Care For Women Research Articles

My ‘normal’ isn't your normal...What is maternal wellbeing? A scoping review

ProblemMany global health strategies are developed to optimise ‘maternal wellbeing’. However, what is meant by this term and therefore how it is interpreted and understood by different groups of people is currently poorly understood. BackgroundFor midwives to provide woman-centred care they must recognise the diverse understandings of what is considered ‘maternal wellbeing’ and be able to identify factors underpinning this. AimTo identify and synthesise the literature related to the meaning and understanding of the term ‘maternal wellbeing.’ MethodsA search of PubMed, CINAHL Ultimate, OVID and Emcare databases was conducted between 2015 and 2024 for studies related to maternal wellbeing. Data from fourteen studies were charted and thematically analysed. FindingsTwo overarching but interrelated themes were identified. One refers to the inner self, and the second to the woman's place in her social world. Theme 1, sense of self, comprises two sub-themes: finding a sense of self and sustaining a sense of self. Theme 2, the sense of place, comprises two sub-themes: sustaining place and making space in place. DiscussionDisconnects between the practice-oriented concept of wellbeing and wellbeing as perceived by women exist. Current maternal wellbeing assessment methods only measure the woman's sense of identity, and sense of self in their changed worlds. ConclusionClear articulation of maternal wellbeing is needed to operationalise health strategies, institutional policies, procedures and standards of care that support positive maternal and infant outcomes. Midwives are pivotal to promoting maternal wellbeing during transitions across the pregnancy, birth, and motherhood continuum.

A systematic literature review on how consumer and community involvement have shaped and influenced pre-pregnancy care interventions for women with diabetes

BackgroundDiabetes and pregnancy studies have found better outcomes when interventions were developed with consumer (individuals with lived experience of diabetes) and community involvement. When consumers are central to development and delivery of interventions, study participants have better engagement and outcomes, particularly for individuals from culturally and linguistically diverse (CALD) and/or lower socio-economic backgrounds. Our study aims to examine the scope of consumer and community involvement (CCI) in the construction and implementation of pre-pregnancy care (PPC) interventions and discuss a framework for consumer-lead intervention development.MethodsA systematic literature review was conducted, examining 3 electronic databases. A meta synthesis analysis of tabulated data summarized in a literature matrix was undertaken with a phenomenological approach to develop a Pre-Pregnancy Care CCI-Driven Intervention Framework.ResultsOverall, 4642 papers were identified, with 29 meeting inclusion criteria. The meta-synthesis and literature matrix identified several common themes across previous studies. These were: barriers to accessing (PPC) such as negativity and stigma in care from behaviours, attitudes and perceptions of HCPs; limited appointment availability not aligning with work and family commitments; fear of losing a “normal” pregnancy journey; awareness of risk but unwillingness to discuss if consumers have not established trust with HCPs; inaccessibility to CALD appropriate PPC and contraception; and digitisation of PPC information resources including peer support and social media. From these results, a PPC Consumer-Driven Intervention Framework for Women with Pregestational Diabetes was developed with recommendations.ConclusionConsumers have been under-involved in the majority of previous developments and implementation of interventions for women with diabetes and pregnancy, and their representation as stakeholders in interventions is paramount to the longevity of intervention outcomes. To assist community involvement in diabetes pregnancy intervention design and delivery we created a new framework, for improving clinical and social outcomes in healthcare, empowering relationships between HCPs and consumers, and highlighting the value of lived experience and women-centred care for increased community engagement.

Pregnant Women's Care Needs During Early Labor-A Scoping Review.

Pregnant women face the challenge of managing early labor on their own until they feel the need to seek professional support. However, professional support during such a vulnerable stage of labor may sometimes be insufficient. This study aims to understand pregnant women's care needs during early labor in order to improve the quality of care provided at the onset of labor. A scoping review was conducted following a systematic search strategy in May 2021 and in August 2022 concentrating on pregnant women in early labor with spontaneous onset of labor. A sensitive search strategy was used with five different databases. The articles were screened by two independent researchers. Data were extracted and mapped to answer the research question. 52 articles were included. Major reasons for seeking professional help are to receive reassurance and get advice and information on how to cope with early labor. Furthermore, many women express the need for professional guidance. Several articles demonstrated women's preferences for hospital admission or a continuous care model. While some women want empowerment and empathy from a midwife, others require clear instructions on helpful measures or even clinical interventions within the process. Managing early labor without professional support creates a major challenge for pregnant women and nurtures insecurities and anxiety. Protecting women from unnecessary interventions is a well-intentioned plan, yet a lack of support in early labor may sometimes jeopardize a positive birth experience. New ways need to be elaborated to support women-centred and individualized approaches to providing early labor care.

