Women's preferences for care delivery during labour and birth in Dutch hospitals: A Q-methodology study

PROBLEM

Women's preferences regarding care delivery during labour and birth remain insufficiently understood. Obtaining a clear understanding of these is important to realise a maternity care system that is future-proof and person-centred.

BACKGROUND

Dutch maternity care deals with capacity issues due to staff shortages. Despite expected stable birth rates in the coming decades, this situation jeopardises the provision of care during labour and birth that is responsive to women's preferences.

AIM

To systematically study a variety of women's preferences for care delivery during labour and birth in Dutch hospitals using Q-methodology.

METHODS

Q-methodology is a mixed methods approach. Thirty individual interviews were conducted with women living in the south-western Netherlands, during which they ranked 29 statements about their labour and birth preferences from least to most important. By-person factor analysis was performed to identify factors (viewpoints). Interpretation of the viewpoints was done using the qualitative interview data.

FINDINGS

Four viewpoints emerged from the study sample: 1) The personal approach, 2) The empowering approach, 3) The expert approach and 4) The needs-based approach. Consensus statements show a shared preference for respectful interaction. The study cohort emphasises continuity of adequate information provision, while continuity of care professional is deemed less important.

DISCUSSION

Our study was the first to apply Q-methodology to capture women's preferences for care delivery during labour and birth in Dutch hospitals. Although preferences are individual, they share commonalities in four viewpoints.

CONCLUSION

The viewpoints provide valuable guidance for the allocation of scarce resources to ensure a maternity care system that is responsive to women's preferences.

The un-silencing of Japanese women's voices in maternity care: A hermeneutic phenomenological study of the woman-midwife relationship

OBJECTIVE

The purpose of this article is to understand the meaning of the woman-midwife relationship, with the overall aim to improve maternity care and women's birth experiences in Japan. To better understand the meaning of the woman-midwife relationship, this article presents women's and midwives' experiences of having or not having a voice in maternity care.

RESEARCH DESIGN

Hermeneutic phenomenology, as described by Max van Manen, helped to uncover the meaning of the phenomenon-the woman-midwife relationship-through participants' lived experience. Individual interviews were conducted with 14 women and 10 midwives living in Japan. The interview data were interpreted and thematically analysed to reveal the meaning of the woman-midwife relationship.

FINDINGS

'Having a voice' emerged as a central theme underpinning the meaning of the woman-midwife relationship; aspects of which included, 1) being unheard, 2) losing a voice, 3) having a voice, and 4) midwives speaking for women. Although having a voice should be a legitimate right for women in maternity care, some women's voices were unheard or lost in the experience with midwives. Conversely, some women gained a voice, especially when they positively and continuously developed their relationship with their midwife. How the woman and the midwife related to each other clearly affected their experience of having a voice in maternity care.

KEY CONCLUSION

Having a voice, which portrays dimensions of choice, control, and autonomy, in their own maternity care is vital for women's positive birth experience. The woman-midwife relationship is critical in enabling women to have a voice and midwives to speak for women. Women and midwives need to develop their relationship. Moreover, the maternity care system needs to allow sufficient time and space, for instance, by ensuring midwife continuity of care to develop a positive woman-midwife relationship.

Midwifery workplace culture in Sydney, Australia

PROBLEM

Aspects of the midwifery workplace culture have previously been measured as negative with limited leadership or support. Support for midwives is essential for them to face the complexity and workloads in Australian maternity units.

BACKGROUND

Understanding the culture of the midwifery workplace is important to develop strategies to stem workforce attrition and to optimise care of women and their families.

AIMS

This study aimed to assess midwives' perceptions of workplace culture in two maternity units in Sydney, Australia, and compare the results with a national study using the same validated instrument.

METHOD

This study reports results using the Australian Midwifery Workplace Culture instrument (n = 49 midwives) and stakeholder groups (n = 10). Simple descriptive statistics were used, and the qualitative responses were analysed thematically.

FINDINGS

Compared to the national sample, participants rated their workplace more favourably, especially their relationships with managers and colleagues. Over one-third (36.7%) considered that their workplace had a positive culture, compared with 27.9%e. However, they rated their workplaces more negatively on time constraints and staff resources, and reported limited autonomy. Workplaces were highly medicalised which impacted their philosophy of woman-centred care and their ability to work autonomously.

DISCUSSION

Factors related to collegiality in the workplace, relationship with managers, midwives' intention to leave the profession and time constraints are discussed in comparison to the national study, as well as other relevant research. Conclusion Workplace collaboration, support, respect and understanding were extremely important to midwives, as were adequate staffing levels, teamwork and opportunities for further education.

