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Cignacco E, Schlenker A, Ammann-Fiechter S, Damke T, de Labrusse CC, Krahl A, Stocker Kalberer B, Weber-Käser A. Advanced Midwifery Practice in Switzerland: Development and challenges. Eur J Midwifery 2024; 8:EJM-8-15. [PMID: 38650967 PMCID: PMC11034162 DOI: 10.18332/ejm/185648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/25/2024] Open
Abstract
Midwifery is undergoing increasing complexity attributed to global epidemiological, socio-economic and technological shifts. Coupled with a shortage of workforce and the imperative for cost-effectiveness and high-quality care, there is an ongoing international discourse and establishment of new care models and specialized roles, notably Advanced Midwifery Practice (AMP). While countries like the UK and Ireland have embraced AMP roles, Switzerland lags behind with only a few pioneering roles. The absence of regulatory frameworks for AMP within the Swiss legal and healthcare system, hinders the evolution of APM roles necessary to address contemporary needs in perinatal healthcare provision. To effectively harness the midwifery workforce and mitigate premature attrition, Switzerland must formulate distinct career trajectories for postgraduate midwives, particularly for Advanced Practice Midwives (APM). This involves establishing legal standards for educational and clinical prerequisites, delineating guidelines for APM responsibilities and competencies, and devising compensation schemes that mirror the autonomy and leadership competencies integral to these advanced roles within inpatient and outpatient perinatal care models. The incorporation of evaluation and research into AMP is indispensable, contributing to improved patient outcomes and the ongoing professionalization of midwifery. In conjunction with the Swiss Federation of Midwives, all Universities of Applied Sciences in Switzerland have collaboratively drafted a national position paper underscoring the significance of developing APM roles to ensure the provision of high-quality perinatal care. This article aims to elucidate current developments in perinatal care within the Swiss context, providing a comprehensive definition for AMP, delineating its contribution to enhancing and sustaining the quality of care.
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Affiliation(s)
- Eva Cignacco
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Anja Schlenker
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Silvia Ammann-Fiechter
- Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Therese Damke
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Claire C. de Labrusse
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Astrid Krahl
- Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
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Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024; 4:CD004667. [PMID: 38597126 PMCID: PMC11005019 DOI: 10.1002/14651858.cd004667.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016. OBJECTIVES To compare the effects of midwife continuity of care models with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (17 August 2022), as well as the reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife continuity of care models or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion criteria, scientific integrity, and risk of bias, and carried out data extraction and entry. Primary outcomes were spontaneous vaginal birth, caesarean section, regional anaesthesia, intact perineum, fetal loss after 24 weeks gestation, preterm birth, and neonatal death. We used GRADE to rate the certainty of evidence. MAIN RESULTS We included 17 studies involving 18,533 randomised women. We assessed all studies as being at low risk of scientific integrity/trustworthiness concerns. Studies were conducted in Australia, Canada, China, Ireland, and the United Kingdom. The majority of the included studies did not include women at high risk of complications. There are three ongoing studies targeting disadvantaged women. Primary outcomes Based on control group risks observed in the studies, midwife continuity of care models, as compared to other models of care, likely increase spontaneous vaginal birth from 66% to 70% (risk ratio (RR) 1.05, 95% confidence interval (CI) 1.03 to 1.07; 15 studies, 17,864 participants; moderate-certainty evidence), likelyreduce caesarean sections from 16% to 15% (RR 0.91, 95% CI 0.84 to 0.99; 16 studies, 18,037 participants; moderate-certainty evidence), and likely result in little to no difference in intact perineum (29% in other care models and 31% in midwife continuity of care models, average RR 1.05, 95% CI 0.98 to 1.12; 12 studies, 14,268 participants; moderate-certainty evidence). There may belittle or no difference in preterm birth (< 37 weeks) (6% under both care models, average RR 0.95, 95% CI 0.78 to 1.16; 10 studies, 13,850 participants; low-certainty evidence). We arevery uncertain about the effect of midwife continuity of care models on regional analgesia (average RR 0.85, 95% CI 0.79 to 0.92; 15 studies, 17,754 participants, very low-certainty evidence), fetal loss at or after 24 weeks gestation (average RR 1.24, 95% CI 0.73 to 2.13; 12 studies, 16,122 participants; very low-certainty evidence), and neonatal death (average RR 0.85, 95% CI 0.43 to 1.71; 10 studies, 14,718 participants; very low-certainty evidence). Secondary outcomes When compared to other models of care, midwife continuity of care models likely reduce instrumental vaginal birth (forceps/vacuum) from 14% to 13% (average RR 0.89, 95% CI 0.83 to 0.96; 14 studies, 17,769 participants; moderate-certainty evidence), and may reduceepisiotomy 23% to 19% (average RR 0.83, 95% CI 0.77 to 0.91; 15 studies, 17,839 participants; low-certainty evidence). When compared to other models of care, midwife continuity of care models likelyresult in little to no difference inpostpartum haemorrhage (average RR 0.92, 95% CI 0.82 to 1.03; 11 studies, 14,407 participants; moderate-certainty evidence) and admission to special care nursery/neonatal intensive care unit (average RR 0.89, 95% CI 0.77 to 1.03; 13 studies, 16,260 participants; moderate-certainty evidence). There may be little or no difference in induction of labour (average RR 0.92, 95% CI 0.85 to 1.00; 14 studies, 17,666 participants; low-certainty evidence), breastfeeding initiation (average RR 1.06, 95% CI 1.00 to 1.12; 8 studies, 8575 participants; low-certainty evidence), and birth weight less than 2500 g (average RR 0.92, 95% CI 0.79 to 1.08; 9 studies, 12,420 participants; low-certainty evidence). We are very uncertain about the effect of midwife continuity of care models compared to other models of care onthird or fourth-degree tear (average RR 1.10, 95% CI 0.81 to 1.49; 7 studies, 9437 participants; very low-certainty evidence), maternal readmission within 28 days (average RR 1.52, 95% CI 0.78 to 2.96; 1 study, 1195 participants; very low-certainty evidence), attendance at birth by a known midwife (average RR 9.13, 95% CI 5.87 to 14.21; 11 studies, 9273 participants; very low-certainty evidence), Apgar score less than or equal to seven at five minutes (average RR 0.95, 95% CI 0.72 to 1.24; 13 studies, 12,806 participants; very low-certainty evidence) andfetal loss before 24 weeks gestation (average RR 0.82, 95% CI 0.67 to 1.01; 12 studies, 15,913 participants; very low-certainty evidence). No maternal deaths were reported across three studies. Although the observed risk of adverse events was similar between midwifery continuity of care models and other models, our confidence in the findings was limited. Our confidence in the findings was lowered by possible risks of bias, inconsistency, and imprecision of some estimates. There were no available data for the outcomes: maternal health status, neonatal readmission within 28 days, infant health status, and birth weight of 4000 g or more. Maternal experiences and cost implications are described narratively. Women receiving care from midwife continuity of care models, as opposed to other care models, generally reported more positive experiences during pregnancy, labour, and postpartum. Cost savings were noted in the antenatal and intrapartum periods in midwife continuity of care models. AUTHORS' CONCLUSIONS Women receiving midwife continuity of care models were less likely to experience a caesarean section and instrumental birth, and may be less likely to experience episiotomy. They were more likely to experience spontaneous vaginal birth and report a positive experience. The certainty of some findings varies due to possible risks of bias, inconsistencies, and imprecision of some estimates. Future research should focus on the impact on women with social risk factors, and those at higher risk of complications, and implementation and scaling up of midwife continuity of care models, with emphasis on low- and middle-income countries.
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Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Declan Devane
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, School of Business and Economics, Institute for Lifecourse and Society, University of Galway, Galway, Ireland
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Leanne V Jones
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Hannah Rayment-Jones
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Callander EJ, Scarf V, Nove A, Homer C, Carrandi A, Abdullah AS, Clow S, Halim A, Mbalinda SN, Nabirye RC, Rahman AF, Rasheed SI, Turk AM, Bazirete O, Turkmani S, Forrester M, Mandke S, Pairman S, Boyce M. Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites. BMJ Glob Health 2024; 9:e013643. [PMID: 38548343 PMCID: PMC10982789 DOI: 10.1136/bmjgh-2023-013643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Achieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative to hospital-based care for low-risk pregnancies where the lead professional at the time of birth is a trained midwife. These have been used in many countries to improve birth outcomes. METHODS The cost analysis used primary data collection from four MLBCs in Bangladesh, Pakistan and Uganda (n=12 MLBC sites). Modelled cost-effectiveness analysis was conducted to compare the incremental cost-effectiveness ratio (ICER), measured as incremental cost per disability-adjusted life-year (DALY) averted, of MLBCs to standard care in each country. Results were presented in 2022 US dollars. RESULTS Cost per birth in MLBCs varied greatly within and between countries, from US$21 per birth at site 3, Bangladesh to US$2374 at site 2, Uganda. Midwife salary and facility operation costs were the primary drivers of costs in most MLBCs. Six of the 12 MLBCs produced better health outcomes at a lower cost (dominated) compared with standard care; and three produced better health outcomes at a higher cost compared with standard care, with ICERs ranging from US$571/DALY averted to US$55 942/DALY averted. CONCLUSION MLBCs appear to be able to produce better health outcomes at lower cost or be highly cost-effective compared with standard care. Costs do vary across sites and settings, and so further exploration of costs and cost-effectiveness as a part of implementation and establishment activities should be a priority.
