Woman-centered care 2.0: Bringing the concept into focus

The future of midwife-led continuity of care: Call for a dialogue

Background/Purpose

Midwife-led continuity of care (MLCC) is an evidence-based care model positively influencing the health and wellbeing of women and their families. Despite the evidence, a sustainable future of the model is uncertain. The aim of this paper is to give an example of a theoretical exercise that enhances the understanding of the trends and developments impacting MLCC's future state.

Methods

The industrial complex theory scaffolded the theoretical approach. The intuitive logics scenario development methodology was used to structure the key variables that influence the utility of MLCC. Dimensionally structured scenarios representing the probable, possible and probable MLCC futures were written.

Results

Thirteen key variables that greatly impact the future MLCC, with varying degrees of certainty were identified. A theoretical framework representing two underlying meta dimensions of MLCC was constructed: identity system of midwife-led continuity of care (fixed vs fluid) and embodied orientation to the world (reasoning vs meaning making). Within the framework, four different storylines of possible, plausible prospective futures emerged: Sense & sensibility, The birth of mothers, Too many sisters and One-stop-shop.

Conclusion

The paper is an example of how to approach the future of MLCC, the method serving as a tool to establish a theoretical truth of how its future state may unfold, the scenarios facilitating a dialogue among stakeholders and informing the public.

The midwife's support during transition to motherhood: A modified Delphi study among care providers and childbearing women

OBJECTIVE

To reach consensus between care providers and childbearing women about the midwife's relevant and appropriate domains and elements to support transition to motherhood.

METHODS

A modified web-based Delphi study was conducted in Flanders (Belgium). After performing a systematic literature review, searching the grey literature and an online poll, a set of 79 items was generated. In two rounds, the items were presented to an expert panel of (1) care providers from various disciplines providing services to childbearing women and (2) to pregnant women and postpartum women up to 1-year postpartum. Consensus was defined when 70% or more of the experts scored ≥6, 5% or less scored ≤3, and a standard deviation of ≤1.1.

FINDINGS

In the first Delphi round, 91 experts reached consensus on 24 items. Seventeen round one items that met one or two consensus objectives were included in round two and were scored by 64 panel experts, reaching consensus on three additional items. The final 27 items covered seven domains: attributes, liaison, management of care from a woman-centred perspective, management of care from the midwife's focus, informational support, relational support, and the midwife's competencies.

CONCLUSION

The shared understanding between childbearing women and care providers shows that the midwife's transitional support is multifaceted. Our findings offer midwives a standard of care, criteria, guidance, and advice on how they can support childbearing women during transition to motherhood, beyond the existing recommendations and current provision of transitional care.

Strategies and interventions used to provide communication education for midwifery students. A scoping review

AIM

To examine the current literature on educational strategies and interventions developed with the objective of teaching or enhancing communication skills of student midwives during their pre-registration education programmes.

DESIGN

A scoping review based on the Joanna Briggs Institute framework was conducted using predefined criteria and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

METHODS

A comprehensive search was conducted using various databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PsycINFO, Maternity and Infant Care Database (MIDIRS), Web of Science and Education Resources Information Centre (ERIC)) in October 2023.

RESULTS

A total of 120 titles and abstracts were screened. A final number of eight articles were subjected to quality appraisal and included in the scoping review. Five themes were identified which describe educational strategies and interventions including: simulation-based training, the use of role-play, pedagogical approaches, theory-based information workshops and debrief and reflection.

CONCLUSIONS

This review highlights a gap in research focusing on the importance of communication skills training for student midwives throughout midwifery education. Despite the limited numbers of studies, different interventions and educational strategies have been recognized for enhancing these skills. To equip midwives with strong communication skills, a combination of interventions is recommended, including communication-focused workshops tailored for midwifery education and debriefing and student reflection sessions specifically designed to enhanced communication skills.

REGISTRATION NUMBER

to be included in abstract after acceptance.

One size does not fit all: Perspectives from Swedish midwives on fetal movement counselling

PROBLEM

Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden.

BACKGROUND

Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities.

AIM

To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings.

METHODS

Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis.

FINDINGS

The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures.

DISCUSSION

Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy.

CONCLUSION

To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.

Women's needs and expectations in midwifery care - Results from the qualitative MiCa (midwifery care) study. Part 1: Preconception and pregnancy

Midwifery services play an important role in healthcare provision, birth preparation and prevention. Knowledge on women's expectations, preferences and needs regarding midwifery care is crucial not only for clinical care during preconception and pregnancy and research, but also for educational purposes. This descriptive qualitative study aimed to investigate the expectations, preferences and the needs of women concerning midwifery care in Germany. Experienced researcher team conducted interviews with women who have the desire to get pregnant and online focus groups with women in early and late pregnancy. A purposeful recruitment strategy with maximum variation sampling was applied to reach diversity in the sample regarding age, previous children and socioeconomic background. A total of 26 women participated. In the qualitative content analysis according to Mayring, seven main categories were developed for both preconceptional phase and pregnancy: (a) care by midwife, (b) care by obstetrician, (c) involvement of family, (d) need for information, (e) physical aspects, (f) psychological aspects and (g) orientation in healthcare system. One additional category referenced (h) organisation and bureaucracy in pregnant women. Women appreciated the personalised experience provided by midwives leading to trust and empowerment. Women's experiences with midwifery care varied. They reported contradictory information they received about services and care options. They valued interprofessional cooperation, continuity of care, structured information and personalised counselling. Midwives play an important role in healthcare provision, birth preparation and prevention. In order to depict the care situation quantitatively, to personalise care and to optimise healthcare models, a tool to assess the quality of healthcare and to evaluate women's needs and benefits of midwifery care will be developed based on the findings of this study. From the public health perspective, deficits in the German healthcare system concerning insufficient intra-sectoral communication, time pressure and low remuneration should be resolved in further research steps and policy action.

Strengthening woman-centred care for pregnant women with female genital mutilation in Australia: a qualitative muti-method study

Woman-centred care is a collaborative approach to care management, where the woman and her health provider recognise one another's expertise and interact based on mutual respect to provide adequate information and individualised care. However, woman-centred care has not been fully achieved, particularly for women who have experienced female genital mutilation in high-income countries. A lack of clear guidelines defining how to implement woman-centred care may negatively impact care provision. This study sought to explore the quality of point-of-care experiences and needs of pregnant women with female genital mutilation in Australia to identify elements of woman-centred care important to women and how woman-centred care can be strengthened during consultations with health professionals. This multi-method qualitative study comprised two phases. In phase one, we conducted interviews with women with female genital mutilation to explore their positive experiences during their last pregnancy, and in phase two, a workshop was held where the findings were presented and discussed to develop recommendations for guidelines to support woman-centred care. The findings of the first phase were presented under three distinct categories of principles, enablers, and activities following a framework from the literature. In phase two, narrative storytelling allowed women to share their stories of care, their preferences, and how they believe health providers could better support them. Their stories were recorded visually. This study highlights the importance of a comprehensive approach to woman-centred care involving experts, clinicians, community members, and women in designing education, tools, and guidelines.