Suture Materials in relation to Wound Care in Women Undergoing Gynecological Oncology Operations

Suture Materials in relation to Wound Care in Women Undergoing Gynecological Oncology Operations

Empowering a Young Mother Through Continuity of Care: A Case Report of a Primiparous Woman's Journey

Continuity of midwifery care (CoMC) is a model of care in which a woman is supported by the same midwife, or a small team of midwives, throughout her pregnancy, childbirth, and the postpartum period. This model has been shown to have several benefits for women and their babies, including reduced rates of intervention, increased satisfaction with care, and improved maternal and neonatal outcomes. This case report describes the experiences of a 21-year-old primiparous woman who received CoMC from a midwife in a community setting. The woman was highly satisfied with the care she received, reporting that she felt empowered and in control of her pregnancy and childbirth experience. She also felt that the midwife was a trusted source of support throughout her journey. In conclusion, this case report provides further evidence of the benefits of CoMC for women and their babies, particularly for young mothers who may require additional support and guidance. It highlights the importance of providing woman-centered care that is responsive to the individual needs of each woman.

Dataset linking women's maternity care experiences with hospital environment and governance in Ireland

Many scholars argue that there is a deepening crisis of trust in healthcare systems. What is not contested is the centrality of public trust in building reputational value in healthcare organisations. However, there is a dearth of research focused on better understanding how trust in healthcare institutions, and the healthcare workforce, can be sustainably cultivated.To enable the exploration of care-related factors within hospitals and their potential impacts on trust in healthcare workers, this dataset was created based on the 2020 National Maternity Experience Survey data. The survey data include responses to 68 structured, tick-box questions and three open-ended questions prepared with the participation of over 250 healthcare practitioners and experts, patients, as well as policymakers and researchers. The survey covers the full pathway of maternity care from antenatal care, through labour and birth, to postnatal care in the community. A total of 19 maternity hospitals and units participated in the survey which ran from February to April 2020, resulting in a total of 3,204 women responses out of an eligible population of 6,357. The survey data was extended with contextual information from a monitoring report on the National Maternity Services Standard published in 2020. The additional data includes compliance levels of maternity hospitals with established standards in four key areas including effective care support, safe care support, leadership governance and management, and workforce. This curated dataset can support investigations into a) the factors that determine overall women's care experience, b) factors contributing to building confidence and trust in the maternity care workforce among different groups of women, and c) how hospital environment, processes and governance impact both women's trust in maternity hospitals and their overall satisfaction.

Women’s Perceptions of the Medicalization of Pregnancy and Their Preferred Models of Care: A Qualitative Analysis

The concept of women-centered care during pregnancy and childbirth has received increasing attention. It addresses the question of the right degree of medical care during pregnancy. Consequently, it further opens a debate about the medicalization of pregnancy, which puts pregnancy into the realm of medicine and treats it as a medical problem. The experience of pregnancy and childbirth plays an essential role in the well-being of both the mother and the future child and is influenced by women’s autonomy and freedom of choice. The aim of this study is to explore the perceptions and perspectives of women on the medicalization of pregnancy and childbirth. The study illuminates the women’s belief about whether pregnancy and childbirth should be a medicalized process to a greater or lesser degree, focusing on their preferred models of care and the implications for healthcare providers. In-depth interviews with 37 women of various backgrounds and experiences were conducted as part of a national qualitative study in Switzerland. A thematic analysis identified key themes and patterns. Two important aspects related to women’s autonomy emerged: the possibility of defining and positioning pregnancy and childbirth according to their own beliefs and life practices, and the freedom to choose the preferred model of care for their pregnancy. The findings suggest that healthcare providers should offer personalized models of care and support women’s specific needs, ensuring genuine choice and integrating authentic informed consent into the decision-making process.

