literature, a survey, interviews and observations. The study is part of the Dutch Birth Centre Study. We first determined the measurability of birth centre quality indicators by describing them in detail. Next, we assessed the birth centres in the Netherlands according to these indicators using data derived from the Dutch Birth Centre General Questionnaire, the Dutch Birth Centre Integration Questionnaire, interviews, and policy documents. SETTING AND PARTICIPANTS representatives of 23 birth centres in the Netherlands. MEASUREMENTS AND FINDINGS 28 of the 30 quality indicators could be used to assess birth centres in the Netherlands, one had no optimal value defined, another could not be scored because the information was not available. Each quality indicator could be scored 0 or 1. Differences between birth centres were shown: the scores ranged from 7 to 22. Some of the quality indicators can be combined or made more specific so that they are easier to assess. Some quality indicators need adaptation because they are only applicable for some birth centres (e.g. only for freestanding or alongside birth centres). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE 28 of the 30 quality indicators are usable to assess structure and process quality of birth centres. With the findings of this study the set of structure and process quality indicators for birth centres in the Netherlands can be reduced to 22 indicators. This set of quality indicators can contribute to the development of a quality system for birth centres. Further research is necessary to formulate standards or minimum quality requirements for birth centres and to improve the set of birth centre quality indicators.
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Affiliation(s)
- Inge C Boesveld
- Jan van Es Institute (Netherlands Expert Centre Integrated Primary Care), Wisselweg 33, 1314 CB Almere, The Netherlands.
| | - Marieke A A Hermus
- Department of Child Health, TNO, PO Box 2215, 2301 CE Leiden, The Netherlands; Department of Obstetrics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands; Midwifery Practice Trivia, Werkmansbeemd 2, 4907 EW Oosterhout, The Netherlands
| | | | - Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014, 3000 CA Rotterdam, The Netherlands
| | - Hanneke J de Graaf
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014, 3000 CA Rotterdam, The Netherlands
| | - Arie Franx
- Division Woman and Baby, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, the The Netherlands
| | - Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
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Hitzert M, Boesveld IC, Hermus MAA, de Graaf JP, Wiegers TA, Steegers EAP, Meijboom BR, Akkermans HA. Quality improvement opportunities for handover practices in birth centres: A case study from a process perspective. J Eval Clin Pract 2018; 24:590-597. [PMID: 29878610 DOI: 10.1111/jep.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 03/30/2018] [Accepted: 04/02/2018] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Handovers within and between health care settings are known to affect quality of care. Health care organizations, struggle how to guarantee best care during handovers. The aim of this paper is to evaluate handover practices in Dutch birth centres from a process perspective, to identify obstacles and opportunities for quality improvements. METHODS This case study in 7 Dutch birth centres was undertaken from a process perspective by conducting observations and using process mapping. This study is part of the Dutch Birth Centre Study. RESULTS Solutions to obstacles during handovers from a birth centre to a hospital were identified in at least 1 of the 7 birth centres. Four of the centres had agreements with a hospital for client support when a caregiver in a birth centre was absent. Face-to-face communication during handover was observed in 6 of the 7 centres. An electronic health record was noted in 1 centre; joint training of acute situations was available in 2 centres with 3 centres indicating that this was not compulsory. Continuity of caregiver was present in 4 birth centres with postpartum care available in 3 centres. CONCLUSIONS Ensuring quality during handovers requires a case-specific process approach. This study reveals distinctive aspects during handovers, concrete obstacles, and potential solutions for quality improvements in inter-organizational networks, transferrable to birth centres in other countries as well.
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Affiliation(s)
- Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Henk A Akkermans
- Tilburg School of Economics and Management, Tilburg, The Netherlands
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van Stenus CMV, Boere-Boonekamp MM, Kerkhof EFGM, Need A. Client experiences with perinatal healthcare for high-risk and low-risk women. Women Birth 2018; 31:e380-e388. [PMID: 29395696 DOI: 10.1016/j.wombi.2018.01.006] [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: 06/23/2017] [Revised: 11/27/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
PROBLEM It is unknown if client experiences with perinatal healthcare differ between low-risk and high-risk women. BACKGROUND In the Netherlands, risk selection divides pregnant women into low- and high-risk groups. Receiving news that a pregnancy or childbirth has an increased likelihood of complications can cause elevated levels of emotional distress. AIM The purpose of this study is to describe client experiences with perinatal healthcare and to determine which, if any, background characteristics, pregnancy circumstances, childbirth or follow-up care characteristics are explaining variables of differences in client experiences between high-risk and low-risk women. METHODS Client experiences were measured with a validated questionnaire completed by 1388 women within 12 weeks after childbirth. FINDINGS Women rated their experiences with perinatal healthcare with a mean score of 3.78 on a scale of 1-4; 5.5% of the women rated their experiences as "notably bad". Client experiences with perinatal healthcare show small variations, with a lower mean score for women who were at high risk (3.75) compared to low-risk women (3.84). This difference is partially due to more unplanned medical interventions and pain relief during childbirth in the high-risk group. Also, single mothers and non-Dutch women were more susceptible to less positive experiences. CONCLUSION Given the potential negative impact of adverse client experiences, this study highlights the need for healthcare professionals to be aware of what women are susceptible for having had negative experiences. It is advised that healthcare provision be altered to tailor to the needs of these women.