Midwives', obstetricians', and nurses' perspectives of humanised care during pregnancy and childbirth for women classified as high risk in high income countries: A mixed methods systematic review

Women classified as 'high risk' or 'complicated' in pregnancy and childbirth have increased difficulty in accessing humanised care/humanisation in childbirth due to perceptions that this approach rejects the use of intervention and/or technology. Humanised care recognises the psychological and physical needs of women in pregnancy and birth. A mixed methods systematic review using a convergent segregated approach was undertaken using the Joanne Briggs Institute (JBI) methodology. The objective of the review was to identify the presence of humanisation for women with high risk pregnancy and/or childbirth in high income countries. Studies were included if they measured humanisation and/or explored the perspectives of midwives, obstetricians, or nurses on humanisation for women classified as having a high-risk or complicated pregnancy or childbirth in a high income country. Qualitative data were analysed using a meta-aggregative approach and a narrative synthesis was completed for the quantitative data. All studies were assessed for their methodological quality using the MMAT tool. Four databases were searched, and nineteen studies met the inclusion criteria. A total of 1617 participants from nine countries were included. Three qualitative findings were synthesised, and a narrative synthesis of quantitative data was completed. The integration of qualitative and quantitative data identified complimentary findings on: (i) the importance of developing a harmonised relationship with women; (ii) increased time counselling women on their choices; and (iii) fear of professional reputational damage if caring outside of protocols. Negotiating with women outside of protocols may have a wider impact on the professional than first thought. Understanding how healthcare professionals individualise care for women at risk in labour requires further investigation.

Woman-centered care and associated factors among midwives working in urban health centers and public and private hospitals in Tabriz, Iran: a cross-sectional study

BACKGROUND

Woman-centered care (WCC) is the cornerstone of the midwifery profession. However, no study has been conducted on WCC provided by Iranian midwives and its associated factors. Thus, this study aimed to determine WCC and factors associated with midwives' WCC for midwives working in urban health centers and public and private hospitals in Tabriz, Iran.

METHODS

This cross-sectional study was the first part (i.e., the quantitative phase) of a sequential explanatory mixed-method study conducted on 575 midwives working in urban health centers and public and private hospitals in Tabriz-Iran from November 2022 to January 2023. The required data was collected by distributing a socio-demographic and job characteristics questionnaire and woman-centered care scale-midwife self-report (WCCS-MSR). To determine the factors associated with WCC, an independent t-test or one-way analysis of variance (ANOVA) was used in bivariate analysis, and a general linear model (GLM) was employed in multivariate analysis to control possible confounding variables.

RESULTS

The statistical population consisted of 575 midwives, with a response rate of 88.2%. According to the GLM, the total mean WCCS-MSR score of single [β (95% CI) 23.02 (7.94 to 38.10)] and married [β (95% CI) 21.28 (6.83 to 35.72)] midwives was significantly higher than that of divorced midwives after adjusting their demographic and job characteristics. Also, the total mean WCCS-MSR score of midwives with sufficient income was significantly higher than those with insufficient income [β (95% CI) 8.94 (0.12 to 17.77). In addition, the total mean WCCS-MSR score of midwives with < 5 years of work experience [β (95% CI) - 7.87 (- 14.79 to - 0.94)], and midwives with official-experimental employment status [β (95% CI) - 17.99 (- 30.95 to - 5.02)], was significantly lower than those with more than 5 years of work experience and contractual employment status.

CONCLUSIONS

The findings indicate that marital status, level of income, years of practice, and employment status were significantly related to WCC provided by midwives. Focusing only on the midwifery community is insufficient to ensure the improved quality of WCC. However, arrangements should be made at three levels, including policy-makers, managers, and health care provider (midwives).

Evaluation of woman-centred care status by Iranian midwives and providing strategies to improve women-centred care: A sequential explanatory mixed method study protocol

AIM

The present study aimed to evaluate the status of WCC provided by Iranian midwives.

DESIGN

A sequential explanatory mixed method study protocol.

METHODS

The present study was conducted in three phases: quantitative, qualitative and mixed. The first phase is a cross-sectional study that will be performed on midwives working in health centres, public and private hospitals in Iranian. The second phase is a qualitative study, in which purposeful sampling will be used, meaning that the midwives who are part of the extreme cases according to the results of quantitative phase and are willing and able to express their own experiences regarding WCC will be selected. Also, pregnant and parturient women under their cover will also be interviewed. Finally, in the mixed phase, we will use a combination of two quantitative and qualitative studies, a literature review and expert opinion using a Delphi method to provide strategies to improve and promote WCC in midwives.

RESULTS

Achieving this goal is expected to provide positive outcomes such as strengthening the midwives professional relationship with women and reducing health care costs. No Patient or Public Contribution.

Prioritizing women's choices, consent, and bodily autonomy: From a continuum of violence to women-centric reproductive care

Obstetric violence is a product of medical institutions' failure to prioritize women-centric reproductive care. Through interviews with local activists and leaders in Oaxaca, Mexico, as well as analysis of primary and secondary sources, we find that women-centric reproductive care is hindered by three barriers that are a part of a continuum of violence. These barriers include the cultural and religious norms surrounding reproductive care, the medical community and medical profiteers' opposition to combatting obstetric violence, and the state's resistance to women's human rights policy changes. Shifting to a women-centric reproductive care model requires: the life of the woman to be prioritized in reproductive care, the criminalization of obstetric violence, improved training for the medical community, reduced monetary incentives for unnecessary cesarean sections, and the respectful inclusion of indigenous and midwife knowledge and practices. Our study's theoretical and empirical contributions add to the scholarly research regarding the systemic causes of obstetric violence and the care ethic required for transformative change. Our recommendations can be applied across contexts with locally developed and culturally inclusive models of women-centric reproductive care.

Women's and midwives' views on the optimum process for informed consent for research in a feasibility study involving an intrapartum intervention: a qualitative study

BACKGROUND

Recruitment to intrapartum research is complex. Women are expected to understand unfamiliar terminology and assess potential harm versus benefit to their baby and themselves, often when an urgent intervention is required. Time pressures of intrapartum interventions are a major challenge for recruitment discussions taking place during labour, with research midwives expected to present, discuss and answer questions whilst maintaining equipoise. However, little is known about these interactions. An integrated qualitative study (IQS) was used to investigate information provision for women invited to participate in the Assist II feasibility study investigating the OdonAssist™-a novel device for use in assisted vaginal birth with an aim to generate a framework of good practice for information provision.

METHODS

Transcripts of in-depth interviews with women participants (n = 25), with recruiting midwives (n = 6) and recruitment discussions between midwives and women (n = 21), accepting or declining participation, were coded and interpreted using thematic analysis and content analysis to investigate what was helpful to women and what could be improved.

RESULTS

Recruiting women to intrapartum research is complicated by factors that impact on women's understanding and decision-making. Three key themes were derived from the data: (i) a woman-centred recruitment process, (ii) optimising the recruitment discussion and (iii) making a decision for two.

CONCLUSION

Despite evidence from the literature that women would like information provision and the research discussion to take place in the antenatal period, intrapartum studies still vary in the recruitment processes they offer women. Particularly concerning is that some women are given information for the first time whilst in labour, when they are known to feel particularly vulnerable, and contextual factors may influence decision-making; therefore, we propose a framework for good practice for information provision for research involving interventions initiated in the intrapartum period as a woman centred, and acceptable model of recruitment, which addresses the concerns of women and midwives and facilitates fair inclusion into intrapartum trials.