Do women have a choice when it comes to fetal monitoring? Perceptions of information provided and choice of fetal monitoring in Australia: A national survey

IntroIn Australia, little research has examined how women and people participate in decision-making about types of fetal monitoring, or their perceptions of information provided by caregivers. MethodsA national cross-sectional survey, the ‘Women’s experiences Of Monitoring Baby’ (WOMB) Study, explored women’s experiences of intrapartum fetal monitoring. This study reports on selected results. ResultsThere were 861 responses. Of respondents, 20 % reported receiving enough information about types of fetal monitoring from care providers and childbirth education, 35 % recalled being asked for consent, and 34 % were unaware they had a choice in monitoring. Most women (86 %) obtained information via ‘other’ sources or own reading, and where monitoring was discussed, it was most likely a ‘brief discussion’ with a midwife (43 %).Women who were monitored via wired CTG (35 %) were more likely to report facing barriers to choosing their preferred monitoring type, (p<0.001). Wired CTG was significantly associated with hospital type and primiparity and 70 % indicated they would not choose it again (p<0.001). ConclusionWomen did not know they had a choice in the type of intrapartum monitoring received, and felt they had insufficient information to make informed decisions. While monitoring via intermittent doppler and wireless CTG was preferred, women experienced barriers to receiving these, especially in public hospitals in rural/regional areas and private metropolitan hospitals. Antenatal models of care and childbirth education are underutilised avenues for providing information however, it is incumbent on maternity systems to provide adequate information resources, access to equipment and appropriate models of woman-centred and humane care.

ANALYSIS OF WOMEN’S SERVICE NETWORKS IN NORTHEAST BRAZIL: CHALLENGES AND PERSPECTIVES FOR THE EFFECTIVENESS OF SERVICES

This article proposes a critical analysis of women's care networks in the Northeast of Brazil, focusing on support services for victims of violence and the promotion of women's health and rights. The research aims to identify the main challenges faced by care networks in the region and explore possible strategies for improving the effectiveness of these services. The analysis will be based on a combination of literature review, secondary data analysis.

"I didn't really fit into any boxes": understanding the experiences of women affected by cancer in pregnancy and up to one-year postpartum-a mixed-method systematic review.

Little is known about women's experiences of cancer during pregnancy and up to one-year postpartum. As the incidence of gestational cancer rises parallel to increasing rates of early onset cancers there is an imperative need to understand their experiences. The aim of this research is to understand women's experiences of gestational cancer during pregnancy and up to one-year postpartum. This systematic integrative review followed the JBI methodology for mixed method systematic reviews (MMSR) which integrates empirical data from qualitative and quantitative primary studies. The search strategy included electronic databases, APA PsycINFO, CINHAL, Medline, Scopus, and the Web of Science Core Collection. The review has been reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive methodological quality assessment was undertaken using the Mixed Methods Appraisal Tool (MMAT). Thirteen studies were included, reporting on the experiences of 266 women. The findings represented the women's insight on the psychological impact of their gestational cancer, the impact on women's identity as a mother and a patient, and women's experiences of complex care. Gestational cancer reflects an emerging focus of clinical practice and an opportunity for much needed new research to explore woman-centered care exploring supportive care needs and models of maternity care. Women's experiences indicate that services are under-resourced to address the holistic and integrated supportive care needs of women affected by cancer across both maternity and cancer care teams.

Analysis of Biological Factors Associated with Preeclampsia in Pregnant Women

Preeclampsia is a serious complication during pregnancy that poses significant health risks to both mother and fetus, potentially leading to death. Early identification of biological factors associated with preeclampsia is crucial for effective prevention. This study aims to analyze the biological factors influencing preeclampsia incidence among pregnant women. A quantitative design with a case-control approach was used, focusing on pregnant women with a history of preeclampsia in the Curug Community Health Center, Karawang Regency. The sample included 10 respondents. The results revealed a significant relationship between parity and preeclampsia incidence (p-value 0.031), BMI (p-value 0.018), diet (p-value 0.041), and history of complications (p-value 0.001). However, no significant association was found between lifestyle activities and preeclampsia (p-value 0.114). These findings suggest that factors like parity, BMI, diet, and complications history are significantly linked to preeclampsia incidence. These results provide a basis for targeted interventions in pregnant women's care. Future studies should expand the sample size and consider additional variables such as employment status, family support, and stress levels for more comprehensive insights into preeclampsia risk factors.