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Affiliation(s)
- Emily J Callander
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Vanessa Scarf
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | | | - Alayna Carrandi
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | | | - Sheila Clow
- University of Cape Town, Cape Town, South Africa
| | - Abdul Halim
- Centre for Injury Prevention and Research, Dhaka, Bangladesh
| | | | | | | | | | | | - Oliva Bazirete
- Novametrics Ltd, Duffield, UK
- University of Rwanda, Kigali, Rwanda
| | - Sabera Turkmani
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Mandy Forrester
- International Confederation Of Midwives, The Hague, The Netherlands
| | - Shree Mandke
- International Confederation Of Midwives, The Hague, The Netherlands
| | - Sally Pairman
- International Confederation Of Midwives, The Hague, The Netherlands
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Martín-Vázquez C, Goás-Gómez N, Calvo-Ayuso N, Rosón-Matilla L, Quiroga-Sánchez E, García-Fernández R. Analysis of Maternal Positions during the Dilation and Expulsive Phase and Their Relationship with Perineal Injuries in Eutocic Deliveries Attended by Midwives. Healthcare (Basel) 2024; 12:441. [PMID: 38391816 PMCID: PMC10888027 DOI: 10.3390/healthcare12040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
This cross-sectional descriptive study aimed to analyze the relationship between maternal positions during the expulsion phase and perineal outcomes in 367 eutocic births attended by midwives or midwifery residents at a public hospital in northern Spain in 2018. A total of 94.3% of women opted for horizontal positions. Limited sacral retroversion was observed in 71.7%, potentially influencing perineal outcomes. A low incidence of tears indicated effective management during the expulsive phase, with an episiotomy rate of 15.3%, which was slightly above the 15% standard. Primiparity and maternal age were identified as risk factors associated with episiotomy. Additionally, sacral mobilization and vertical positions during delivery were significantly related to fewer perineal injuries, suggesting benefits for both mother and newborn. The correlation between maternal positions and the need for epidural analgesia highlighted the importance of considering these in pain management during childbirth. Despite limitations, the study provides valuable insight into obstetric practices and advocates for a woman-centered approach that respects autonomy during childbirth. Further research is needed to explore biomechanical parameters and enhance childbirth experiences.
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Affiliation(s)
- Cristian Martín-Vázquez
- Department of Nursing and Physiotherapy, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Noelia Goás-Gómez
- Centro de Salud Vilalba, Servizo Galego de Saúde (SERGAS), 27800 Lugo, Spain
| | - Natalia Calvo-Ayuso
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | | | - Enedina Quiroga-Sánchez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Rubén García-Fernández
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, 1600-190 Lisbon, Portugal
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Palau-Costafreda R, García Gumiel S, Eles Velasco A, Jansana-Riera A, Orus-Covisa L, Hermida González J, Algarra Ramos M, Canet-Vélez O, Obregón Gutiérrez N, Escuriet R. The first alongside midwifery unit in Spain: A retrospective cohort study of maternal and neonatal outcomes. Birth 2023; 50:1057-1067. [PMID: 37589398 DOI: 10.1111/birt.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/07/2022] [Accepted: 06/28/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Midwife-led units have been shown to be safer and reduce interventions for women at low risk of complications at birth. In 2017, the first alongside birth center was opened in Spain. The aim of this study was to compare outcomes for women with uncomplicated pregnancies giving birth in the Midwife-led unit (MLU) and in the Obstetric unit (OU) of the same hospital. METHODS Retrospective cohort study comparing birth outcomes between low-risk women, depending on their planned place of birth. Data were analyzed with an intention-to-treat approach for women that gave birth between January 2018 and December 2020. RESULTS A total of 878 women were included in the study, 255 women chose to give birth in the MLU and 623 in the OU. Findings showed that women in the MLU were more likely to have a vaginal birth (91.4%) than in the OU (83.8%) (aOR 2.98 [95%CI 1.62-5.47]), less likely to have an instrumental delivery, 3.9% versus 11.2% (0.25 [0.11-0.55]), to use epidural analgesia, 19.6% versus 77.9% (0.15 [0.04-0.17]) and to have an episiotomy, 7.4% versus 15.4% (0.27 [0.14-0.53]). There were no differences in rates of postpartum hemorrhage, retained placenta, or adverse neonatal outcomes. Intrapartum and postpartum transfer rates from the MLU to the OU were 21.1% and 2.4%, respectively. CONCLUSIONS The high rate of obstetric interventions in Spain could be reduced by implementing midwife-led units across the whole system, without an increase in maternal or neonatal complications.
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Affiliation(s)
- Roser Palau-Costafreda
- Biomedicine Programme, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra - affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Sara García Gumiel
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Amaranta Eles Velasco
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Anna Jansana-Riera
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain
| | - Lluna Orus-Covisa
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Júlia Hermida González
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Miriam Algarra Ramos
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Olga Canet-Vélez
- Department of Nursing, Faculty of Health Sciences, Universitat Ramon Llull, Barcelona, Spain
| | | | - Ramón Escuriet
- Directorate General of Health Planning, Ministry of Health of the Government of Catalonia, Barcelona, Spain
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Strijbos LTM, Hendrix MLE, Al-Nasiry S, Smits LJM, Scheepers HCJ. Which first-trimester risk assessment method for preeclampsia is most suitable? A model-based impact study. Am J Obstet Gynecol MFM 2023; 5:100974. [PMID: 37062507 DOI: 10.1016/j.ajogmf.2023.100974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Low-dose aspirin treatment reduces the risk of preeclampsia among high-risk pregnant women. Internationally, several first-trimester risk-calculation methods are applied. OBJECTIVE This study aimed to assess the costs and benefits of different first-trimester preeclampsia risk estimation algorithms: EXPECT (an algorithmic prediction model based on maternal characteristics), National Institute for Health and Care Excellence (a checklist of risk factors), and the Fetal Medicine Foundation (a prediction model using additional uterine artery Doppler measurement and laboratory testing) models, coupled with low-dose aspirin treatment, in comparison with no risk assessment. STUDY DESIGN We constructed a decision analytical model estimating the number of cases of preeclampsia with each strategy and the costs of risk assessment for preeclampsia and early aspirin treatment, expressed in euros (€) in a hypothetical population of 100,000 women. We performed 1-way sensitivity analyses to assess the impact of adherence rates on model outcomes. RESULTS Application of the EXPECT, National Institute for Health and Care Excellence, and Fetal Medicine Foundation models results in respectively 1.98%, 2.55%, and 1.90% of the women developing preeclampsia, as opposed to 3.00% of women in the case of no risk assessment. Overall, the net financial benefits of the EXPECT, National Institute for Health and Care Excellence, and Fetal Medicine Foundation models relative to no risk assessment are €144, €43, and €38 per patient, respectively. The respective percentages of women receiving aspirin treatment are 18.6%, 10.2%, and 6.0% for the 3 risk assessment methods. CONCLUSION The EXPECT and Fetal Medicine Foundation model are comparable with regard to numbers of prevented preeclampsia cases, and both are superior to the National Institute for Health and Care Excellence model and to no risk assessment. EXPECT is less resource-demanding and results in the highest cost savings, but also requires the highest number of women to be treated with aspirin. When deciding which strategy is preferable, cost savings and easier use have to be weighed against the degree of overtreatment, although low-dose aspirin has no clear disadvantages during pregnancy.