Midwives' Experience of Providing Continuity of Care in a Pilot Project: Findings of a Prospective Qualitative Research Study

INTRODUCTION

There has been a strategic drive for several years in midwifery to improve models of care and enable women to receive care from a known midwife. However over the past decade new models of care to achieve this have not been sustained and some midwives have expressed opinions that such models can never be sustainable for the staff working them. This study was designed to explore the midwives experience of working a continuity of care model, develop understanding of the lived experience of midwives, and provide insight into how such models can be sustainable from the midwives perspective. A local trust initiative to pilot a small team continuity of care model in one geographical area was introduced and a group of midwives interested in working differently were recruited onto the study to share their experiences. This article details the process and themes identified through a small qualitative research study to explore midwives' experiences of working in a new way to provide increased continuity of care for women. The study results are written in response to a local drive for change and within the context of a small group of midwives taking part in a service improvement project. The article specifically identifies themes in the midwives' experiences and lessons learnt for sustainable change in relation to continuity of care within midwifery services.

METHOD

The study was a qualitative descriptive study. The main purpose of the study was to gain further understanding of the personal experiences of midwives. Data was collected over a 12-month period from eight midwives who took part; reflective diaries, notes from team meetings and data from the team's “WhatsApp” group chat were used to capture the data over time. Themes identified were then verified with the participants through one to one semi structured interviews.

FINDINGS

The research data has been organized into four overarching themes related to May's (2009) normalization process theory: Coherence—same difference, cognitive participation—operational workability, collective action—relationships and reflexive monitoring—personal sustainability.

DISCUSSION

A key theme running throughout the data was the importance of autonomy, flexibility, and trust, enabling midwives and women to build effective therapeutic relationships. This is important to note when developing systems for care. Staff needed to feel trusted in order to work flexibly and take control over their own work/life balance. The findings indicate that where staff felt enabled to organize their own workloads they did in fact work harder to meet the needs of the women. A shift in culture in maternity systems would need to be embraced for this level of control to be afforded all midwives. It should be noted that the study was conducted in one specific area and with a small number of midwives. Hence the findings cannot be generalized and will need to be explored further across different cultures.

Evaluation of a student-led midwifery group practice: A woman's perspective

BACKGROUND

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OBJECTIVE

To evaluate women's experiences of a student-led midwifery group practice.

DESIGN

A mixed methods design was used to examine women's experiences and level of satisfaction about a student-led midwifery model of care. An on-line survey elucidated women's levels of satisfaction and experiences with the student-led midwifery group practice. The online survey was sent to all women (n = 25) who were receiving care from third year Bachelor of Midwifery students in 2018 via email up to 6 weeks postnatally. The online survey was distributed in the first instance to obtain baseline information about the importance of this student-led midwifery group practice and so the survey information was linked to the in-depth interview in the analysis for the purpose of identifying if the women were primiparous or multiparous. Women (n = 9) were invited to participate in an in-depth interview by self-opting on the survey and this extra data provided a richer understanding about the level of satisfaction about woman-centred care led by midwifery students. Retrospective data were also collected from the Maternity database - E-Maternity about birth outcomes.

SETTING

A tertiary teaching public hospital in New South Wales (NSW).

PARTICIPANTS

Fifteen women participated in an online survey. Five primiparous and four multiparous women opted to be involved in the in-depth interviews on the online survey.

MEASUREMENTS AND FINDINGS

Analysis in SPSS provided descriptive statistics including frequencies and percentages of data including birth outcomes. Simple correlations enabled associations to be established between levels of satisfaction, individualised care, quality of care, benefits and anxiety during pregnancy. The overarching themes from the qualitative findings identified the students' presence for the women as the most important component of the women's journey. The four main themes that emerged from the study included: familiarity of the caregiver, staying informed on the journey, feeling supported and reassured by their expertise, and control and decisions over birth events.

KEY CONCLUSIONS

For a variety of reasons, women valued the presence of the students throughout their childbearing journey, including valuing the woman's private space during labour and her time with her partner. This combination of pedagogical approaches provides an alternative to the current placement approach, which includes working shifts in all areas of maternity. This approach will better support midwifery students to achieve the skills necessary to provide a continuity of care experience (CoCE) amongst a small team by a student-led midwifery group practice that is supported by a registered midwife in the antenatal clinic. The midwifery student is able to develop a relationship with the woman as a component of the CoCE under the guidance of a registered midwife and this is an important underpinning of the philosophy of woman-centred care.

IMPLICATIONS FOR PRACTICE

This model of care provides evidence that women do value the students' support and presence throughout their experience and that the benefits of this model should be offered to all women as a normal component of their midwifery care.