The Lived Experiences of Midwives in Private Birthing Home Practice

Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?

To describe demographic and practice characteristics of male and female midwives in private practice (MIPPs) in 10 cities of Peru, and their role in the delivery of reproductive health care, specifically management of sexually transmitted infections (STIs). As part of an intervention trial in 10 cities in the provinces of Peru designed to improve STI management, detailed information was collected regarding the number of midwives in each city working in various types of practices. A door-to-door survey of all medical offices and institutions in each city was conducted. Each MIPP encountered was asked to answer a questionnaire regarding demographics, training, practice type(s), number of STI cases seen per month, and average earnings per consultation. Of the 905 midwives surveyed, 442 reported having a private practice, either exclusively or concurrently with other clinical positions; 99.3% of these MIPPs reported managing STI cases. Andean cities had the highest density of MIPPs, followed by jungle and coastal cities, respectively. Jungle cities had the largest proportion of male MIPPs (35.5%). While both male and female MIPPs reported seeing male patients, male MIPPs saw a significantly greater number than their female counterparts. In areas of Peru where physicians are scarce, MIPPs provide needed reproductive health services, including STI management. Male MIPPs in particular appear to serve as health care providers for male patients with STIs. This trend, which may exist in other developing countries with similar healthcare workforce demographics, highlights the need for new areas of training and health services research.

Incidence of low birth weight in Bengkulu City has increased from 7,86% in 2009 to 11.50% in 2010. One effort to increase the stimulation of growth and development in LBW infants is infant massage.The factors that influence it are knowledge and motivation. The perpose of this study was to determine the relationship of knowledge and motivation of midwives in private practice in the implementasi of inflant massage. This study uses an observational design with a descriptive cross sectional approach, total sampling from 59 BPS. Retrievel of data using the primary data through questionnaires. Analyzed by univariate and bivariate chi squer. The results obtained that almost half of respondents did not perfort inflant massage. There was a significant association between knowledge of midwives in private practice with the implementation of inflant massage (p=0.00) and there was a significant association between the motivation of BPS with the implementasi of inflant massage (p= 0.009). the conclusion from the result of this study is there is a significant relationship between knowledge and motivation of midwives in private practice to the implementation of inflant massage.

In 2010, the supply of exclusive breast milk in Medan is very low. It is only 3,04% of infants who get exclusive breast milk. Low supply of this exclusive breast milk is caused by the private practice midwives’ behavior in giving formula milk for newborns. This study is aimed to analyze the influence of personal selling performed by private practice midwives who give formula milk feeding for newborns. Methods : This type of research is explanatory research which is aimed to analyze the effect of the personal selling performed by private practice midwives who give formula milk feeding for newborns. The writer used survey method with cross sectional approach. Results : Three variables that were significantly associated to formula breastfeeding to neonatal infants are personal selling (p<0,05), knowledge and attitude. Conclusion : The results show that the personal selling has dominant influence toward formula milk feeding for newborns. The writer suggests the private practice midwives to provide correct and clear information about exclusive breast milk. Keywords : Formula Milk , Personal Selling , Private Practice Midwife

Background: Economy factor is one of the factors that could hampered community’s access in the utilization of health service. To guarantee effort of poor community access toward health service, the government was conducted managed program. The limitation of working hours in primary health care was causing limited service hours. Therefore, in order to solve the problem, the government stated that private midwife practice as one of the health services could be utilized by poor community with budget that was covered by government. The government’s policy has not yet able to improve the coverage of delivery attendant by health care provider. Hence, an evaluation to find out the phenomenon occurred in the community is necessary to solve this problem in order to improve the health service in the future. Objective : This research was aimed to find out the description of delivery care for poor community by private midwife in Tanjungpinang Municipality. Method: This was a descriptive research that used qualitative approach with case study design. The research subject was civil servant midwife who had midwifery private practice, head of primary health care, head of health office, head of family health division, and mothers who delivered and had askeskin (health insurance for poor community) card. The selection for midwife and mothers who delivered was using purposive sampling technique. Furthermore, the data was collected by using primary data that was obtained from indepth interview result that used interview guidance, while the secondary data was obtained from document observation, and the data will be analysed qualitatively. Result: The policy of delivery for poor community in Tanjungpinang Municipality has not yet obtained optimal support.The limited bugdet availability affected in a way that not all of the midwives were willing to assist askeskin patient with cost claim to primary health care. Private practice midwife asked for fee from askeskin patient. There was no difference the treatment given between askeskin patient and private/ paying patient. However, askeskin patient was satisfied with the service given by private practice midwife. Conclusion: The implementation of delivery policy for poor community by private practice midwife has not yet optimal as there was a lack of support from municipality government, administratively or financially. Keyword: Evaluation, policy implementation, private midwife practice and poor community