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Affiliation(s)
- Lynn T M Strijbos
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands (Drs. Strijbos).
| | - Manouk L E Hendrix
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, The Netherlands (Dr. Hendrix, Dr. Al-Nasiry, and Dr Scheepers)
| | - Salwan Al-Nasiry
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, The Netherlands (Dr. Hendrix, Dr. Al-Nasiry, and Dr Scheepers); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands (XX Al-Nasiry and XX Scheepers)
| | - Luc J M Smits
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands (Prof. Smits)
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, The Netherlands (Dr. Hendrix, Dr. Al-Nasiry, and Dr Scheepers); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands (XX Al-Nasiry and XX Scheepers)
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Panda S, Begley C, Daly D. Clinicians' views of factors influencing decision-making for CS for first-time mothers-A qualitative descriptive study. PLoS One 2022; 17:e0279403. [PMID: 36576912 PMCID: PMC9797090 DOI: 10.1371/journal.pone.0279403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
Clinicians' perspectives of the reasons for performing caesarean section (CS) are fundamental to deepening knowledge and understanding of factors influencing decision-making for CS. The aim of this study was to explore midwives' and obstetricians' views of factors influencing decision-making for CS for first-time mothers. A qualitative descriptive study with semi-structured one-to-one audio-recorded interviews was used to gather data from clinicians (15 midwives and 20 senior obstetricians). Following research ethics committee approval, clinicians, who were directly involved in the decision-making process for CS during the period of data collection, were purposively selected from three maternity units in the Republic of Ireland between June 2016 to July 2017. The interviews were transcribed verbatim and analysed thematically. Three interrelated themes with several subthemes reflective of clinicians' views and experiences emerged following data analysis. These were: 'A fear factor' describing clinicians' fear of adverse outcomes and subsequent litigation, 'Personal preferences versus a threshold-clinician driven factors emphasising the influence of clinicians' personal beliefs, and 'Standardised versus individualised care-a system perspective' explaining the effects of, or lack of, organisational policy and its direct and indirect impact on the decision-making process. Findings show that decisions to perform a CS are, on occasion, based on clinicians' personal beliefs and interpretation, similar to findings from other published literature. Consideration of broader issues related to organisational, socio-cultural and political context is essential when seeking solutions to the rising CS rates. The findings will enable clinicians to reflect on their day-to-day practice, in order to look for modifiable factors that influence their decision-making, and help women understand the multitude of factors that can lead to a decision to perform a CS. Findings will also contribute to the development of the 'next step action' and assist in devising future intervention studies to reduce any unnecessary CSs.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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8
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Rayment-Jones H, Harris J, Harden A, Turienzo CF, Sandall J. Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation. Women Birth 2022; 36:e314-e327. [PMID: 36443217 DOI: 10.1016/j.wombi.2022.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. AIM To evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. METHODS Realist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. FINDINGS Experiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women's anxiety, enabled the development of a supportive network and improved women's ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. CONCLUSION The identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole.
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Bradford BF, Wilson AN, Portela A, McConville F, Fernandez Turienzo C, Homer CSE. Midwifery continuity of care: A scoping review of where, how, by whom and for whom? PLOS Glob Public Health 2022; 2:e0000935. [PMID: 36962588 PMCID: PMC10021789 DOI: 10.1371/journal.pgph.0000935] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022]
Abstract
Systems of care that provide midwifery care and services through a continuity of care model have positive health outcomes for women and newborns. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? Using a scoping review framework, we searched electronic and grey literature databases for reports in any language between January 2012 and January 2022, which described current and recent trials, implementation or scaling-up of midwifery continuity of care studies or initiatives in high-, middle- and low-income countries. After screening, 175 reports were included, the majority (157, 90%) from high-income countries (HICs) and fewer (18, 10%) from low- to middle-income countries (LMICs). There were 163 unique studies including eight (4.9%) randomised or quasi-randomised trials, 58 (38.5%) qualitative, 53 (32.7%) quantitative (cohort, cross sectional, descriptive, observational), 31 (19.0%) survey studies, and three (1.9%) health economics analyses. There were 10 practice-based accounts that did not include research. Midwives led almost all continuity of care models. In HICs, the most dominant model was where small groups of midwives provided care for designated women, across the antenatal, childbirth and postnatal care continuum. This was mostly known as caseload midwifery or midwifery group practice. There was more diversity of models in low- to middle-income countries. Of the 175 initiatives described, 31 (18%) were implemented for women, newborns and families from priority or vulnerable communities. With the exception of New Zealand, no countries have managed to scale-up continuity of midwifery care at a national level. Further implementation studies are needed to support countries planning to transition to midwifery continuity of care models in all countries to determine optimal model types and strategies to achieve sustainable scale-up at a national level.
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Affiliation(s)
- Billie F Bradford
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Alyce N Wilson
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Anayda Portela
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Fran McConville
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | | | - Caroline S E Homer
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
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Martin-Arribas A, Escuriet R, Borràs-Santos A, Vila-Candel R, González-Blázquez C. A comparison between midwifery and obstetric care at birth in Spain: Across-sectional study of perinatal outcomes. Int J Nurs Stud 2021; 126:104129. [PMID: 34890836 DOI: 10.1016/j.ijnurstu.2021.104129] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The organizational structure of maternity services determines the choice of which professionals provide care during pregnancy, birth, and the postnatal period, and it influences the kind of care they deliver and the level of continuity of care offered. There is considerable evidence that demonstrates a relationship between how care is provided and the maternal and neonatal health outcomes. Registered midwives and obstetricians provide maternity care across Spain. To date, no studies have assessed whether maternity outcomes differ between these two groups. OBJECTIVE The aim of this study was to examine the association between the care received (midwifery care versus obstetric care) and the maternal and neonatal outcomes in women with normal, low- and medium-risk pregnancies in Spain from 2016 to 2019. DESIGN A prospective, multicentre, cross-sectional study was carried out as part of COST Action IS1405 at 44 public hospitals in Spain in the years 2016-2019. The protocol can be accessed through the registry ISRCTN14062994. The sample size of this study was 11,537 women. The primary outcome was mode of birth. The secondary outcomes included augmentation with oxytocin, use of epidural analgesia, women's position at birth, perineal integrity, third stage of labour management, maternal and neonatal admission to intensive care, Apgar score, neonatal resuscitation, and early initiation of breastfeeding. Chi-square tests for categorical variables and independent sample t-test for continuous variables to assess differences between the midwifery and obstetric groups were calculated. Odds ratio with intervals of confidence at 95% were calculated for obstetric interventions and perinatal outcomes. A multivariate logistic regression model was applied in order to examine the effect of type of healthcare provider on perinatal outcomes. These models were adjusted for care provider, type of onset of labour, use of anaesthesia, pregnancy risk, maternal age, parity, and gestational age at birth. RESULTS Midwifery care was associated with lower rates of operative births and severe perineal damage and had no higher adverse outcomes. No statistically significant differences were observed in the use of other obstetric interventions between the two groups. CONCLUSIONS The findings of this study should encourage a shift in the current maternity care system towards a greater integration of midwifery-led services in order to achieve optimal birth outcomes for women and newborns. REGISTRY NUMBER ISRCTN14062994.
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Affiliation(s)
- Anna Martin-Arribas
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain; Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.
| | - Ramon Escuriet
- Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain.
| | - Alicia Borràs-Santos
- Gimbernat School of Nursing, Universitat Autònoma de Barcelona (UAB), Sant Cugat del Vallès, Spain.
| | - Rafael Vila-Candel
- La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Alzira, Valencia, Spain; Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain; Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.
| | - Cristina González-Blázquez
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.
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Goncalves AS, Ferreira IM, Pestana-Santos M, Prata AP, McCourt C. Antenatal care policies for low-risk pregnant women in high-income countries with a universal health system: a scoping review protocol. JBI Evid Synth 2021; 18:1537-1545. [PMID: 32813393 DOI: 10.11124/jbisrir-d-19-00197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this scoping review is to map the available evidence on the nature, extent, and range of antenatal care policies for low-risk pregnant women in high-income countries with a health system founded on the Beveridge Model. INTRODUCTION Low-risk women in high-income countries have good evolutionary perinatal outcomes but high intervention rates in pregnancy and childbirth, which ultimately leads to high morbidity. This has implications at all levels including families, the health care system, and society. This review aims to inform future policy and identify the viability of the adoption of alternative models to the Portuguese context that can reduce unnecessary interventions. INCLUSION CRITERIA Studies, protocols, guidelines, and policies that provide guidance on antenatal care for low-risk pregnant women in high-income countries with a health system founded on the Beveridge Model (universal health care) will be considered. Documents from 2005 to present will be included, and no language restrictions will be imposed. METHODS An initial search will be conducted in databases including MEDLINE (via PubMed) and CINAHL (via EBSCOhost), followed by a manual search of the reference lists from the documents accepted for inclusion, and a hand search of gray literature. For the countries whose policies are not available through the earlier steps, key persons from health ministries and academia will be contacted. Search results will be exported and data extracted using charting forms. Data will be synthesized using narrative description.