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Affiliation(s)
- Cherelle M V van Stenus
- Institute for Innovation and Governance Studies, Departments of Public Administration and Health Technology & Services Research, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | - Magda M Boere-Boonekamp
- Institute for Innovation and Governance Studies, Department of Health Technology & Services Research, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | | | - Ariana Need
- Institute for Innovation and Governance Studies, Department of Public Administration, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
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Mapping midwifery and obstetric units in England. Midwifery 2018; 56:9-16. [DOI: 10.1016/j.midw.2017.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 11/21/2022]
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Hermus MAA, Hitzert M, Boesveld IC, van den Akker-van Marle ME, Dommelen PV, Franx A, Graaf JPD, Lith JMMV, Luurssen-Masurel N, Steegers EAP, Wiegers TA, Bruin KMVDPD. Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study. BMJ Open 2017; 7:e016958. [PMID: 29150465 PMCID: PMC5701986 DOI: 10.1136/bmjopen-2017-016958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife. DESIGN Prospective cohort study. SETTING Low-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study. PARTICIPANTS 3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births. MAIN OUTCOME MEASUREMENTS The Optimality IndexNL-2015, a tool to measure 'maximum outcome with minimal intervention', was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth. RESULTS There were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women. CONCLUSION The Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.
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Affiliation(s)
- Marieke A A Hermus
- Department of Child Health, TNO (Netherlands Organisation for Applied Scientific Research), Leiden, The Netherlands
- Department of Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
- Midwifery Practice Verloskundigen Oosterhout, Werkmansbeemd, Oosterhout, the Netherlands
| | - Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus MC university Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | | | - Paula van Dommelen
- Department of Life Style, TNO (NetherlandsOrganisation for Applied Scientific Research), Leiden, The Netherlands
| | - Arie Franx
- Division of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Erasmus MC university Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Nathalie Luurssen-Masurel
- Department of Child Health, TNO (Netherlands Organisation for Applied Scientific Research), Leiden, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC university Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Therese A Wiegers
- NIVEL(Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Karin M van der Pal-de Bruin
- Department of Child Health, TNO (Netherlands Organisation for Applied Scientific Research), Leiden, The Netherlands
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Logsdon K, Smith-Morris C. An ethnography on perceptions of pain in Dutch "Natural" childbirth. Midwifery 2017; 55:67-74. [PMID: 28942216 DOI: 10.1016/j.midw.2017.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/04/2017] [Accepted: 09/08/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE this study offers insight into how women perceive childbirth pain and how they make decisions about whether to use an epidural during childbirth in the low technology context of the Netherlands maternity care system. DESIGN ethnographic research consisting of participant observation at births and prenatal and postnatal appointments; semi-structured interviews with a sample of recently post-partum women; coding and triangulation of data to determine key themes in the interviews. SETTING AND PARTICIPANTS the study was carried out with participants in thirteen urban cities around the Netherlands. The 40 post-partum women had lived in the Netherlands for at least 10 years prior to participation in the study, spoke English proficiently, and had a vaginal birth within the past 18 months. Additionally, participant observation occurred in midwifery practices. FINDINGS analysis of the interviews revealed three key themes: first, participants perceive childbirth pain as "natural" and positive, and approach its management through non-medical birth methods; second, participants prioritize autonomy in childbirth which they see as something they can "do on [their] own" without pain medication; and third, participants' decisions about using an epidural was supported by professional advice and social connections, such as friends and family members. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE women's conception of pain is central to decisions about childbirth in the Netherlands. This ethnographic research illustrates how perceptions and attitudes toward childbirth pain are affected by definitions of a "natural" birth, women's capacity to give birth, and the presence of professional and social support for non-medical births.
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Affiliation(s)
- Katie Logsdon
- Department of Anthropology, Southern Methodist University, Heroy Hall 415, Dallas, TX 75275, USA.
| | - Carolyn Smith-Morris
- Department of Anthropology, Southern Methodist University, Heroy Hall 415, Dallas, TX 75275, USA.
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Hitzert M, Hermus MMAA, Boesveld IIC, Franx A, van der Pal-de Bruin KKM, Steegers EEAP, van den Akker-van Marle EIME. Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study. BMJ Open 2017; 7:e016960. [PMID: 28893750 PMCID: PMC5595203 DOI: 10.1136/bmjopen-2017-016960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. DESIGN Economic evaluation based on a prospective cohort study. SETTING 21 Dutch birth centres, 46 hospital locations where midwife-led birth was possible and 110 midwifery practices where home birth was possible. PARTICIPANTS 3455 low-risk women under the care of a community midwife at the start of labour in the Netherlands within the study period 1 July 2013 to 31 December 2013. MAIN OUTCOME MEASURES Costs and health outcomes of birth for different planned places of birth. Healthcare costs were measured from start of labour until 7 days after birth. The health outcomes were assessed by the Optimality Index-NL2015 (OI) and a composite adverse outcomes score. RESULTS The total adjusted mean costs for births planned in a birth centre, in a hospital and at home under the care of a community midwife were €3327, €3330 and €2998, respectively. There was no difference between the score on the OI for women who planned to give birth in a birth centre and that of women who planned to give birth in a hospital. Women who planned to give birth at home had better outcomes on the OI (higher score on the OI). CONCLUSIONS We found no differences in costs and health outcomes for low-risk women under the care of a community midwife with a planned birth in a birth centre and in a hospital. For nulliparous and multiparous low-risk women, planned birth at home was the most cost-effective option compared with planned birth in a birth centre.
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Affiliation(s)
- Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | - Arie Franx
- Department of Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Eric, EAP Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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