The merits of mixed public and private health systems are debated. Although private providers have become increasingly important in the Indonesian health system, there is no comprehensive assessment of the quality of private facilities. This study examined the quality of physical resources of public and private facilities in Indonesia from 1993 to 2007. Data from the Indonesian Family Life Surveys in 1993, 1997, 2000 and 2007 were used to evaluate trends in the quality of physical resources for public and private facilities, stratified by urban/rural areas and Java-Bali/outer Java-Bali regions. The quality of six categories of resources was measured using an adapted MEASURE Evaluation framework. Overall quality was moderate, but higher in public than in private health facilities in all years regardless of the region. The higher proportion of nurses and midwives in private practice was a determinant of scope of services and facilities available. There was little improvement in quality of physical resources following decentralization. Despite significant increases in public investment in health between 2000 and 2006 and the potential benefits of decentralization (2001), the quality of both public and private health facilities in Indonesia did not improve significantly between 1993 and 2007. As consumers commonly believe the quality is better in private facilities and are increasingly using them, it is essential to improve quality in both private and public facilities. Implementation of minimum standards and effective partnerships with private practice are considered important.

In France, gynecological care is provided by three types of health professionals: gynecologists, primary care physicians, and midwives. The objective of this study was to describe the gynecological care provided by these different health professionals at the national level. A descriptive and analytical study of indicators of gynecological care (cervical and vaginal swabs, contraception procedures, and initial contraception and preventive consultations) by gynecologists, primary care physicians, and midwives in private practice in 2022, using data from the French National Health Data System (SNDS) to establish profiles of health professionals using multivariate analysis (principal component analysis and hierarchical clustering). Three gynecologist profiles, five primary care physician profiles, and four midwife profiles were identified based on the intensity of their gynecological care activity and their specialization in certain types of procedures. Professionals with significant gynecological care activity often have a particular focus on private practice, are more frequently female, and belong to younger age groups. The geographical distribution of professionals with significant gynecological care activity varies according to the profession. We demonstrate significant heterogeneity in gynecological care, both between different types of professionals and within the same profession. Understanding gynecological care provision and its dynamics thus requires us to take into account the variety of actors at both the inter- and intra-professional levels.

Background and purpose: Mother-to-child transmission of HIV has been one of the problems in HIV prevention. In Indonesia, private practice midwives (PPM) play an important role in maternal and child health services. The roles of PPM in HIV vertical transmission prevention through PMTCT have not yet clearly understood. This research aims to analyse the roles of PPM in Bali Province in the PMTCT program as well as the PPM’s characteristics, knowledge, and attitudes about the program.Methods: This study was a descriptive cross-sectional survey, conducted from March to May 2020. The study population was PPM in Bali Province. The samples obtained were 404 out of a total of 1,736 PPM (23% response rate). The variables studied included socio-demographic characteristics, services and resources characteristics, knowledge, attitudes, and the role of PPM in four PMTCT prongs. Data was collected via self-filled online questionnaires distributed through Indonesian Midwives Associations branches in every district/city in Bali Province. Data were analysed descriptively and differences in roles in PMTCT were analysed using the chi-square test.Results: Of the 404 PPM, 66.1% served childbirth (deliveries), 25.4% had served HIV-positive women, and 18.3% had served HIV-positive pregnant women. As many as 95.5% of PPM played a good role in prong 1, and 99.0% of PPM, who had served HIV positive patients, played a good role in prong 2, 3 and 4. Statistically significant determinants for good implementation of prong 1 of PMTCT by the PPM were indicated by ownership or access to PMTCT information media (p=0.026), experience of serving HIV positive women (p&lt;0.00), and having served higher number of PMTCT patients (p=0.019).Conclusion: The PPM in Bali Province has played a good role in PMTCT, with a significant difference for good PMTCT implementation in prong 1 determined by the availability of information media, a history of serving HIV-positive women, and the number of PMTCT patients who have been served.