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Affiliation(s)
- Andreia Soares Goncalves
- 1Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal 2UICISA:E - Unidade de Investigação em Ciências da Saúde: Enfermagem, Portugal 3Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence 4Escola Superior de Enfermagem do Porto, Porto, Portugal 5CINTESIS - Innovation & Development in Nursing: Center for Health Technology and Services Research, Porto, Portugal 6School of Health Sciences, Division of Midwifery and Radiography, City, University of London, London, United Kingdom
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Symon A, Shinwell S, Craig J. Process lessons from evaluating a combined continuity of carer and home birth scheme. Birth 2020; 47:389-396. [PMID: 33289141 DOI: 10.1111/birt.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Continuity of midwifery carer improves outcomes, but there is significant variation in how such schemes are implemented and evaluated cross-culturally. The Angus home birth scheme in Scotland incorporates continuity of carer throughout pregnancy, labor, birth, and the postnatal period. METHODS Manual maternity case note review to evaluate the 80% continuity of carer and 3% planned home birth rate targets. RESULTS Of 1466 women booking for maternity care, 69 joined the scheme. Forty-four had a planned home birth (3% overall), of whom seven were originally deemed ineligible. Of the 44, eight (18%) also achieved 80% continuity of carer with the primary midwife; by including a home birth team colleague, the continuity rate rose to 73%. Women whose care achieved home birth and continuity targets had lower deprivation scores. Eligibility issues, women's changing circumstances, and data recording lapses were complicating issues. CONCLUSIONS Targets must be both feasible and meaningful and should be complemented by assessing a broad range of outcomes while viewing the scheme holistically. By expanding eligibility criteria, the home birth rate target was met; including input from a home birth team colleague in the calculation meant the continuity target was nearly met. With dedicated and competent staff, adequate resource and political support, and when considered in the round, the scheme's viability within local services was confirmed. Other generalizable learning points included the need to standardize definitions and data recording methods. Comparability across schemes helps grow the evidence base so that the links between processes and outcomes can be identified.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, UK
| | - Shona Shinwell
- Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, UK
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Gama SGND, Viellas EF, Medina ET, Angulo-Tuesta A, Silva CKRTD, Silva SDD, Santos YRP, Esteves-Pereira AP. Delivery care by obstetric nurses in maternity hospitals linked to the Rede Cegonha, Brazil - 2017. Cien Saude Colet 2020; 26:919-929. [PMID: 33729347 DOI: 10.1590/1413-81232021263.28482020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess whether nurses' presence in delivery care in maternity hospitals linked to the Rede Cegonha program promotes access to best obstetric practices during labor and delivery. We conducted an evaluative study in 2017 in all 606 SUS maternity hospitals that joined this strategic policy in all Brazilian states. We collected data from maternity hospital managers and puerperae. The analysis was performed at two levels: hospital with or without a nurse in delivery care; and professionals that attended vaginal delivery, whether doctors or nurses. We used best practices and interventions for vaginal deliveries and cesarean section rates as dependent variables. We included 5.016 subjects for analyses of vaginal deliveries and 9.692 to calculate cesarean section rates. Multiple regressions were adjusted for geographic region, maternity hospital size, and puerperae skin color and parity. Maternity hospitals with nurses in delivery care used more the partograph and less oxytocin, lithotomy, episiotomy, and cesarean section. Deliveries attended by nurses had more frequent use of the partograph and a lower likelihood of lithotomy and episiotomy. The inclusion of nurses in vaginal delivery care has successfully brought women closer to a more physiological and respectful delivery.
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Affiliation(s)
| | - Elaine Fernandes Viellas
- Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | | | | | | | | | - Yammê Ramos Portella Santos
- Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Ana Paula Esteves-Pereira
- Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
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Goemaes R, Beeckman D, Verhaeghe S, Van Hecke A. Sustaining the quality of midwifery practice in Belgium: Challenges and opportunities for advanced midwife practitioners. Midwifery 2020; 89:102792. [PMID: 32653612 DOI: 10.1016/j.midw.2020.102792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/10/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Midwifery practice is essential in achieving high-quality maternal and newborn care in all settings and countries. However, midwifery practice has become more complex over the past decades. Considerable demands are being placed on midwives to meet increasing epidemiological, socio-economic, and technological challenges. These require a well-trained midwifery workforce ready to shape the care in the near and long-term future. OBJECTIVE To discuss advanced midwife practitioner role implementation in Belgium as a possible answer to healthcare-related challenges that impact midwifery practice. Furthermore, to stimulate a debate within the profession at all levels in Belgium and in countries considering advanced midwife practitioner roles. METHOD The framework by De Geest et al. (2008) served as a basis for discussing the drivers for advanced midwife practitioner role implementation: the legal, policy and economic context, workforce issues, education, practice patterns, and healthcare needs of the population. FINDINGS A legal basis for advanced midwife practitioner role implementation is lacking in Belgium. Remuneration opportunities for the non-clinical part of these roles (e.g. leadership and innovation activities) are missing. It might be challenging for healthcare organisations to support the implementation of such roles, as immediate revenues of non-clinical activities are absent. However, sufficient potential resources are available to fill in future advanced midwife practitioner positions. Additionally, advanced midwife practitioner specific master programmes are being planned in the near future. CONCLUSIONS Although several barriers for the implementation of advanced midwife practitioner roles were identified, a discussion should be held on the opportunities of implementing these roles to facilitate the development of new models of care that meet current and future challenges in midwifery practice and healthcare. After initial discussions amongst midwives in academic, managerial, and policy positions, stakeholders such as obstetricians, general practitioners, associations representing healthcare organisations, and policy makers should be involved as a next step.
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Affiliation(s)
- Régine Goemaes
- PhD student University Centre for Nursing & Midwifery Department of Public Health and Primary Care Faculty of Medicine and Health Sciences, Ghent University. University Centre for Nursing & Midwifery Ghent University, U.Z. 5K3 Corneel Heymanslaan 10, B-9000 Ghent, Belgium.
| | - Dimitri Beeckman
- University Centre for Nursing & Midwifery Department of Public Health and Primary Care Faculty of Medicine and Health Sciences, Ghent University Centre for Nursing & Midwifery Ghent University, U.Z. 5K3 Corneel Heymanslaan 10, B-9000, Ghent, Belgium.
| | - Sofie Verhaeghe
- University Centre for Nursing & Midwifery Department of Public Health and Primary Care Faculty of Medicine and Health Sciences, Ghent University Centre for Nursing & Midwifery, Ghent University, U.Z. 5K3 Corneel Heymanslaan 10, B-9000, Ghent, Belgium.
| | - Ann Van Hecke
- University Centre for Nursing & Midwifery Department of Public Health and Primary Care Faculty of Medicine and Health Sciences, Ghent University Centre for Nursing & Midwifery, Ghent University, U.Z. 5K3 Corneel Heymanslaan 10, B-9000, Ghent, Belgium; Nursing Department, University Hospital Ghent, Corneel Heymanslaan 10, B-9000, Ghent, Belgium..
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Styles C, Kearney L, George K. Implementation and upscaling of midwifery continuity of care: The experience of midwives and obstetricians. Women Birth 2020; 33:343-351. [DOI: 10.1016/j.wombi.2019.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022]
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Masciullo L, Petruzziello L, Perrone G, Pecorini F, Remiddi C, Galoppi P, Brunelli R. Caesarean Section on Maternal Request: An Italian Comparative Study on Patients' Characteristics, Pregnancy Outcomes and Guidelines Overview. Int J Environ Res Public Health 2020; 17:ijerph17134665. [PMID: 32610490 PMCID: PMC7369872 DOI: 10.3390/ijerph17134665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Accepted: 06/27/2020] [Indexed: 01/23/2023]
Abstract
In recent years, the rate of caesarean sections has risen all over the world. Accordingly, efforts are being made worldwide to understand this trend and to counteract it effectively. Several factors have been identified as contributing to the selection of caesarean section (CS), especially an obstetricians' beliefs, attitudes and clinical practices. However, relatively few studies have been conducted to understand the mechanisms involved, to explore influencing factors and to clearly define the risks associated with the caesarean section on maternal request (CSMR). This comparative study was conducted to elucidate the factors influencing the choice of CSMR, as well as to compare the associated risks of CSMR to CS for breech presentation among Italian women. From 2015 to 2018, a total of 2348 women gave birth by caesarean section, of which 8.60% (202 women) chose a CSMR. We found that high educational attainment, use of assisted reproductive technology, previous operative deliveries and miscarriages within the obstetric history could be positively correlated with the choice of CSMR in a statistically significant way. This trend was not confirmed when the population was stratified based on patients' characteristics, obstetric complications and gestational age. Finally, no major complications were found in patients that underwent CSMR. We believe that it is essential to evaluate patients on a case-by-case basis. It is essential to understand the personal experience, to explain the knowledge available on the subject and to ensure a full understanding of the risks and benefits of the medical practice to guarantee the patients not only their best scientific preparation but also human understanding.
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Hanahoe M. Midwifery-led care can lower caesarean section rates according to the Robson ten group classification system. Eur J Midwifery 2020; 4:7. [PMID: 33537609 PMCID: PMC7839114 DOI: 10.18332/ejm/119164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Midwifery-led care is recognised as the best choice of maternity care for low-risk women. Robson’s Ten Group Classification System (TGCS) is an internationally recognised audit tool, however there is no midwifery-led service presenting their statistics in this way. The objective of this study was to analyse caesarean section rates for the women attending midwifery-led care at the National Maternity Hospital Dublin, Ireland, using the Robson TGCS. METHODS This is a retrospective study of electronic records for a total of 1097 women who were booked to attend the community midwife team in the National Maternity Hospital, during 2016 and 2017. RESULTS The rate of caesarean section in low-risk nulliparous women (Robson Group 1) was under 6%, without affecting the perinatal outcome. The induction rate in nulliparous women (Group 2) was 36%, less than the national average the cesarean rates were quadruple in this group. CONCLUSIONS Low-risk women who attend midwifery-led services, have a low caesarean section rate in this study. This was achieved with continuity of care, good antenatal preparation, and support throughout labour and birth by a dedicated team of midwives. Outcomes can only be truly compared if we use the same criteria to measure them. The TGCS demonstrates the effectiveness of midwifery-led care.