TRIAL REGISTRATION

ISRCTN. This qualitative research was undertaken as part of the ASSIST II Trial (trial registration number: ISRCTN38829082. Prospectively registered on 26/06/2019).

Experiences of childbirth care among immigrant and non-immigrant women: a cross-sectional questionnaire study from a hospital in Norway

BACKGROUND

Immigrant women have higher risks for poor pregnancy outcomes and unsatisfactory birth experiences than the general population. The mechanisms behind these associations remain largely unknown, but they may result from differential care provided to immigrant women or unsatisfactory interactions with health providers. This study aimed to investigate immigrant and non-immigrant women's experiences of health care during childbirth, particularly assessing two dimensions: perceived general quality of care and attainment of health care needs during childbirth.

METHODS

This was a cross-sectional study carried out over 15 months in 2020 and 2021, and data were collected from a self-completed questionnaire. The labour and birth subscale from the Experience of Maternity Care questionnaire was used to assess the primary outcome of care experiences. A total of 680 women completed the questionnaire approximately within two days after birth (mean 2.1 days) at a hospital in Trondheim, in central Norway. The questionnaire was provided in eight languages.

RESULTS

The 680 respondents were classified as immigrants (n = 153) and non-immigrants (n = 527). Most women rated their quality of care during childbirth as high (91.5%). However, one-quarter of the women (26.6%) reported unmet health care needs during childbirth. Multiparous immigrant women were more likely than multiparous non-immigrant women to report that their health care needs were unmet during childbirth (OR: 3.31, 95% CI: 1.91-5.72, p < 0.001, aOR: 2.83, 95% CI: 1.53-5.18, p = 0.001). No other significant differences between immigrant versus non-immigrant women were found in subjective ratings of childbirth care experiences. Having a Norwegian-born partner and a high level of Norwegian language skills did not influence the immigrant women's experience of childbirth care.

CONCLUSIONS

Our findings indicate that many women feel they receive high-quality health care during childbirth, but a considerable number still report not having their health care needs met. Also, multiparous immigrant women report significantly more unmet health care needs than non-immigrants. Further research is required to assess immigrant women's childbirth experiences and for health care providers to give optimal care, which may need to be tailored to a woman's cultural background and individual expectations.

Patient engagement practice within perinatal eHealth: A scoping review

BACKGROUND

There is a gap in knowledge about how perinatal eHealth programs function to support autonomy for new and expectant parents from pursuing wellness goals.

OBJECTIVES

To examine patient engagement (access, personalization, commitment and therapeutic alliance) within the practice of perinatal eHealth.

DESIGN

Scoping review.

METHODS

Five databases were searched in January 2020 and updated in April 2022. Reports were vetted by three researchers and included if they documented maternity/neonatal programs and utilized World Health Organization (WHO) person-centred digital health intervention (DHI) categories. Data were charted using a deductive matrix containing WHO DHI categories and patient engagement attributes. A narrative synthesis was conducted utilizing qualitative content analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 'extension for scoping reviews' guidelines were followed for reporting.

RESULTS

Twelve eHealth modalities were found across 80 included articles. The analysis yielded two conceptual insights: (1) The nature of perinatal eHealth programs: (1) emergence of a complex structure of practice and (2) practising patient engagement within perinatal eHealth.

CONCLUSION

Results will be used to operationalize a model of patient engagement within perinatal eHealth.

Professional Self-Esteem of Turkish Midwifery Students: A Mixed-Methods Approach

Professional self-esteem (PSE) is the individual's judgment of worthiness formed regarding the self-attributions related to the individual's profession. A well-developed PSE is important for midwives to be successful in their profession, have a strong sense of belonging, and see the profession as important and valuable. This study aims to determine the perception of PSE among midwifery students, explain how their perceptions are formed, and reveal how they perceive the midwifery profession and how the components that make up this perception determine their PSE. Students' average PSE score was analyzed, and the study was conducted using an explanatory sequential, which is a mixed-method approach, to interpret the results of the questionnaire and comparative analysis in more detail through direct interviews with university midwifery program students in western Turkey. Quantitative data were collected using the Individual Data Collection Form and the Professional Self-Esteem Scale. One-way analysis variance and independent sample t-tests were used to analyze the quantitative data. The students with the highest and lowest scale scores from each class level were interviewed using a Semi-Structured Interview Form. Thematic analysis was applied to analyze the qualitative data. The mean PSES score was 117.51 ± 17.60. The t-test analysis result shows that there was a significant difference between the PSES score and choosing the midwifery department willingly, believing that they could perform the midwifery profession before and after starting the midwifery education (p < 0.05). Three main themes were obtained: the meaning of being a midwife, deciding to become a midwife, and the difficulties of being a midwife. It can be said that the main force behind the students' belief that the difficulties of the midwifery profession can be overcome is their strong love for the midwifery profession and their internalization of its importance.

‘It's about developing a trustful relationship’: A Realist Evaluation of midwives’ relational competencies and confidence in a Danish antenatal psychosocial screening programme

OBJECTIVE

to explore how contextual conditions influence midwives' relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions.

DESIGN

a realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations.

SETTING

nine community-based and hospital-based midwife clinics in the North Region of Denmark.

INTERVENTION

a dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated.

PARTICIPANTS AND DATA

15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted.

FINDINGS

contextual conditions at multiple levels which supported midwives' relational competencies, autonomy and the power of peer reflection-and thus facilitation of a woman-centred approach and trust-were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship.

CONCLUSION

midwives' ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships - which is essential for disclosure - was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.

When complications arise during birth: LBTQ people's experiences of care

OBJECTIVE

To explore the care experiences of lesbian, bisexual, transgender, and queer (LBTQ) people during births where complications have arisen.

DESIGN

Data were collected through semi-structured interviews with self-identified LBTQ people who had experienced obstetrical and/or neonatal complications.

SETTING

Interviews were conducted in Sweden.

PARTICIPANTS

A total of 22 self-identified LBTQ people participated. 12 had experienced birth complications as the birth parent and ten as the non-birth parent.

FINDINGS

Most participants had felt invalidated as an LBTQ family. Separation of the family due to complications elevated the number of hetero/cisnormative assumptions, as new encounters with healthcare professionals increased. Dealing with normative assumptions was particularly difficult in stressful and vulnerable situations. A majority of the birth parents experienced disrespectful treatment from healthcare professionals that violated their bodily integrity. Most participants experienced lack of vital information and emotional support, and expressed that the LBTQ identity made it harder to ask for help.

CONCLUSIONS

Disrespectful treatment and deficiencies in care contributed to negative experiences when complications arose during birth. Trusting care relationships are important to protect the birth experience in case of complications. Validation of the LBTQ identity and access to emotional support for both birth and non-birth parents are crucial for preventing negative birth experiences.

IMPLICATIONS FOR PRACTICE

To reduce minority stress and create conditions for a trusting relationship, healthcare professionals should specifically validate the LBTQ identity, strive for continuity of carer and zero separation of the LBTQ family. Healthcare professionals should make extensive efforts to transfer LBTQ related information between wards.