Background and purpose: Mother-to-child transmission of HIV has been one of the problems in HIV prevention. In Indonesia, private practice midwives (PPM) play an important role in maternal and child health services. The roles of PPM in HIV vertical transmission prevention through PMTCT have not yet clearly understood. This research aims to analyse the roles of PPM in Bali Province in the PMTCT program as well as the PPM’s characteristics, knowledge, and attitudes about the program. Methods: This study was a descriptive cross-sectional survey, conducted from March to May 2020. The study population was PPM in Bali Province. The samples obtained were 404 out of a total of 1,736 PPM (23% response rate). The variables studied included socio-demographic characteristics, services and resources characteristics, knowledge, attitudes, and the role of PPM in four PMTCT prongs. Data was collected via self-filled online questionnaires distributed through Indonesian Midwives Associations branches in every district/city in Bali Province. Data were analysed descriptively and differences in roles in PMTCT were analysed using the chi-square test. Results: Of the 404 PPM, 66.1% served childbirth (deliveries), 25.4% had served HIV-positive women, and 18.3% had served HIV-positive pregnant women. As many as 95.5% of PPM played a good role in prong 1, and 99.0% of PPM, who had served HIV positive patients, played a good role in prong 2, 3 and 4. Statistically significant determinants for good implementation of prong 1 of PMTCT by the PPM were indicated by ownership or access to PMTCT information media (p=0.026), experience of serving HIV positive women (p&lt;0.00), and having served higher number of PMTCT patients (p=0.019). Conclusion: The PPM in Bali Province has played a good role inPMTCT, with a significant difference for good PMTCT implementation in prong 1 determined by the availability of information media, a history of serving HIV-positive women, and the number of PMTCT patients who have been served.

Efforts to reduce maternal and infant mortality through various programs including the National Health Insurance program. Midwives play an important role in reducing MMR and IMR, because the midwife is a health worker at the forefront and deal directly with the public, to provide continuous service and complete. This study aims to determine the factors that affect the participation of Independent Midwife Practice On the National Health Insurance Program in the city of Palangkaraya. The approach used in this study was an observational analytic and cross-sectional design. The population in this study are all midwives private practice located in the city of Palangkaraya in 2016. The samples included 105 midwives in private practice. Univariate analysis performed by the frequency distribution for bivariate analysis, age, education, length of practice, knowledge, communication, motivation, cooperation procedure, process claims, the administration process and tariff services using chi-square (x2) and the relationships among several variables were analyzed with multiple logistic regression , The result showed that the factors of education (p = 0.002), duration of practice (p = 0.003), procedure of cooperation (p = 0.000), the process claim (p = 0.042), and administrative processes (p = 0.001) showed a significant effect on the participation of midwives practice of independent Reviewed JKN program. Multiple logistic regression analysis showed that factors of education (OR = 72.23; 95% CI = 2.38 to 218.76), p &lt;0.05, Lama practices (OR = 79.94; 95% CI = 5.22 - 122.45, p &lt;0.05), communications (OR = 97.98; 95% CI = 3.10 to 309.40, p &lt;0.05) and administrative procedures (OR = 56.25; 95% CI = 4.21 to 750.77, p &lt;0.05) simultaneously have a significant influence on the program with the participation of midwives private practices JKN. Conclusion The research results are the effect of education, length of practice, communication, cooperation procedure, process claims, and administrative processes with midwives private practices participation in the program JKN