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Cegolon L, Mastrangelo G, Maso G, Dal Pozzo G, Ronfani L, Cegolon A, Heymann WC, Barbone F. Understanding Factors Leading to Primary Cesarean Section and Vaginal Birth After Cesarean Delivery in the Friuli-Venezia Giulia Region (North-Eastern Italy), 2005-2015. Sci Rep 2020; 10:380. [PMID: 31941963 PMCID: PMC6962159 DOI: 10.1038/s41598-019-57037-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 12/22/2019] [Indexed: 01/21/2023] Open
Abstract
Although there is no evidence that elevated rates of cesarean sections (CS) translate into reduced maternal/child perinatal morbidity or mortality, CS have been increasingly overused almost everywhere, both in high and low-income countries. The primary cesarean section (PCS) has become a major driver of the overall CS (OCS) rate, since it carries intrinsic risk of repeat CS (RCS) in future pregnancies. In our study we examined patterns of PCS, pl compared with planned TOLAC anned PCS (PPCS), vaginal birth after 1 previous CS (VBAC-1) and associated factors in Friuli Venezia Giulia (FVG), a region of North-Eastern Italy, collecting data from its 11 maternity centres (coded from A to K) during 2005-2015. By fitting three multiple logistic regression models (one for each delivery mode), we calculated the adjusted rates of PCS and PPCS among women without history of CS, whilst the calculation of the VBAC rate was restricted to women with just one previous CS (VBAC-1). Results, expressed as odds ratio (OR) with 95% confidence interval (95%CI), were controlled for the effect of hospital, calendar year as well as several factors related to the clinical and obstetric conditions of the mothers and the newborn, the obstetric history and socio-demographic background. In FVG during 2005-2015 there were 24,467 OCS (rate of 24.2%), 19,565 PCS (19.6%), 7,736 PPCS (7.7%) and 2,303 VBAC-1 (28.4%). We found high variability of delivery mode (DM) at hospital level, especially for PCS and PPCS. Breech presentation was the strongest determinant for PCS as well as PPCS. Leaving aside placenta previa/abuptio placenta/ante-partum hemorrhage, further significant factors, more importantly associated with PCS than PPCS were non-reassuring fetal status and obstructed labour, followed by (in order of statistical significance): multiple birth; eclampsia/pre-eclampsia; maternal age 40-44 years; placental weight 600-99 g; oligohydramios; pre-delivery LoS 3-5 days; maternal age 35-39 years; placenta weight 1,000-1,500 g; birthweight < 2,000 g; maternal age ≥ 45 years; pre-delivery LoS ≥ 6 days; mother's age 30-34 years; low birthweight (2,000-2,500 g); polyhydramnions; cord prolaspe; ≥6 US scas performed during pregnancy and pre-term gestations (33-36 weeks). Significant factors for PPCS were (in order of statistical significance): breech presentation; placenta previa/abruptio placenta/ante-partum haemorrhage; multiple birth; pre-delivery LoS ≥ 3 days; placental weight ≥ 600 g; maternal age 40-44 years; ≥6 US scans performed in pregnancy; maternal age ≥ 45 and 35-39 years; oligohydramnios; eclampsia/pre-eclampsia; mother's age 30-34 years; birthweight <2,000 g; polyhydramnios and pre-term gestation (33-36 weeks). VBAC-1 were more likely with gestation ≥ 41 weeks, placental weight <500 g and especially labour analgesia. During 2005-2015 the overall rate of PCS in FVG (19.6%) was substantially lower than the corresponding figure reported in 2010 for the entire Italy (29%) and still slightly under the most recent national PCS rate for 2017 (22.2%). The VBAC-1 rate on women with history of one previous CS in FVG was 28.4% (25.3% considering VBAC on all women with at least 1 previous CS), roughly three times the Italian national rate of 9% reported for 2017. The discrepancy between the OCS rate at country level (38.1%) and FVG's (24.2%) is therefore mainly attributable to RCS. Although there was a marginal decrease of PCS and PPCS crudes rates over time in the whole region, accompained by a progressive enhancement of the crude VBAC rate, we found remarkable variability of DM across hospitals. To further contain the number of unnecessary PCS and promote VBAC where appropriate, standardized obstetric protocols should be introduced and enforced at hospital level. Decision-making on PCS should be carefully scrutinized, introducing a diagnostic second opinion for all PCS, particularly for term singleton pregancies with cephalic presentation and in case of obstructed labour as well as non-reassuring fetal status, grey areas potentially affected by subjective clinical assessment. This process of change could be facilitated with education of staff/patients by opinion leaders and prenatal counseling for women and partners, although clinical audits, financial penalties and rewards to efficient maternity centres could also be considered.
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Affiliation(s)
- L Cegolon
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Treviso, Italy.
| | - G Mastrangelo
- Padua University, Department of Cardio-Thoracic & Vascular Sciences, Padua, Italy
| | - G Maso
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - G Dal Pozzo
- Hospital "Villa Salus", Obstetric & Gynecology Unit, Venice, Italy
| | - L Ronfani
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - A Cegolon
- University of Macerata, Department of Political Sciences, Comunication and International Relationships, Macerata, Italy
| | - W C Heymann
- Florida Department of Health, Sarasota County Health Department, Sarasota, Florida, USA
- Florida State University, College of Medicine, Department of Clinical Sciences, Sarasota, Florida, USA
| | - F Barbone
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
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De Jonge A, Downe S, Page L, Devane D, Lindgren H, Klinkert J, Gray M, Jani A. Value based maternal and newborn care requires alignment of adequate resources with high value activities. BMC Pregnancy Childbirth 2019; 19:428. [PMID: 31752742 PMCID: PMC6868860 DOI: 10.1186/s12884-019-2512-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background Evidence based practice has been associated with better quality of care in many situations, but it has not been able to address increasing need and demand in healthcare globally and stagnant or decreasing healthcare resources. Implementation of value-based healthcare could address many important challenges in health care systems worldwide. Scaling up exemplary high value care practices offers the potential to ensure values-driven maternal and newborn care for all women and babies. Discussion Increased use of healthcare interventions over the last century have been associated with reductions in maternal and newborn mortality and morbidity. However, over an optimum threshold, these are associated with increases in adverse effects and inappropriate use of scarce resources. The Quality Maternal and Newborn Care framework provides an example of what value based maternity care might look like. To deliver value based maternal and newborn care, a system-level shift is needed, ‘from fragmented care focused on identification and treatment of pathology for the minority to skilled care for all’. Ideally, resources would be allocated at population and individual level to ensure care is woman-centred instead of institution/ profession centred but oftentimes, the drivers for spending resources are ‘the demands and beliefs of the acute sector’. We argue that decisions to allocate resources to high value activities, such as continuity of carer, need to be made at the macro level in the knowledge that these investments will relieve pressure on acute services while also ensuring the delivery of appropriate and high value care in the long run. To ensure that high value preventive and supportive care can be delivered, it is important that separate staff and money are allocated to, for example, models of continuity of carer to prevent shortages of resources due to rising demands of the acute services. Summary To achieve value based maternal and newborn care, mechanisms are needed to ensure adequate resource allocation to high value maternity care activities that should be separate from the resource demands of acute maternity services. Funding arrangements should support, where wanted and needed, seamless movement of women and neonates between systems of care.