A global review of the inferred meaning of woman centred care within midwifery professional standards

BACKGROUND

As an integral and guiding approach, woman centred care is well-grounded as the cornerstone of midwifery training and practice. A previous global review established that the concept, even though acknowledged as pivotal, has limited attention within the professional standards documents that underpin the discipline [1]. Whilst not detracting from the overall importance of woman centred care, it is further suggested that a broader meaning is generally being implied.

OBJECTIVE

Whether other related inferences and meanings of the actual term 'woman centred care' are also being utilised, has not yet been established. Therefore, this review of professional documents sought to investigate the occurrence of further depictions of the concept.

METHODS

With an implied and inferred meaning of 'woman centred care' as the focus, a review and synthesis of narrative from a global sample of midwifery professional standards was conducted. The principles of meta-ethnography were utilised to develop a qualitative approach. Rather than the actual words 'woman centred care' further phrases implying or inferring the concept were sought. 'A priori' phrases were developed and narrative and examples were synthesised for each.

FINDINGS

Standards and governance documents were located from within Australia, the United Kingdom and New Zealand and a further 139 nations. Overall, the seven phrases, each considered as an inference to woman centred care, were all substantiated. As a proportion of all documents, these were collated with the outcomes being a woman's right to choice (89%), being culturally sensitive (80.5%), a woman's voice and right to be heard (78%), the woman as an individual (68%), universal human rights (40%), being holistic (39%) and being self-determined (17.5%).

CONCLUSION

The outcomes of this review demonstrate that woman centred care may be a multidimensional concept. There were occurrences of all seven phrases across a broad scope of global professional midwifery documents, and each can be shown through its meaning to contribute something to an understanding of woman centred care. The creation of a universal meaning is recommended.

Iranian midwives' lived experiences of providing continuous midwife-led intrapartum care: a qualitative study

Background & Objective

Continuity of midwifery-led care during labour and birth is considered optimal. To ensure its sustainability in practice where limited evidence is available, the aim of the present study was to explore midwives’ lived experiences of delivering continuous midwife-led intrapartum care.

Methods

This study took a qualitative approach in meeting its aim. Participants were midwives working in the labour wards of private and public hospitals in Iran. The data were purposefully collected in 2019 through in-depth, semi-structured, and face-to-face interviews with midwives (n = 10) aged between 26 and 55 years. A thematic analysis based on descriptive phenomenology was undertaken to make sense of the data collected.

Results

“Wanting to lead continuous woman-centered care but being unable to” was identified as an overarching theme. Three other themes “emphasis on the non-interventional care”, “midwifery-specific focus” and “barriers and challenges of midwifery care” were also identified. Ultimately, midwives described knowing how to and wanting to lead continuous ‘woman’-centered care but being unable to. Perceived barriers included lack of familiarity with and knowledge in relation to childbirth, the insignificant role of midwives in decision making, obstetrician utilitarianism, high workloads along with work-related stress argument-driven communication between midwives and obstetricians and an absence of a ‘triangle of trust’ in care.

Conclusion

Future research strategies could usefully include obstetricians and focus on the upscaling of midwifery in Iran using continuity of care models, highlight the value of midwives, identify why uptake of antenatal education in Iran is poor and develop user friendly, evidence based, midwife-led programs. Initiatives aiming to promote mutual professional respect, trust and collegiality and increased remuneration for midwifery work would be also welcomed in pursuit of reducing maternal and infant mortality in Iran.

Midwives' empathy and shared decision making from women's perspective - sensitivity of an assessment to compare quality of care in prenatal and obstetric care

Background

For quality-oriented evaluation of prenatal and obstetric care, it is important to systematically consider the perspective of the women receiving care in order to comprehensively assess and optimize quality in a woman-centered manner. Empathy and Shared Decision Making (SDM) are essential components of woman-centered midwifery care. The aim of the study was to analyze measurement invariance of the items of the Consultation and Relational Empathy (CARE) and Shared Decision Making-Questionnaire (SDM-Q-9) scales depending on the prenatal versus obstetric care setting.

Methods

One hundred fifty women retrospectively assessed aspects of woman-centered midwifery care in both prenatal and obstetric care setting. The birth of the child was a maximum of 12 months ago. A structural equation modelling approach was adopted to separate true effects from response shift (RS) effects depending on care setting. The latter were analyzed in terms of recalibration (changing women’s internal measurement standards), Reprioritization (changing associations of items and construct) as well as Reconceptualization (redefining the target construct).

Results

A response shift model was identified for both assessments (pregnancy/birth: CFI = .96/.96; SRMR = .046/.051). At birth, both scales indicated lower quality of care compared with prenatal care (SDM-Q-9-M/CARE-8-M:|d| = 0.190/0.392). Although no reconceptualization is required for the items of both scales, RS effects are evident for individual items. Due to recalibration and reprioritization effects, the true differences in the items are partly underestimated (SDM-Q-9-M/CARE-8-M: 3/2 items) or overestimated (4/2 items).

Conclusion

The structure of the constructs SDM and Empathy, indicating woman-centered midwifery care, are moderated by the care settings. To validly assess midwives’ empathy and shared decision making from women’s perspective, setting-dependent response shift effects have to be considered. The proven item-specific response effects contribute to a better understanding of construct characteristics in woman-centered care by midwives during pregnancy and childbirth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05041-y.

Religious practices of Muslim women in the UK during maternity: evidence-based professional practice recommendations

Background

Muslim women commonly observe certain religious practices during their maternity journey and research in this area suggests that more could be done from a service provision perspective to support Muslim women in the UK through this significant life event.

Aim

This study identifies Muslim women’s religious practices during maternity, needs and challenges of religious practice while engaging with maternity services, and support needs from healthcare professionals.

Method

Qualitative mixed method study; that includes eight longitudinal interviews with first-time pregnant Muslim women, five focus groups with 23 Muslim mothers experiencing childbirth in last three years in UK, and 12 one-to-one interviews with Health care Professionals (HCPs) with previous experience working with Minority Ethnic groups. Participants recruited from local Muslim community groups and Maternity Care Provider, North West Coast, England. Data analysed using thematic analysis.

Result

Qualitative findings indicate common religious practices that Muslim women exercise at different stages of their maternity journey. These practices can be divided into two categories of common religious practices for Muslim women that 1) require only healthcare professionals’ awareness of these practices and 2) require awareness and active involvement of healthcare professionals. Findings highlight key recommendations for healthcare professionals when addressing Muslim women’s religious needs in the UK.

Discussion/Conclusion

This study provides evidence-based recommendations for professional practice to assist healthcare professionals in developing understanding and addressing Muslim women’s religious practice needs in the UK. Further research is required to explore the impact of these recommendations for professional practice.

Midwifery Now: Narratives about Motivations for Career Choice

The objective of this study was to analyse nursing students’ motivation to choose the midwifery career. This is a cross-sectional study with a qualitatively driven mixed-methods approach. The settings are three higher education institutions located in Portugal. The study was conducted between September 2019 and November 2021, with the participation of 74 midwifery master’s students, through convenience sampling. The data were collected through the LimeSurvey software and were subsequently analysed in the SPSS and IRaMuTeQ software programs. The emerging thematic areas were as follows: (1) building a professional identity and (2) knowledge construction. From these two thematic areas, six classes emerged that revealed commitment to the profession. It is in Class 6 that the ancestral essence of the profession lies, revealing the meanings of competence and care perpetuation linked to gender. Midwifery is a first-line profession, and the career choice reflects a commitment to support the mother/newborn dyad in view of the inevitability of human care for the preservation of the species. Midwives with a Socratic inspiration are the model for the profession. Given the development of professional identity, it can be interesting to have an educational curriculum where human values are reinforced. A woman-centred birth environment and birth territory are elementary for midwifery education.