Navigating the COVID-19 crisis: exploring care arrangements and gendered inequalities for migrant women in transnational families in Berlin

ABSTRACT The COVID-19 pandemic has precipitated a notable shift in care responsibilities, transferring them from institutions to families, with a pronounced impact on migrant women in transnational families who navigate both local and transnational care arrangements. This study explored how the pandemic affected women's care arrangements and exacerbated existing inequalities at the intersection of labour, migration, and welfare regimes. Following a qualitative methodology based on grounded theory and ethnography, this study analysed interviews with migrant women, their family members, and experts to understand their experiences with caregiving and transnational family dynamics during the pandemic, the costs and coping strategies related to gendered aspects of care, and the changing landscape of migration and care policies during the pandemic. This study scrutinised the intricate web of local and transnational caregiving structures, emphasising women's agency in negotiating care needs amid pandemic restrictions and constraints on access to formal social protection.

How does place impact intrapartum practice for midwives and obstetricians?

BackgroundRising rates of labour and birth interventions are causing concern, having the potential to cause harm if used inappropriately. International evidence demonstrates that place itself influences birth outcomes, but evidence is limited as to how. In New Zealand there are differences in the rates of spontaneous vaginal births by place, along with differences when benchmarking uncomplicated primiparae birthing in hospital maternity facilities throughout the country. AimTo develop understanding of how place influenced midwives’ and obstetricians’ practice in relation to supporting physiological birth. MethodFor this Hermeneutic Phenomenological study participants were purposively selected and consisted of nine midwives (employed and self-employed) and three obstetricians, all practising in midwifery led units or hospital maternity facilities. Data was collected using semi-structured interviews. The method of analysis involved writing and rewriting to surface interpretive insights, drawing on philosophical notions from Heidegger and Gadamer. FindingsThe findings revealed that place influences what practitioners are attuned to, what is easier for them to achieve, and their ability to provide woman-centred care. Competing tensions and pressures within place can blur the perceived relationship between normality and risk, influencing what is considered to be safe. SummaryPlace is not neutral; it influences how midwives and obstetricians practise and shapes how they support physiological labour and birth. The findings of this research contribute to a deeper understanding of the barriers and enablers to supporting physiological birth within place.

Through the looking glass; midwifery students' experience of ethical issues: A feminist explanatory case study

BackgroundThe ethical component in midwifery education is governed by international professional values, codes, and ethical principles. The aim of midwifery education is to encourage students to develop a lifelong commitment to ethical practice within their midwifery role and scope. However, little evidence is available on the experiences of midwifery students and how they navigate ethical issues in maternity systems. AimTo present a case study from a midwifery students' perspective that demonstrates observed ethical issues and to provide analysis of the ethical issues identified. DesignA Single explanatory case study design with a feminist lens applied. Explanatory case studies present the ‘how and why’ of a phenomenon and contributes to understanding phenomena in a holistic and real-life context. SettingThis project was set at a West Australian university from which pre-registration midwifery courses are delivered. ParticipantsA solitary case study is presented from a midwifery students' clinical placement. MethodsEthics were approved 2023-04805. Edith Cowan University HREC. The source of data for this case study was direct observation by the primary author (Priya, 2021) and the Joanna Briggs Methods for Case study reporting guide followed. Thematic analysis with a feminist lens was applied to the data. ResultsThree themes were generated ‘Through the looking glass; observing ethical issues’; ‘Whose body Is It? The Erosion of Maternal Consent’ and ‘Relational care versus defensive practice’. These themes explain the antecedents and consequences of the ethical issues identified by the midwifery student, the findings are supported by ethical theory and midwifery philosophy to highlight some of the underlying causes that contribute to ethical issues. ConclusionMidwifery students experience ethical distress when they observe ethical issues and are powerless to support birth people in a way that aligns with midwifery philosophy of relational, woman-centred care. Further research is required to better understand how midwifery students may be better supported to foster ethical care.