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Affiliation(s)
- Ank De Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands. .,Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Soo Downe
- Research in Childbirth and Health (ReaCH Group), School of Health, College of Health and Wellbeing, University of Central Lancashire, Fylde Rd, Preston, PR1 2HE, UK
| | - Lesley Page
- Visiting Professor in Midwifery King's College London, Faculty of Nursing and Midwifery, KCL, 57 Waterloo Rd, London, SE18WA, UK
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland, University Road, Galway, H91 TK33, Ireland
| | - Helena Lindgren
- Department of Women's and Children's Health (KBH), K6, Karolinska Institute, Barnmorskeprogrammet, Retzius väg 13 A-B, plan 4, 171 77, Stockholm, Sweden
| | - Joke Klinkert
- EVAA Holding (Primary Care Midwives Amsterdam Amstelland), Rijtuigenhof 105, Amsterdam, 1054, NC, The Netherlands
| | - Muir Gray
- Nuffield Department of Primary Care Health Sciences, Medical Science Division, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Anant Jani
- Nuffield Department of Primary Care Health Sciences, Medical Science Division, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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Smith V, Gallagher L, Carroll M, Hannon K, Begley C. Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: An overview of systematic reviews. PLoS One 2019; 14:e0224313. [PMID: 31648289 PMCID: PMC6812784 DOI: 10.1371/journal.pone.0224313] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/11/2019] [Indexed: 12/16/2022] Open
Abstract
Concern has been expressed globally over rising caesarean birth rates. Recently, the International Federation of Gynaecology and Obstetrics (FIGO) called for help from governmental bodies, professional organisations, women’s groups, and other stakeholders to reduce unnecessary caesareans. As part of a wider research initiative, we conducted an overview of systematic reviews of antenatal and intrapartum interventions, and reports of evidence based recommendations, to identify and highlight those that have been shown to be effective for reducing caesarean birth, promoting vaginal birth and reducing fear of childbirth. Following registration of the review protocol, (PROSPERO 2018 CRD42018090681), we searched The Cochrane Database of Systematic Reviews, PubMed, CINAHL and EMBASE (Jan 2000-Jan 2018) and searched for grey literature in PROSPERO, and on websites of health professional and other relevant bodies. Screening and selection of reviews, quality appraisal using AMSTAR-2, and data extraction were performed independently by pairs of at least two reviewers. Excluding reviews assessed as ‘critically low’ on AMSTAR-2 (n = 54), 101 systematic reviews, and 10 reports of evidence based recommendations were included in the overview. Narrative synthesis was performed, due to heterogeneity of review methodology and topics. The results highlight twenty-five interventions, across 17 reviews, that reduced the risk of caesarean, nine interventions across eight reviews that increased the risk of caesarean, eight interventions that reduced instrumental vaginal birth, four interventions that increased spontaneous vaginal birth, and two interventions that reduced fear of childbirth. This overview of reviews identifies and highlights interventions that have been shown to be effective for reducing caesarean birth, promoting vaginal births and reducing fear of childbirth. In recognising that clinical practices change over time, this overview includes reviews published from 2000 onwards only, thus providing contemporary evidence, and a valuable resource for clinicians when making decisions on practices that should be implemented for reducing unnecessary caesarean births safely. Protocol Registration: PROSPERO 2018 CRD42018090681. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018090681
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Affiliation(s)
- Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Louise Gallagher
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Margaret Carroll
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Hannon
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Isaline G, Marie-Christine C, Rudy VT, Caroline D, Yvon E. An exploratory cost-effectiveness analysis: Comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Belgium. Midwifery 2019; 75:117-126. [DOI: 10.1016/j.midw.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/18/2018] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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Scarf VL, Yu S, Viney R, Lavis L, Dahlen H, Foureur M, Homer C. The cost of vaginal birth at home, in a birth centre or in a hospital setting in New South Wales: A micro-costing study. Women Birth 2019; 33:286-293. [PMID: 31227444 DOI: 10.1016/j.wombi.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings. AIM The aim of this study was to determine the direct cost of giving birth vaginally at home, in a birth centre or in a hospital for women at low risk of complications, in New South Wales. METHODS A micro-costing design was used. Observational (time and motion) and resource use data collection was undertaken to identify the staff time and resources required to provide care in a public hospital, birth centre or at home for women with a healthy pregnancy. FINDINGS The median cost of providing care for women who plan to give birth at home, in a birth centre and in a hospital were similar (AUD $2150.07, $2100.59 and $2097.30 respectively). Midwifery time was the largest contributor to the cost of birth at home, and overhead costs accounted for over half of the total cost of BC and hospital birth. The cost of consumables was low in all three settings. CONCLUSION In this study, we have found there is little difference in the cost to the health service when a woman has an uncomplicated vaginal birth at home, in a birth centre or in a hospital setting.
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Affiliation(s)
- Vanessa L Scarf
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Australia.
| | - Serena Yu
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia.
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia.
| | - Laura Lavis
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Australia.
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia.
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Australia; School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Australia.
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Australia; Burnet Institute, Melbourne, Australia.
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Nagle C, McDonald S, Morrow J, Kruger G, Cramer R, Couch S, Hartney N, Bryce J, Birks M, Heartfield M. Informing the development midwifery standards for practice: A literature review for policy development. Midwifery 2019; 76:8-20. [PMID: 31150936 DOI: 10.1016/j.midw.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 05/17/2019] [Accepted: 05/19/2019] [Indexed: 11/16/2022]
Abstract
AIM To critically appraise and synthesise the literature regarding the role and scope of midwifery practice, specifically to inform the evidence based development of standards for practice for all midwives in Australia. DESIGN A structured scoping review of the literature DATA SOURCES: CINAHL Complete, MEDLINE Complete and Cochrane Libraries databases, online and grey literature databases REVIEW METHODS: Comprehensive searches of databases used key words and controlled vocabulary for each database to search for publications 2006-2016. Studies were not restricted by research method. FINDINGS There is no substantive body of literature on midwifery competency standards or standards for practice. From 1648 papers screened, twenty-eight papers were identified to inform this review. Eight studies including systematic reviews were annotated with three research papers further assessed as having direct application to this review. To inform the development of Midwife standards for practice, the comprehensive role of the midwife across multiple settings was seen to include: woman centred and primary health care; safe supportive and collaborative practice; clinical knowledge and skills with interpersonal and cultural competence. KEY CONCLUSIONS Midwifery practice is not restricted to the provision of direct clinical care and extends to any role where the midwife uses midwifery skills and knowledge. This practice includes working in clinical and non-clinical relationships with the woman and other clients as well as working in management, administration, education, research, advisory, regulatory, and policy development roles. IMPLICATIONS FOR PRACTICE This review articulates the definition, role and scope of midwifery practice to inform the development of contemporary standards for practice for the Australian midwife.
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Affiliation(s)
- Cate Nagle
- James Cook University, Centre for Nursing and Midwifery Research, 1 James Cook Drive, Townsville, Queensland 4814 Australia; Townsville Hospital and Health Service, 100 Angus Smith Drive, Douglas QLD 4814 Australia.
| | - Susan McDonald
- La Trobe University, School of Nursing and Midwifery, Kingsbury Dr Bundoora, Victoria 3086, Australia; Mercy Health, Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Jane Morrow
- Australian Catholic University, School of Nursing, Midwifery and Paramedicine, 115 Victoria Parade, Fitzroy, 3065 Victoria, Australia
| | - Gina Kruger
- St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia
| | - Rhian Cramer
- Federation University, School of Nursing Midwifery and Healthcare, Mt Helen Campus, Ballarat, Victoria 3353 Australia
| | - Sara Couch
- Australian Nursing and Midwifery Accreditation Council, Level 1, 15 Lancaster Place, Majura Park, Canberra Airport, 2609 ACT, Australia
| | - Nicole Hartney
- Deakin University, School of Nursing and Midwifery, 1 Gheringhap St, Geelong 3220, Victoria, Australia
| | - Julianne Bryce
- Australian Nursing and Midwifery Federation, Level 1, 365 Queen Street Melbourne 3000, Victoria, Australia
| | - Melanie Birks
- James Cook University, Centre for Nursing and Midwifery Research, 1 James Cook Drive, Townsville, Queensland 4814 Australia
| | - Marie Heartfield
- Deakin University, School of Nursing and Midwifery, 1 Gheringhap St, Geelong 3220, Victoria, Australia
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Donnellan-Fernandez RE, Creedy DK, Callander EJ. Cost-effectiveness of continuity of midwifery care for women with complex pregnancy: a structured review of the literature. Health Econ Rev 2018; 8:32. [PMID: 30519755 PMCID: PMC6755549 DOI: 10.1186/s13561-018-0217-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Critical evaluation of the cost-effectiveness and clinical effectiveness of continuity of midwifery care models for women experiencing complex pregnancy is an important consideration in the review and reform of maternity services. Most studies either focus on women who experience healthy pregnancy or mixed risk samples. These results may not be generalised across the childbearing continuum to women with risk factors. This review critically evaluates studies that measure the cost of care for women with complex pregnancies, with a focus on method and quality. AIMS / OBJECTIVES To critically appraise and summarise the evidence relating to the combined cost-effectiveness, resource use and clinical effectiveness of midwifery continuity models for women who experience complex pregnancies and their babies in developed countries. DESIGN Structured review of the literature utilising a matrix method to critique the methods and quality of studies. METHOD A search of Medline, CINAHL, MIDIRS, DARE, EMBASE, OVID, PubMed, ProQuest, Informit, Science Direct, Cochrane Library, NHS Economic Evaluation Database (NHSEED) for the years 1994 - 2018 was conducted. RESULTS Nine articles met the inclusion criteria. The review identified four areas of economic evaluation that related to women who experienced complex pregnancy and continuity of midwifery care. (1) cost and clinical effectiveness comparisons between continuity of midwifery care versus obstetric-led units; (2) cost of continuity of midwifery care and/or team midwifery compared to Standard Care; (3) cost-effectiveness of continuity of midwifery care for Australian Aboriginal women versus standard care; (4) patterns of antenatal care for women of high obstetric risk and comparative provider cost. Cost savings specific to women from high risk samples who received continuity of midwifery care compared with obstetric-led standard care was stated for only one study in the review. Kenny et al. 1994 identified cost savings of AUS $29 in the antenatal period for women who received the midwifery team model from a stratified sub-set of high-risk pregnant woman within a mixed risk sample of 446 women. One systematic review relevant to the UK context, Ryan et al. (2013), applied sensitivity analysis to include women of all risk categories. Where risk ratio for overall fetal/neonatal death was systematically varied based on the 95% confidence interval of 0.79 to 1.09 from pooled studies, the aggregate annual net monetary benefit for continuity of midwifery care ranged extremely widely from an estimated gain of £472 million to a loss of £202 million. Net health benefit ranged from an annual gain of 15 723 QALYs to a loss of 6 738 QALYs. All other studies in this review reported cost savings narratively or within mixed risk samples where risk stratification was not clearly stated or related to the midwifery team model only. CONCLUSIONS Studies that measure the cost of continuity of midwifery care for women with complex pregnancy across the childbearing continuum are limited and apply inconsistent methods of economic evaluation. The cost and outcomes of implementing continuity of midwifery care for women with complex pregnancy is an important issue that requires further investigation. Robust cost-effectiveness evidence is essential to inform decision makers, to implement sustainable systems change in comparative maternity models for pregnant women at risk and to address health inequity.