Evaluating the development, woman-centricity and psychometric properties of maternity patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs): A systematic review protocol

INTRODUCTION

Woman-centred care is the right of every woman receiving maternity care, irrespective of where care is being received and who is providing care. This protocol describes a planned systematic review that will identify, describe and critically appraise the psychometric properties of maternity patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). The woman-centricity of PROM and PREM development and content validation (ie, the extent to which women were involved in these processes) will also be assessed. This information will be used to develop a maternity PROMs and PREMs database to support service and system performance measurement, and value-based maternity care initiatives.

METHODS AND ANALYSIS

This study will be guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for systematic reviews of outcome measurement instruments. Studies identified via MEDLINE, CINAHL Plus, PsycINFO and EMBASE describing the development, content validation and/or psychometric evaluation of PROMs and PREMs specifically designed for maternity populations throughout pregnancy, childbirth and postnatal periods will be considered if published from 2010 onward, in English, and available in full text. The COSMIN risk of bias checklist will be used to evaluate the quality of studies reporting on the development, content validation and/or psychometric evaluation of PROMs and PREMs. COSMIN criteria for good content validity will be used to assess the woman-centricity of PROM and PREM development and content validation studies. COSMIN standards of good psychometric properties will be used to evaluate the validity and reliability of the identified instruments.

ETHICS AND DISSEMINATION

Ethical permission for this research is not required. The findings of this research will be submitted for publication in an international, peer-reviewed journal. Abstracts for national and international conference presentations will also be submitted. The proposed maternity PROMs and PREMs database will be freely accessible online, and developed with consumer input to ensure its usefulness to a range of maternity care stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42021288854.

Midwives Perceiving and Dealing With Violence Against Women: Is It Mostly About Midwives Actively Protecting Women? A Modified Grounded Theory Study

Violence against women (VAW) affects pregnancy, birthing, and puerperium. In this sense, domestic violence (DV) or intimate partner violence (IPV) may increase during pregnancy, sexual child abuse may affect the birthing process, and obstetric violence may occur during birthing. Thus, consideration of violence during pregnancy and puerperium is essential to providing optimal care for women. This implies that midwives should be able to identify women affected by VAW. Therefore, this study explored VAW as perceived by midwives in one region of Austria. Interviews with 15 midwives (mean age 38.7 years) were conducted in Tyrol, Austria, between December 2014 and December 2015. Data were analyzed with a modified version of Grounded Theory. The core category "protecting but walking on eggshells" showed the caution with which midwives approached VAW and in particular DV or IPV. Including VAW in midwifery was connected to midwives being active protectors of women in their care. This meant being an intuitive, sensible, guiding, and empowering midwife to the woman. Staying active was necessary to fulfill the protective role also with regard to DV. However, this was influenced by the visibility of the connection between VAW, pregnancy, childbirth, and puerperium. The key to including VAW and particularly DV was midwives' professional role of actively protecting women. Neglecting DV during pregnancy, labor, and puerperium meant further silencing DV, and keeping it hidden. Considering these aspects in planning and implementing actions to prevent VAW is expected to support sustainability and motivation to ask women about all forms of violence during and after pregnancy.

Strategies to improve the quality of midwifery care and developing midwife-centered care in Iran: analyzing the attitudes of midwifery experts

Background

In recent years, extensive studies have been designed and performed in the context of providing midwifery care in developed countries, which has been unfortunately neglected in some low resources and upper middle-income countries such as Iran. This study was conducted to identify the best strategies for improving the quality of midwifery care and developing midwife-centered care in Iran.

Methods

This was a qualitative study using focus group discussion and content analysis method. Data were collected from 121 participants including midwifery board members, gynecologists, heads of midwifery departments, midwifery students, in charge midwives in hospitals, and midwives in the private sector. Focused-group discussions were used for data collection, and data were analyzed using content analysis method.

Results

The main themes extracted from the participants’ statements regarding improving the quality of midwifery care were as follows: Promotion and development of education, Manpower management, Rules, and regulations and standards for midwifery services, and Policy making.

Conclusion

This study showed that to improve midwifery care, health policy makers should take into account both the quality and quantity of midwifery education, and promote midwifery human resources through employment. Furthermore, insurance support, encouragement, supporting and motivating midwives, enhancing and improving the facilities, providing hospitals and maternity wards with cutting-edge equipment, promoting and reinforcing the position of midwives in the family doctor program, and using a referral system were the strategies proposed by participants for improving midwifery care. Finally, establishing an efficient and powerful monitoring system to control the practice of gynecologists and midwives, promoting the collaborative practice of midwives and gynecologists, and encouraging team-work with respect to midwifery care were other strategies to improve the midwifery services in Iran. Authorities and policymakers may set the stage for developing high quality and affordable midwifery care by relying on the strategies presented in this study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04379-7.

Midwifery Practice and Education in Antwerp: Forecasting Its Future With Scenario Planning

BACKGROUND

Midwifery across the world is facing changes and uncertainties. By recognizing plausible future options, a contemporary and strategic scope of midwifery practice and education can be established. The city of Antwerp, Belgium, was the indicative case for this study. Key drivers were identified to serve as input for scenarios.

METHOD

Structuration theory and intuitive logics scenario planning methods were used to structure contextual midwifery scenarios.

RESULTS

Six certain and six uncertain variables were identified. A two-dimensional framework showed these factors: (a) maternity care services and organization and (b) the society of child-bearing women and their families. Three scenarios described the plausible future of midwifery: (a) midwife-led care monitoring maternal health needs, (b) midwife-led holistic care, and (c) midwife/general practitioner-led integrated maternity care.

CONCLUSION

All of the scenarios show the direction of change with a strategic focus, the importance of midwifery authenticity, and digital adaptability in maternity services. Also, the coronavirus disease 2019 (COVID-19) pandemic cannot be ignored in future midwifery. [J Contin Educ Nurs. 2022;53(1):21-29.].

What is needed to facilitate healthy dietary behaviours in pregnant women: A qualitative study of Dutch midwives' perceptions of current versus preferred nutrition communication practices in antenatal care

OBJECTIVE

The aim of this paper was to explore midwives' perceptions of current and preferred nutrition communication practices in antenatal care, and to identify what is needed to achieve their preferred practices.

DESIGN

A qualitative descriptive design was used. Semi-structured interviews were conducted with twenty Dutch midwives working in primary care or secondary care settings across the Netherlands. To create a positive atmosphere, interviews were based on the principles of Appreciative Inquiry.

FINDINGS

Opportunities identified in current practices included midwives' sense of responsibility, their skills and experience, availability of resources, and group consultations. Barriers were the precarity and lack of prioritization of the topic, and the current focus on food safety (risks). Ideally, midwives envisioned nutrition communication as a continuous trajectory, in which not only reliable and consistent information is provided, but also more personalized and positive communication, to empower pregnant women.