Women and midwives’ experiences of an audio-visual enhanced hospital birth environment: An interview study

ProblemMost hospital birth environments remain clinical in appearance and are not attuned to the neurohormonal processes that orchestrate labour and birth. Hospital environments are therefore not aligned with the innate needs of a woman to feel safe and secure in the place where she gives birth. BackgroundResearch has suggested that audio-visual effects such as nature images and sounds may help promote physiological labour in women at low risk of complications. This study aimed to explore the experiences of women labouring in a hospital birth environment enhanced with audio-visual technology, regardless of pregnancy complexity and use of interventions. Experiences of midwives providing one-to-one midwifery care in this environment were also explored. MethodsTranscripts of semi-structured interviews conducted with thirty-two women and six midwives were analysed thematically. FindingsUniversally, women reported that access to audio-visual imagery and soundtracks in the birth environment positively influenced their experience of labour. Nature images and sounds during labour helped create serenity and calmness within the woman and her surroundings, allowing her to relax and focus inwards. Midwives used this technology to create a calm and psychologically safe environment for women giving birth in the hospital. Projecting nature images and sounds became a medium for midwives to create ambience and instil calmness in the clinical environment. Midwives also reported observing positive impacts on the behaviours of other clinicians entering the room. ConclusionAudio-visual enhancement of the hospital birth environment was found to enhance women’s birth experiences and support midwives providing woman-centred care.

Partnering with the woman who declines recommended maternity care: Development of a statewide guideline in Queensland, Australia.

Choice, a fundamental pillar of woman-centred maternity care, depends in part on the right to decline recommended care. While professional guidance for midwives and obstetricians emphasises informed consent and respect for women's autonomy, there is little guidance available to clinicians or women about how to navigate maternity care in the context of refusal. To describe the process and outcomes of co-designing resources to support partnership between the woman who declines recommended maternity care and the clinicians and health services who provide her care. Following a participatory co-design process involving consumer representatives, obstetricians, midwives, maternal fetal medicine specialists, neonatologists, health service executives, and legal and ethics experts, implementation of the resources was trialled in seven Queensland Health services using Improvement Science's Plan-Do-Study-Act cycles. Resources for Partnering with the woman who declines recommended maternity care have now been implemented statewide, in Queensland, including a guideline, two consumer information brochures (available in 11 languages), clinical form, flowcharts, consumer video, clinician education, and culturally capable First Nations resources. Central to these resources is an innovative shared clinical form, that is accessible online, may be initiated and carried by the woman, and where she can document her perspective as part of the clinical notes. Queensland is the first Australian jurisdiction, and perhaps internationally, to formally establish this kind of guidance in clinical practice. Such guidance is identified as an enabler of choice in the national Australian strategy Woman-centred care: Strategic directions for Australian maternity services.

Who Cares? Women entrepreneurs and the transition to the Canada-wide Early Learning and Child Care Agreement in Nova Scotia

The Canada-wide Early Learning and Child Care Agreements signed in 2021/2022 represent an unprecedented investment into child care across Canada, supporting the expansion of care spaces, reductions in parent fees, and increased wages for care workers. In the province of Nova Scotia, however, the new funding model faced considerable pushback from women entrepreneurs in the care field, who felt overlooked and bullied by the provincial government amidst the policy rollout. This paper evaluates the experiences of child care owners in Nova Scotia during the transition to the new funding agreement through a series of interviews with entrepreneurs. The paper posits that the consultation and communications between the province and care owners reified gendered power relations, particularly through the devaluation and exploitation of women's care work. Interviewees report feeling treated as “glorified babysitters” and experiencing significant mental health strains as a result of the policy negotiation with the province.

Factors Associated with Birth-Related Post-Traumatic Stress Disorder Symptoms and the Subsequent Impact of Traumatic Birth on Mother-Infant Relationship Quality.

This study aimed to investigate factors associated with birth-related PTSD symptoms and the subsequent impact on mother-infant relationship quality, exploring what women felt they needed to be different about their birth process to further understand the problem. Participants were recruited using social media advertising. A multi-method approach, using qualitative and quantitative analyses, was employed. The study included 142 pregnant women residing in Australia aged between 19 and 42 years (M = 31.24; SD = 4.70). High extraversion significantly predicted greater birth-related PTSD symptoms. There was a significant relationship between birth-related PTSD symptoms and poorer mother-infant relationship quality. The content analysis of the responses from women who reported a desire for a different or improved birth experience generated four themes: (1) less intrusive intervention, (2) better communication, (3) access to more supportive intervention, and (4) better post-birth care. The findings highlight the importance of supporting women's choices during birth by promoting informed and respectful woman-centred care. Postnatally, the screening and assessment of women should go beyond mood screening and include an assessment of the woman's response to her birth experience.