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Affiliation(s)
- Roslyn E. Donnellan-Fernandez
- Transforming Maternity Care Collaborative, Nursing and Midwifery, Griffith University, Logan campus, University Drive, Meadowbrook, Queensland 4131 Australia
| | - Debra K. Creedy
- Transforming Maternity Care Collaborative, Nursing and Midwifery, Griffith University, Logan campus, University Drive, Meadowbrook, Queensland 4131 Australia
| | - Emily J. Callander
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland 4222 Australia
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Panda S, Daly D, Begley C, Karlström A, Larsson B, Bäck L, Hildingsson I. Factors influencing decision-making for caesarean section in Sweden - a qualitative study. BMC Pregnancy Childbirth 2018; 18:377. [PMID: 30223780 PMCID: PMC6142337 DOI: 10.1186/s12884-018-2007-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/04/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians' and midwives' perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden. METHODS A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo© and thematically analysed. Ethical approval was granted by Trinity College Dublin. RESULTS The thematic analysis resulted in three main themes; 'Belief in normal birth - a cultural perspective'; 'Clarity and consistency - a system perspective' and 'Obstetrician makes the final decision, but...', and each theme contained a number of subthemes. However, 'Belief in normal birth' emerged as the core central theme, overarching the other two themes. CONCLUSION Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a 'team approach' helped them achieve their goal and keep their CS rate low.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, 2 Clare Street, D02 CK80 Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Karlström
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Birgitta Larsson
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Lena Bäck
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Ingegerd Hildingsson
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
- Department of Women’s and Children’s health, Uppsala University, Uppsala, Sweden
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Walsh D, Spiby H, Grigg CP, Dodwell M, Mccourt C, Culley L, Bishop S, Wilkinson J, Coleby D, Pacanowski L, Thornton J, Byers S. Mapping midwifery and obstetric units in England. Midwifery 2018; 56:9-16. [DOI: 10.1016/j.midw.2017.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 11/21/2022]
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Fawsitt CG, Bourke J, Murphy A, McElroy B, Lutomski JE, Murphy R, Greene RA. A Cost-Benefit Analysis of Two Alternative Models of Maternity Care in Ireland. Appl Health Econ Health Policy 2017; 15:785-794. [PMID: 28828573 PMCID: PMC5701951 DOI: 10.1007/s40258-017-0344-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND The Irish government has committed to expand midwifery-led care alongside consultant-led care nationally, although very little is known about the potential net benefits of this reconfiguration. OBJECTIVES To formally compare the costs and benefits of the major models of care in Ireland, with a view to informing priority setting using the contingent valuation technique and cost-benefit analysis. METHODS A marginal payment scale willingness-to-pay question was adopted from an ex ante perspective. 450 pregnant women were invited to participate in the study. Cost estimates were collected primarily, describing the average cost of a package of care. Net benefit estimates were calculated over a 1-year cycle using a third-party payer perspective. RESULTS To avoid midwifery-led care, women were willing to pay €821.13 (95% CI 761.66-1150.41); to avoid consultant-led care, women were willing to pay €795.06 (95% CI 695.51-921.15). The average cost of a package of consultant- and midwifery-led care was €1,762.12 (95% CI 1496.73-2027.51) and €1018.47 (95% CI 916.61-1120.33), respectively. Midwifery-led care ranked as the best use of resources, generating a net benefit of €1491.22 (95% CI 989.35-1991.93), compared with €123.23 (95% CI -376.58 to 621.42) for consultant-led care. CONCLUSIONS While both models of care are cost-beneficial, the decision to provide both alternatives may be constrained by resource issues. If only one alternative can be implemented then midwifery-led care should be undertaken for low-risk women, leaving consultant-led care for high-risk women. However, pursuing one alternative contradicts a key objective of government policy, which seeks to improve maternal choice. Ideally, multiple alternatives should be pursued.
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Affiliation(s)
- Christopher G Fawsitt
- Health Economics at Bristol (HEB), Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland.
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.
| | - Jane Bourke
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Brendan McElroy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Jennifer E Lutomski
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosemary Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
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Escuriet R, García-Lausin L, Salgado-Poveda I, Casañas R, Robleda G, Canet O, Pérez-Botella M, Frith L, Daly D, Pueyo M. Midwives’ contribution to normal childbirth care. Cross-sectional study in public health Settings. MidconBirth Study protocol. Eur J Midwifery 2017. [DOI: 10.18332/ejm/76820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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McCarthy R, Choucri L, Ormandy P, Brettle A. Midwifery continuity: The use of social media. Midwifery 2017; 52:34-41. [DOI: 10.1016/j.midw.2017.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
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Dencker A, Smith V, McCann C, Begley C. Midwife-led maternity care in Ireland - a retrospective cohort study. BMC Pregnancy Childbirth 2017; 17:101. [PMID: 28351386 PMCID: PMC5371234 DOI: 10.1186/s12884-017-1285-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/22/2017] [Indexed: 11/25/2022] Open
Abstract
Background Midwife-led maternity care is shown to be safe for women with low-risk during pregnancy. In Ireland, two midwife-led units (MLUs) were introduced in 2004 when a randomised controlled trial (the MidU study) was performed to compare MLU care with consultant-led care (CLU). Following study completion the two MLUs have remained as a maternity care option in Ireland. The aim of this study was to evaluate maternal and neonatal outcomes and transfer rates during six years in the larger of the MLU sites. Methods MLU data for the six years 2008–2013 were retrospectively analysed, following ethical approval. Rates of transfer, reasons for transfer, mode of birth, and maternal and fetal outcomes were assessed. Linear-by-Linear Association trend analysis was used for categorical data to evaluate trends over the years and one-way ANOVA was used when comparing continuous variables. Results During the study period, 3,884 women were registered at the MLU. The antenatal transfer rate was 37.4% and 2,410 women came to labour in the MLU. Throughout labour and birth, 567 women (14.6%) transferred to the CLU, of which 23 were transferred after birth due to need for suturing or postpartum hemorrhage. The most common reasons for intrapartum transfer were meconium stained liquor/abnormal fetal heart rate (30.3%), delayed labour progress in first or second stage (24.9%) and woman’s wish for epidural analgesia (15.1%). Of the 1,903 babies born in the MLU, 1,878 (98.7%) were spontaneous vaginal births and 25 (1.3%) were instrumental (ventouse/forceps). Only 25 babies (1.3%) were admitted to neonatal intensive care unit. All spontaneous vaginal births from the MLU registered population, occurring in the study period in both the MLU and CLU settings (n = 2,785), were compared. In the MLU more often 1–2 midwives (90.9% vs 69.7%) cared for the women during birth, more women had three vaginal examinations or fewer (93.6% vs 79.9%) and gave birth in an upright position (standing, squatting or kneeling) (52.0% vs 9.4%), fewer women had an amniotomy (5.9% vs 25.9%) or episiotomy (3.4% vs 9.7%) and more women had a physiological management of third stage of labour (50.9% vs 4.6%). Conclusions Midwife-led care is a safe option that could be offered to a large proportion of healthy pregnant women. With strict transfer criteria there are very few complications during labour and birth. Maternity units without the option of MLU care should consider its introduction.