KEY CONCLUSIONS

Midwives favour nutrition communication practices characterized by continuity of care and woman-centeredness. Opportunities to realize such practices in antenatal care are the use of innovative tools to support nutrition communication, more sustainable collaborations with dietitians, and better nutrition education for midwives.

IMPLICATIONS FOR PRACTICE

Midwives could act as facilitators and gatekeepers in nutrition communication, requiring limited time and expertise from midwives, and empowering pregnant women.

Assessment of the quality of woman-centred midwifery care from the mothers' perspective: A structural analysis of cross-sectional survey data

OBJECTIVE

Development and psychometric evaluation of a multidimensional model and assessment scales measuring core aspects of the quality of woman-centred midwifery care processes in Germany.

DESIGN & PARTICIPANTS

201 women, who received midwifery care during their pregnancy in 2018, were enrolled 6 to 18 months after birth. Data were assessed in a retrospective cross-sectional survey in Germany.

MEASUREMENTS

Established scales that are used in health care were adapted to the context of woman-centred midwifery care: Shared Decision-Making (SDM-Q-9-M), Empathy (CARE-M), Internal Team Participation (TEAM-M) and Professional Competence (PC-M). Confirmatory factor analyses were adapted to prove (a) the homogeneity of the single scales and (b) the multidimensional structure of the entire item pool.

FINDINGS

Appropriate to good model fit was confirmed for both the single assessments (CFI ≥ .96; SRMR ≤ .032) and the multidimensional model (CFI=.96; SRMR=.049). Minor model modifications reflecting local item dependencies had to be considered for the scales SDM-Q-9-M, TEAM-M, and PC-M. For the CARE-M scale, Participatory Communication proved to be a separate, second structural component.

CONCLUSIONS

Shared Decision-Making, Empathy, Internal Team Participation, and Professional Competence constitute core components of woman-centred midwifery care processes. A multi-dimensional assessment is now available measuring women's experiences with midwifery care. The assessment provides an essential component to master the complex challenge of measuring the quality of midwifery care inside and outside the hospital by means of a standardised and validated assessment.

Development of the Woman-Centred Care Scale- Midwife Self Report (WCCS-MSR)

Background

Woman-centred care is recognised as a fundamental construct of midwifery practice yet to date, there has been no validated tool available to measure it. This study aims to develop and test a self-report tool to measure woman-centred care in midwives.

Methods

A staged approach was used for tool development including deductive methods to generate items, testing content validity with a group of experts, and psychometrically testing the instrument with a sample drawn from the target audience. The draft 58 item tool was distributed in an online survey using professional networks in Australia and New Zealand. Testing included item analysis, principal components analysis with direct oblimin rotation and subscale analysis, and internal consistency reliability.

Results

In total, 319 surveys were returned. Analysis revealed five factors explaining 47.6% of variance. Items were reduced to 40. Internal consistency (.92) was high but varied across factors. Factors reflected the extent to which a midwife meets the woman’s unique needs; balances the woman’s needs within the context of the maternity service; ensures midwifery philosophy underpins practice; uses evidence to inform collaborative practice; and works in partnership with the woman.

Conclusion

The Woman-Centred Care Scale-Midwife Self Report is the first step in developing a valid and reliable tool to enable midwives to self-assess their woman-centredness. Further research in alternate populations and refinement is warranted.

Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study

BACKGROUND

Midwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care.

AIM

This research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings.

SETTING

Midwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital.

METHODS

A convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: 'How is it for you to be a midwife in South Africa?' Transcribed interviews were analysed using thematic coding.

RESULTS

Five themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife.

CONCLUSION

Midwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services.

CONTRIBUTION

This research provides evidence of the midwifery experience with implications for needed health policy change.

Reproducing normative femininity: Women's evaluations of their birth experiences analysed by means of word frequency and thematic analysis

BACKGROUND

Given the significance of the birth experience on women's and babies' well-being, assessing and understanding maternal satisfaction is important for providing optimal care. While previous research has thoroughly reviewed women's levels of satisfaction with the childbirth experience from a multitude of different angles, there is a dearth of papers that use a gender lens in this area. The aim of this study is to explore through a gender perspective the circumstances attributed to both women's assessment of a positive birth experience and those which contribute to a lack of satisfaction with their birth experience.

METHODS

Through the use of a local birth evaluation form at a Swedish labour ward, 190 women gave written evaluations of their birth experiences. The evaluations were divided into groups of positive, ambiguous, and negative evaluations. By means of a latent and constructionist thematic analysis based on word count, women's evaluations are discussed as reflections of the underlying sociocultural ideas, assumptions, and ideologies that shape women's realities.

RESULTS

Three themes were identified: Grateful women and nurturing midwives doing gender together demonstrates how a gender-normative behaviour may influence a positive birth experience when based on a reciprocal relationship. Managing ambiguous feelings by sympathising with the midwife shows how women's internalised sense of gender can make women belittle their negative experiences and refrain from delivering criticism. The midwifery model of relational care impeded by the labour care organisation describes how the care women receive during labour and birth is regulated by an organisation not always adapted to the benefit of birthing women.

CONCLUSIONS

Most women were very satisfied, predominantly with emotional support they received from the midwives. The latent constructionist thematic analysis also elicited women's mixed feelings towards the birth experience, with the majority of negative experiences directed towards the labour care organisation. Recognising the impact of institutional and medical discourses on childbirth, women's birth evaluations demonstrate the benefits and challenges of gender-normative behaviour, where women's internalised sense of gender was found to affect their experiences. A gender perspective may provide a useful tool in unveiling gender-normative complexities surrounding the childbirth experience.

Is the Concept of Midwifery Abdication Evident in Australian Case Law? A Systematic Review of Legal Literature, Court/Tribunal Decisions, and Coronial Findings

BACKGROUND

This review builds upon previous work exploring the concept of Midwifery Abdication, within the national midwifery literature. This article focuses on Australian legal literature, court/tribunal decisions and coronial or coroner's court findings.

OBJECTIVE

To explore Midwifery Abdication and whether it is evident within Australian caselaw.

DATA SOURCES

Australian Legal literature, coronial findings, and court/tribunal decisions reported by the Australian Health Practitioner Regulation Agency, during 2005–2020.

ELIGIBILITY CRITERIA

1,246 cases were located using the presented search terms. Use of exclusion criteria resulted in the inclusion of 41 cases.

METHODS

While there are no validated tools to appraise caselaw, this review followed a robust protocol that guides the preparation and reporting of systematic reviews. Midwifery Abdication was identified using previously validated, interrelated constructs.

RESULTS

Midwifery Abdication occurred in 41 cases; that included one or more previously identified constructs. In line with the associated integrative review, a midwife's professional identity, environmental hierarchy and associated culture of social obedience are all shown to act as influencing factors in Midwifery Abdication.

LIMITATIONS

Rigorous and reproducible processes were used; however, limited search functionality of some data sources may have resulted in inadvertent omission of cases. While this review relates to case law in one high-income country it provides a platform for further international research.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Acknowledging Midwifery Abdication in Australian caselaw may serve to strengthen the midwifery voice and encourage an enhanced educational and reflective focus on midwifery philosophy and decision-making. Midwifery education must empower midwives to embrace their autonomous status while enhancing their abilities to optimize informed decision-making within a woman-centered midwifery philosophy.