BackgroundSexually Transmitted diseases (STD) syndrome management has been one cornerstone of STD treatment. Persons with STD symptoms in many countries, especially those with limited resources, often initially seek care in pharmacies. The objective of the study was to develop and evaluate an integrated network of physicians, midwives and pharmacy workers trained in STD syndromic management (The PREVEN Network) as part of a national urban community-randomized trial of sexually transmitted infection prevention in Peru.Methods and FindingsAfter a comprehensive census of physicians, midwives, and pharmacies in ten intervention and ten control cities, we introduced seminars and workshops for pharmacy workers, and continuing education for physicians and midwives in intervention cities and invited graduates to join the PREVEN Network. “Prevention Salespersons” visited pharmacies, boticas and clinicians regularly for educational support and collection of information on numbers of cases of STD syndromes seen at pharmacies and by clinicians in intervention cities. Simulated patients evaluated outcomes of training of pharmacy workers with respect to adequate STD syndrome management, recommendations for condom use and for treatment of partners. In intervention cities we trained, certified, and incorporated into the PREVEN Network the workers at 623 (80.6%) of 773 pharmacies and 701 (69.6%) of 1007 physicians and midwives in private practice. Extremely high clinician and pharmacy worker turnover, 13.4% and 44% respectively in the first year, dictated continued training of new pharmacy workers and clinicians. By the end of the intervention the Network included 792 pharmacies and 597 clinicians. Pharmacies reported more cases of STDs than did clinicians. Evaluations by simulated patients showed significant and substantial improvements in the management of STD syndromes at pharmacies in intervention cities but not in control cities.ConclusionsTraining pharmacy workers linked to a referral network of clinicians proved feasible and acceptable. High turn-over was challenging but over come.

Medication during low-risk pregnancy

Early Initiation of Breastfeeding (IMD) is one way to lower the infant mortality rate (IMR). Early Initiation of Breastfeeding Practice (IMD), especially in Indonesia is still very low. Early Initiation of Breastfeeding is giving breast milk to newborns, infants should not be cleaned in advance and are not separated from the mother. Early Initiation of Breastfeeding Success program (IMD) is also strongly influenced by the attitudes, knowledge and methods of delivery and physical fatigue experienced by mothers giving birth. This study aims to determine the factors associated with the implementation of early breastfeeding initiation (IMD) in women post partum in Hospital Delivery Room Yarsi Pontianak. This research is an analytic survey with cross sectional approach. Large sample study of 56 samples. Each of the studied variables were tested using Chi-square test. The results show that knowledge (p value = 0.034), attitude (p value = 0.008), method of delivery (p value = 0.016), physical fatigue (p value = 0.01), and family support (husband) (p value = 0.007) had a significant relationship with the implementation of the IMD on Post Partum Mother in Hospital Delivery Room Yarsi Pontianak. Advice for hospitals to cooperate with midwives in private practice and community health centers to provide an explanation about the meaning and importance of IMD. Keywords : Knowledge , Attitude , Method of Delivery , Physical Fatigue , Family Support , Early Initiation of Breastfeeding ( IMD )

Diarrhea is still a public health problem in developing countries such as Indonesia because morbidity and mortality rates are still high in these areas. A morbidity survey conducted by the Diarrhea Department of the Ministry of Health in Indonesia between 2000 and 2010 shows rising incidences of diarrhea in children. In 2000, Incidence Rate (IR) diarrhea incidents occurred in 301/1000 members of the population, and this increased to 411/1000 in 2010. Cases of diarrhea have become dangerous when suffered by infants because the mortality rate will increase because weaker immunity than olders. Environmental factors such as water, waste, and toilet contribute greatly to cases of diarrhea; therefore, in this research, we analyze environmental characteristics’ effects on the incidence of diarrhea in infants in Palembang. This study uses a mixed-method design combining quantitative data collection using secondary data from the Department of Health with qualitative data collection using in-depth interviews of Palembang’s local government and health center personnel in the districts with the highest and lowest cases of diarrhea. Quantitative data analysis are visualized in the form of a map, while qualitative data are analyzed using content analysis. The results show that Ilir Timur I has the highest incidences of diarrhea while the Sako district has the lowest. Based on the results of the analysis, Ilir Timur I has more cases of diarrhea largely because of its non-working area health centers. Sako has the fewest cases of diarrhea because the clinics, doctors, and midwives in private practice in the region of Sako do not report the cases, as well as because of factors related to access remote health centers. Therefore, interventions based on health data for diarrhea need to be restyled for a drastic reduction of diarrhea cases.&#x0D; Keywords: Area, diarrhea, children, characteristic, environment, data

O45 - Birth Houses in Australia: Women's motivations for and experiences of using birth houses