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Affiliation(s)
- Anna Dencker
- Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden. .,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02T283, Ireland
| | | | - Cecily Begley
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02T283, Ireland
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Abstract
INTRODUCTION For over a decade, enquiries into adverse perinatal outcomes have led to reports that poor collaboration has been detrimental to the safety and experience of maternity care. Despite efforts to improve collaboration, investigations into maternity care at Morecambe Bay (UK) and Djerriwarrh Health Services (Australia) have revealed that poor collaboration and decision-making remain a threat to perinatal safety. The Labouring Together study will investigate how elements hypothesised to influence the effectiveness of collaboration are reflected in perceptions and experiences of clinicians and childbearing women in Victoria, Australia. The study will explore conditions that assist clinicians and women to work collaboratively to support positive maternity outcomes. Results of the study will provide a platform for consumers, clinician groups, organisations and policymakers to work together to improve the quality, safety and experience of maternity care. METHODS AND ANALYSIS 4 case study sites have been selected to represent a range of models of maternity care in metropolitan and regional Victoria, Australia. A mixed-methods approach including cross-sectional surveys and interviews will be used in each case study site, involving both clinicians and consumers. Quantitative data analysis will include descriptive statistics, 2-way multivariate analysis of variance for the dependent and independent variables, and χ2 analysis to identify the degree of congruence between consumer preferences and experiences. Interview data will be analysed for emerging themes and concepts. Data will then be analysed for convergent lines of enquiry supported by triangulation of data to draw conclusions. ETHICS AND DISSEMINATION Organisational ethics approval has been received from the case study sites and Deakin University Human Research Ethics Committee (2014-238). Dissemination of the results of the Labouring Together study will be via peer-reviewed publications and conference presentations, and in written reports for each case study site to support organisational change.
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Affiliation(s)
- Vanessa Watkins
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Eastern Health, Women and Children Program, Victoria, Australia
| | - Cate Nagle
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Women's and Children's Division, Western Health, Sunshine Hospital, Victoria, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
| | | | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
- Centre for Nursing Research, Deakin University and Monash Health Partnership, Monash Health, Victoria, Australia
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Abstract
This article presents a case study on the organization of maternity health care in Switzerland. Switzerland has a costly health care system with high intervention rates within an obstetric-led maternity care model. Evidence has shown that midwifery care is associated with lower cost, higher satisfaction rates among women, and less intervention. However, in this model, midwives are both marginalized and underused.The article focuses on the distribution of power and knowledge between midwives, women, and the medical profession. The varying power structures that shape the maternity care system in Switzerland are examined, using a case study approach that draws on Foucault’s concepts of the gaze, surveillance, disciplinary power, and the docile body. This article critically analyzes the model of maternity care received by women in Switzerland and how it negatively impacts on both women’s personal and midwives’ professional autonomy while simultaneously driving up costs.A better understanding of the underlying power structures operating within the maternity care system may facilitate the implementation of more midwifery-led care currently being endorsed by the Swiss Midwifery Association and some government agencies. This could result in reduced cost and lower intervention rates with reduced associated morbidity.
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Affiliation(s)
- Sunita Panda
- Clinical midwife manager, Coombe Women and Infants University Hospital; PhD student, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Cecily Begley
- Chair of Nursing and Midwifery, School of Nursing and Midwifery, Trinity College Dublin; visiting professor, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Deirdre Daly
- Assistant professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Abstract
BACKGROUND Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. OBJECTIVES To compare midwife-led continuity models of care with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2016) and reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e. regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and all fetal loss before and after 24 weeks plus neonatal death using the GRADE methodology: all primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss before and after 24 weeks plus neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants = 17,561; studies = 13; high quality evidence). Women who had midwife-led continuity models of care were more likely to experience spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.07; participants = 16,687; studies = 12; high quality). There were no differences between groups for caesarean births or intact perineum.For the secondary outcomes, women who had midwife-led continuity models of care were less likely to experience amniotomy (average RR 0.80, 95% CI 0.66 to 0.98; participants = 3253; studies = four), episiotomy (average RR 0.84, 95% CI 0.77 to 0.92; participants = 17,674; studies = 14) and fetal loss less than 24 weeks and neonatal death (average RR 0.81, 95% CI 0.67 to 0.98; participants = 15,645; studies = 11). Women who had midwife-led continuity models of care were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.21, 95% CI 1.06 to 1.37; participants = 10,499; studies = seven), have a longer mean length of labour (hours) (mean difference (MD) 0.50, 95% CI 0.27 to 0.74; participants = 3328; studies = three) and more likely to be attended at birth by a known midwife (average RR 7.04, 95% CI 4.48 to 11.08; participants = 6917; studies = seven). There were no differences between groups for fetal loss equal to/after 24 weeks and neonatal death, induction of labour, antenatal hospitalisation, antepartum haemorrhage, augmentation/artificial oxytocin during labour, opiate analgesia, perineal laceration requiring suturing, postpartum haemorrhage, breastfeeding initiation, low birthweight infant, five-minute Apgar score less than or equal to seven, neonatal convulsions, admission of infant to special care or neonatal intensive care unit(s) or in mean length of neonatal hospital stay (days).Due to a lack of consistency in measuring women's satisfaction and assessing the cost of various maternity models, these outcomes were reported narratively. The majority of included studies reported a higher rate of maternal satisfaction in midwife-led continuity models of care. Similarly, there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models. AUTHORS' CONCLUSIONS This review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care.Further research is needed to explore findings of fewer preterm births and fewer fetal deaths less than 24 weeks, and all fetal loss/neonatal death associated with midwife-led continuity models of care.
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Affiliation(s)
- Jane Sandall
- Women's Health Academic Centre, King's Health PartnersDivision of Women's Health, King's College, London10th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge RoadLondonUKSE1 7EH
| | - Hora Soltani
- Sheffield Hallam UniversityCentre for Health and Social Care Research32 Collegiate CrescentSheffieldUKS10 2BP
| | - Simon Gates
- Division of Health Sciences, Warwick Medical School, The University of WarwickWarwick Clinical Trials UnitGibbet Hill RoadCoventryUKCV4 7AL
| | - Andrew Shennan
- King's College LondonWomen's Health Academic Centre10th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge RoadLondonUKSE1 7EH
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyUniversity RoadGalwayIreland
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Scarf V, Catling C, Viney R, Homer C. Costing Alternative Birth Settings for Women at Low Risk of Complications: A Systematic Review. PLoS One 2016; 11:e0149463. [PMID: 26891444 DOI: 10.1371/journal.pone.0149463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/31/2016] [Indexed: 11/26/2022] Open
Abstract
Background There is demand from women for alternatives to giving birth in a standard hospital setting however access to these services is limited. This systematic review examines the literature relating to the economic evaluations of birth setting for women at low risk of complications. Methods Searches of the literature to identify economic evaluations of different birth settings of the following electronic databases: MEDLINE, CINAHL, EconLit, Business Source Complete and Maternity and Infant care. Relevant English language publications were chosen using keywords and MeSH terms between 1995 and 2015. Inclusion criteria included studies focussing on the comparison of birth setting. Data were extracted with respect to study design, perspective, PICO principles, and resource use and cost data. Results Eleven studies were included from Australia, Canada, the Netherlands, Norway, the USA, and the UK. Four studies compared costs between homebirth and the hospital setting and the remaining seven focussed on the cost of birth centre care and the hospital setting. Six studies used a cost-effectiveness analysis and the remaining five studies used cost analysis and cost comparison methods. Eight of the 11 studies found a cost saving in the alternative settings. Two found no difference in the cost of the alternative settings and one found an increase in birth centre care. Conclusions There are few studies that compare the cost of birth setting. The variation in the results may be attributable to the cost data collection processes, difference in health systems and differences in which costs were included. A better understanding of the cost of birth setting is needed to inform policy makers and service providers.
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Cederfeldt J, Carlsson J, Begley C, Berg M. Quality of intra-partum care at a university hospital in Nepal: A prospective cross-sectional survey. Sex Reprod Healthc 2015; 7:52-7. [PMID: 26826046 DOI: 10.1016/j.srhc.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/19/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the quality of intra-partum care provided to women with an expected normal birth at a university hospital in Nepal. METHODS A prospective cross-sectional study was conducted during three weeks in November 2013. Nurses at the labor ward collected data from 292 consecutive births. Of these, 164 women of low risk were expected to have a normal birth and were included in the study; 107 (65%) were nulliparous. The self-administered questionnaire covered maternal characteristics, previous pregnancies and births, current pregnancy, labor and birth. Nine items assessed care management, five of which comprised the Bologna score with a total possible score of 5: presence of a companion, use of partograph, non-use of augmentation, non-supine position, and skin-to-skin contact. RESULTS The women were assisted by physicians (56%), nurses (42%) or students under supervision (2%). All were in good health after birth. Two had a postpartum hemorrhage exceeding 500 ml and 49% had an episiotomy. Apgar score in all neonates was ≥ 7 at five minutes. Mean Bologna score was 1.43 (variance 0-3). CONCLUSIONS The management of care in normal birth could be improved in the studied setting, and there is a need for more research to support such improvement.
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Affiliation(s)
- Johanna Cederfeldt
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. BOX 457, SE 405 30 Gothenburg, Sweden.
| | - Jenny Carlsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. BOX 457, SE 405 30 Gothenburg, Sweden
| | - Cecily Begley
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. BOX 457, SE 405 30 Gothenburg, Sweden; School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. BOX 457, SE 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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