Prenatal Anxiety and Depression: Treatment Uptake, Barriers, and Facilitators in Midwifery Care

Background: While many women experience prenatal symptoms of anxiety and/or depression (PSAD), treatment uptake rates are relatively low. Left untreated, symptoms can unfavorably affect maternal and infant health. The first aim of this study was to identify the treatment uptake rate and modalities of treatment received in a community sample of Dutch pregnant women. The second aim was to investigate reasons for not engaging in treatment and to describe facilitators for treatment uptake. The third aim was to determine facilitators and barriers for self-disclosure of feelings to midwives. Materials and Methods: Data were collected from a convenience sample of 1439 Dutch women with low-risk mid-term pregnancies in midwifery care. PSAD was assessed with online questionnaires on symptoms. Reasons, facilitators, and barriers were determined with checklists and open questions. Data were analyzed using conventional content analysis and open code quantification. Results: Only 15% of women with PSAD (scoring above cutoffs; 22% of the full sample) received treatment. Psychotherapy was the most commonly received treatment. The main reason for not engaging in treatment was regarding PSAD as a natural part of pregnancy (71%). The main facilitator to engage in treatment was referral by midwives (16%), and for self-disclosure was the midwife asking about PSAD (59%), whereas not asking formed the main barrier for self-disclosure (23%). Conclusions: Relatively few pregnant women received treatment for PSAD. Midwives play an essential role in identifying and referring women for treatment. Routine screening may be a starting point to offer support and, if needed, referral.

From Midwife-Dominated to Midwifery-Led Antenatal Care: A Meta-Ethnography

Provision of antenatal care includes risk identification, prevention and management of pregnancy-related diseases, but also health education, health promotion, support and guidance to smooth the transition to parenthood. To ensure good perinatal health, high-quality, free and easily accessed antenatal care is essential. The aim of this study was to identify, integrate and synthesize knowledge of midwives' experiences of providing antenatal care, attending to clients' individual needs whilst facing multiple challenges. We conducted a meta-ethnography, which is a seven-step grounded, comparative and interpretative methodology for qualitative evidence synthesis. A lines-of-argument synthesis based on two metaphors was developed, based on refutational themes emerging from an analogous translation of findings in the included 14 papers. The model reflects midwives' wished-for transition from a midwife-dominated caring model toward a midwifery-led model of antenatal care. Structural, societal and personal challenges seemingly influenced midwives' provision of antenatal care. However, it emerged that midwives had the willingness to change rigid systems that maintain routine care. The midwifery-led model of care should be firmly based in midwifery science and evidence-based antenatal care that emphasize reflective practices and listening to each woman and her family. The change from traditional models of antenatal care towards increased use of digitalization no longer seems to be a choice, but a necessity given the ongoing 2020 pandemic.

Models for midwifery care: A mapping review

INTRODUCTION

According to WHO, midwives are found competent to provide evidencebased and normalcy-facilitating maternity care. Models for midwifery care exist, but seem to be lacking explicit epistemological status, mainly focusing on the practical and organizational level of care delivery. To make the values and attitudes of care visible, it is important to implement care models with explicit epistemological status. The aim of this paper is to identify and gain an overview of publications of theoretical models for midwifery care.

METHODS

A mapping review was conducted with systematic searches in nine databases for studies describing a theoretical model or theory for midwifery care that either did or was intended to impact clinical practice. Eligibility criteria were refined during the selection process.

RESULTS

Six models from six papers originating from different parts of the world were included in the study. The included models were developed using different methodologies and had different philosophical underpinnings and complexity gradients. Some characteristics were common, the most distinctive being the emphasis of the midwife-woman relationship, secondly the focus on woman-centeredness, and thirdly the salutogenic focus in care.

CONCLUSIONS

Overall, scarcity exists regarding theoretical models for midwifery care with explicit epistemological status. Further research is needed in order to develop generic theoretical models with an epistemological status to serve as a knowledge base for midwifery healthcare.

Exploring the medicalisation of childbirth through women's preferences for and use of pain relief

BACKGROUND

Sweden, along with other countries, is facing rising intrapartum intervention rates.

AIM

To explore the medicalisation of childbirth through women's preferences for and use of pain relief, and to investigate whether the presence of a birth plan had any impact on use of pain relief, rate of intervention, and satisfaction with the birth experience.

METHODS

The study was cross-sectional, and included 129 women with birth plans and 110 without, all of whom gave birth in one hospital in Sweden between March and June 2016. Data from birth plans and medical records was analysed through descriptive statistics and logistic regression.

FINDINGS

Parity rather than birth plan was a greater determinant for use of pain relief, frequency of interventions, and level of satisfaction; primiparas used more pain relief, had more interventions, and were less satisfied with their birth experiences than multiparas. Epidural analgesia was associated with a two to threefold increase in interventions, but 79.5% of all women had some form of intervention during birth, regardless of having an epidural or not. Women were generally highly satisfied with their birth experiences, women without epidural analgesia and interventions slightly more so.

CONCLUSION

Contrary to their initial plans, especially primiparas used more pharmacological pain relief than intended, and nearly all (94.6%) had some form of intervention during labour and birth. More interventions were associated with lower levels of satisfaction. The high rate of intervention in a healthy population of birthing women is disquieting and requires further attention.

The Woman-Centeredness of Various Dutch Maternity Service Providers During Antenatal and Postnatal Care

AIMS

To examine the woman-centeredness of maternity care providers from the woman's perspective. To investigate the validity and reliability of the Client Centered Care Questionnaire among a childbearing population.

DESIGN

A cross-sectional study.

METHODS

The self-report Client Centered Care Questionnaire was administered to evaluate women's one-on-one antenatal and postnatal care appointments with various Dutch care providers: community and hospital-based midwives, General Practitioners, (registrar) obstetricians, sonographers, and maternity care nurses.

RESULTS

Eight-hundred and fifteen completed questionnaires were received. Exploratory and confirmatory factor analyses provided support for a two-factor model, with an acceptable model fit. Woman-centeredness of all maternity care providers showed scores above baseline for the neutral value. Welch ANOVA showed a statistical significant effect of the type of maternity care practitioner in providing woman-centered care during antenatal and postnatal visits (F(5.8) = 7.79). The Bonferroni post hoc test showed that women assigned significantly higher woman-centered care scores to community-based midwives compared with hospital-based midwives (p .011) and compared with registrars/obstetricians (p < .001).

CONCLUSION

Although overall scores of perceived woman-centeredness indicated a good to excellent performance of woman-centered care, with significantly higher scores for community-based midwives, it cannot be assumed that current woman-centered care completely meets the needs of Dutch childbearing women. The Client Centered Care Questionnaire (CCCQ) is an adequate instrument to measure woman-centered care in antenatal and postnatal maternity services. Further research regarding measuring woman-centered care is needed.

Traumatic childbirth experiences: practice-based implications for maternity care professionals from the woman's perspective

OBJECTIVE

To explore women's traumatic childbirth experiences in order to make maternity care professionals more aware of women's intrapartum care needs.

METHOD

A qualitative exploratory study with a constant comparison/grounded theory design was performed. Thirty-six interviews were conducted with women who had given birth in a Dutch birth setting.