A comprehensive assessment of care competence and maternal experience of first antenatal care visits in Mexico: Insights from the baseline survey of an observational cohort study.

Comprehensive antenatal care (ANC) must prioritize competent, evidence-based medical attention to ensure a positive experience and value for its users. Unfortunately, there is scarce evidence of implementing this holistic approach to ANC in low- and middle-income countries, leading to gaps in quality and accountability. This study assessed care competence, women's experiences during the first ANC visit, and the factors associated with these care attributes. The study analyzed cross-sectional baseline data from the maternal eCohort study conducted in Mexico from August to December 2023. The study adapted the Quality Evidence for Health System Transformation (QuEST) network questionnaires to the Mexican context and validated them through expert group and cognitive interviews with women. Pregnant women aged 18 to 49 who had their first ANC visit with a family physician were enrolled in 48 primary clinics of the Instituto Mexicano del Seguro Social across 8 states. Care competence and women's experiences with care were the primary outcomes. The statistical analysis comprised descriptive statistics, multivariable linear and Poisson regressions. A total of 1,390 pregnant women were included in the study. During their first ANC visit, women received only 67.7% of necessary clinical actions on average, and 52% rated their ANC experience as fair or poor. Women with previous pregnancies (adjusted regression coefficient [aCoef.] -3.55; (95% confidence intervals [95% CIs]): -4.88, -2.22, p < 0.001), at risk of depression (aCoef. -3.02; 95% CIs: -5.61, -0.43, p = 0.023), those with warning signs (aCoef. -2.84; 95% CIs: -4.65, -1.03, p = 0.003), common pregnancy discomforts (aCoef. -1.91; 95% CIs: -3.81, -0.02, p = 0.048), or those who had a visit duration of less than 20 minutes (<15 minutes: aCoef. -7.58; 95% CIs: -10.21, -4.95, p < 0.001 and 15 to 19 minutes: aCoef. -2.73; 95% CIs: -4.79, -0.67, p = 0.010) and received ANC in the West and Southeast regions (aCoef. -5.15; 95% CIs: -7.64, -2.66, p < 0.001 and aCoef. -5.33; 95% CIs: -7.85, -2.82, p < 0.001, respectively) had a higher probability of experiencing poorer care competence. Higher care competence (adjusted prevalence ratio [aPR] 1.004; 95% CIs:1.002, 1.005, p < 0.001) and receiving care in a small clinic (aPR 1.19; 95% CIs: 1.06, 1.34, p = 0.003) compared to a medium-sized clinic were associated with a better first ANC visit experience, while common pregnancy discomforts (aPR 0.94; 95% CIs: 0.89, 0.98, p = 0.005) and shorter visit length (aPR 0.94; 95% CIs: 0.88, 0.99, p = 0.039) were associated with lower women's experience. The primary limitation of the study is that participants' responses may be influenced by social desirability bias, leading them to provide socially acceptable responses. We found important gaps in adherence to ANC standards and that care competence during the first ANC visit is an important predictor of positive user experience. To inform quality improvement efforts, IMSS should institutionalize the routine monitoring of ANC competencies and ANC user experience. This will help identify poorly performing facilities and providers and address gaps in the provision of evidence-based and women-centered care.

Postnatal care of women with diabetes: a clinical update

Diabetes mellitus and gestational diabetes mellitus significantly affect pregnant women, their fetuses and neonates. Midwives need to be aware of their vital role in the care of women with diabetes and keep up to date with the latest evidence and guidelines. However, midwives have reported a deficit in their knowledge regarding postnatal care of women with diabetes. In this article, the challenges of maternity care for women with diabetes are highlighted, and the specific midwifery role in some aspects of postnatal care is discussed. The provision of woman-centred care by midwives, together with the expert knowledge of the diabetic team, can reduce postnatal diabetic complications.