FINDINGS

Three themes, playing a profound role in the occurrence of traumatic birth experiences, emerged: (i) lack of information and consent - maternity care professionals' unilateral decision making during intrapartum care, lacking informed-consent. (ii) feeling excluded - women's mal-adaptive response to the healthcare professionals's one-sided decision making, leaving women feeling distant and estranged from the childbirth event and the experience. (iii) discrepancies - inconsistency between women's expectations and the reality of labour and birth - on an intrapersonal level.

CONCLUSION

Women's intrapartum care needs cohere with the concept of woman-centred care, including personalised care and reflecting humanising values. Care should include informed consent and shared decision-making. Maternity care professionals need to continuously evaluate whether the woman is consistently part of her own childbearing process. Maternity care professionals should maintain an ongoing dialogue with the woman, including women's internalised ideas of birth.

The International Childbirth Initiative: 12 steps to safe and respectful MotherBaby-Family maternity care

The ICI has developed a quality assurance program of 12 steps for safe and respectful MotherBaby–Family maternity care that all birthing units can implement.

Using a quality care framework to evaluate user and provider experiences of maternity care: A comparative study

OBJECTIVE

The Quality Maternal and Newborn Care Framework describes the components and characteristics of quality care and emphasises relational and continuity elements. Continuity of care is increasingly a focus of maternity care policy in the United Kingdom. While some outcomes have been shown to be improved, there is uncertainty about why certain models of care are more effective. Our overall objective is to develop a maternity care evaluation toolkit which incorporates this Framework along with other outcome evaluations. An initial step in developing this toolkit was to use the adapted Framework to evaluate perceptions and experiences of maternity care. Our specific objective in this study was to test this adapted Framework in a series of focus groups with key stakeholders, and to compare findings between different groups. Findings related to service users (pregnant women and new mothers) are reported in our accompanying paper; this paper presents findings from focus groups with service providers (midwives and obstetricians), and then compares user and provider perspectives.

DESIGN

A qualitative comparative enquiry involving three focus groups with 26 midwives (eight newly qualified; eight working in a community midwifery unit; and ten senior tertiary-based) and two focus groups with twelve obstetricians of all grades. We used a six-phase thematic analysis to derive then compare the focus groups' principal sub-themes; we then mapped these to the original Quality Maternal and Newborn Care Framework and compared these service providers' responses with those from the pregnant women and new mothers.

SETTING

Two health boards in Scotland.

PARTICIPANTS

Midwives and obstetricians who had experience of various models of maternity care.

FINDINGS

There were significant areas of overlap in their perceptions of providing maternity care. All groups reported 'limited resources and time'; the community midwifery unit and senior midwives and one group of obstetricians provided a critique of the system. Achieving tailored care was acknowledged as a problem by the senior midwives and one group of obstetricians. Only obstetricians discussed strategies for improvement. The newly qualified midwives were most positive in their responses. There was both overlap and contrast when comparing the views of service users and providers. We found most agreement when participants discussed some of the Framework's characteristics of care in negative terms, such as (in) accessible care, (lack of) adequate resources, and (absence of) tailored care.

KEY CONCLUSIONS

Being able firstly to map the participants' responses to the Quality Maternal and Newborn Care Framework, and then to identify strengths and gaps in the provision of quality maternity care, suggests to us that the Framework, derived as it is from a comprehensive analysis of the global evidence on quality care, can indeed be used to inform an evaluation toolkit. While aware that we cannot generalise from this limited qualitative study, we are currently undertaking similar work in other countries by which we hope to confirm our findings and further develop the toolkit.

Reports of work-related traumatic events: A mixedmethods study

INTRODUCTION

There is limited evidence of the effect and impact on midwives of being involved or witnessing traumatic work-related events. We categorised midwives' selfreported traumatic work-related events and responses to an event and explored the impact on the midwives' professional and personal life.

METHODS

A sequential explanatory mixed-methods study, consisting of a questionnaire and semi-structured interviews for midwives who practised or who had practised in the Netherlands or Flanders.

RESULTS

In total, 106 questionnaires were completed. We categorised various workrelated traumatic events: witnessing birth trauma/complications (34%), death (28.3%), (mis)management of care (19.8%), events related to the perceived social norm of maternity services' practitioners (9.5%), events related to environmental and contextual issues (5.6%) and to (mis)communication (2.8%). Sharing the experience with colleagues, family and friends, a supervisor or the woman involved in the event, was the most common response. In all, 74.5% of the participants still experienced the influence of work-related events in day-to-day practice and 37.5% still experienced the effects in their personal life. The scores of three participants (3.2%) indicated the likelihood of post-traumatic stress. Twenty-four interviews were conducted. Four themes emerged from the content analysis: 1) Timeline, 2) Drawing up the balance of relations with others, 3) Fretting and worrying, and 4) Lessons learned.

CONCLUSIONS

Various work-related traumatic events can impact on midwives' professional and/or personal life. Although not all midwives reported experiencing (lasting) effects of the events, the impact was sometimes far-reaching. Therefore, midwives' experiences and impact of work-related traumatic events cannot be ignored in midwifery practice, education and in supervision or mentoring.

Addressing transition to motherhood, guideline adherence by midwives in prenatal booking visits: Findings from video recordings

OBJECTIVE

To assess if and how primary care midwives adhere to the guideline by addressing transition to motherhood at the first prenatal booking visit and to what extent there was a difference in addressing transition to motherhood between nulliparous and multiparous women.

DESIGN

Cross-sectional observational study of video-recorded prenatal booking visits.

SETTING AND PARTICIPANTS

126 video recordings of prenatal booking visits with 18 primary care midwives in the Netherlands taking place between August 2010 and April 2011.

MEASUREMENTS

Five observers assessed dichotomously if midwives addressed seven topics of transition to motherhood according to the Dutch guideline prenatal midwifery care from the Royal Dutch Organization of Midwives and used six communication techniques. Frequencies and percentages of addressing each topic and communication technique were calculated. Differences between nulliparous and multiparous women were examined with Chi-Square tests or Fischer Exact tests, were appropriate. The agreement between the five observers was quantified using Fleiss' Kappa.

FINDINGS

During all visits at least one of the seven topics of transition to motherhood was addressed. The topics mother-to-infant bonding and support were addressed respectively in 2% and 16% of the visits. In almost all visits the topics desirability of the pregnancy, experience with the ultrasound examination or abdominal palpation or hearing the foetal heartbeat and practical preparation were addressed. Open questions for addressing transition to motherhood were used in 6% of the prenatal booking visits. Dutch midwives addressed transition to motherhood mostly by giving information (100%) and by using closed-ended questions (94%) and following woman's initiative (90%). Nulliparous women brought up transition to motherhood on their own initiative more often than multiparous women (97% versus 84%). For the topics 'desirability of the pregnancy 'and' practical preparations' and for conversation techniques 'giving information' and 'closed-ended questions', 100% agreement was achieved. However, the topic 'Support' had poor agreement (kappa = 0.19).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Although during every visit the transition of motherhood was addressed, the topics mother-to-infant bonding and support should get more attention. Midwives should improve adherence to the guideline by addressing transition to motherhood and by using more open questions. Furthermore, they should focus on taking the initiative to address the transition to motherhood in multiparous women themselves.